Abstract

An 18-year-old woman presented with severe features of seborrhoeic dermatitis involving her scalp. Subsequently, the toe webs and intertriginous areas became affected by an erythematous, slightly scaly and weepy rash. The groin area was most severely affected, and complicated by intermittent infections with staphylococci and herpes simplex. The patient admitted to smoking heroin and was subsequently enrolled in a methadone programme. A biopsy from the groin area showed a combination of parakeratosis and keratinocyte vacuolar changes, supporting a diagnosis of necrolytic migratory erythema (NME). On completion of methadadone withdrawal, the rash cleared. The rash returned upon recommencing methadone. NME consists of an irregular annular eruption with an erythematous crusted edge. It is often mistaken for intertrigo or seborrhoeic dermatitis. In this patient, a direct effect of heroin and methadone on the epidermal metabolism might be speculated. There could be a variant of the opiate recepter, which is especially sensitive to the effects of opiates. This is the second case occurring in association with opiate dependency and the first case where the patient was rechallenged, although the precise role of the opiates in the aetiology remains somewhat speculative.

Links

Publisher Full Text

Authors

Muller FM, Arseculeratne G, Evans A, Fleming C

Institution

Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK. f.muller@nhs.net

Source

Clinical and experimental dermatology 33:1 2008 Jan pg 40-2

MeSH

Adolescent
Analgesics, Opioid
Diagnosis, Differential
Erythema
Female
Heroin
Humans
Methadone
Necrosis
Opioid-Related Disorders
Scalp Dermatoses

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17983452