Pigmented contact dermatitis development in a Sjögren’s syndrome patient

Pigmented contact dermatitis (PCD) is characterized by facial hyperpigmentation and has been associated with allergens that are often found in cosmetics [1]. Sjögren’s syndrome (SJS) is an autoimmune exocrinopathy present with lymphocytic infiltration of the lachrymal and salivary glands [2]. Herein, we present a case of facial melanosis with negative patch test and photo patch test reactions to the cosmetics and standard thin layer rapid use epicutaneous (TRUE) test allergens. She has also been diagnosed with SJS.
A 50-year-old female patient with SJS Fitzpatrick skin type 3 was admitted to our clinic because of 8-year history of intense hyperpigmentation of the face (fig. 1) and both hands (fig. 2). When the patient was referred to us, she was using systemic methylprednisolone, hydroxychloroquine, azathioprine and an unknown cream for moisturizing topically for a long time. Intense hyperpigmentation on the bilateral malar region and dorsum of the hands was observed in the dermatological examination. Antinuclear antibody (ANA) yielded positive results with 1/160 titre in the serologic tests. Anti-SSA (anti-Ro), anti-SSB (anti-La) were also positive however, anti-dsDNA, anti-Sm, rheumatoid factor (RF), anti-centromere antibodies, anti-Scl70 and anti-CCP antibodies were negative. Dermoscopy of facial hyperpigmentation showed the pseudo network, grey dots/granules and telangiectatic vessels. Patch test and photo patch test reactions to the cosmetics and standard TRUE test. No allergic reaction was detected in the relevant allergens. Histopathological examination showed interface dermatitis with vacuolar basal degeneration, lymphocytic infiltration, melanophages and colloid bodies in the superficial dermis (fig. 3). Direct immunofluorescence study was also performed at the perilesional site on the left cheek. It was negative. Clinical and histopathological features were consistent with the PCD eruption. In addition to an SPF50/PPD39 sunscreen, we prescribed tacrolimus 0.1% ointment and azelaic acid 20% cream for 2 months. A little improvement of intense hyperpigmentation was detected. The patient is being followed up.
SJS patients show signs of dryness involving organs, particularly of the skin (xeroderma), eyes (xerophthalmia) and mouth (xerophthalmia). These symptoms are related to an immune-mediated process, lymphocyte infiltration and gradual destruction of the involved exocrine glands [3].
PCD is a lichenoid tissue reaction that...


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