OF THE METALS to which man is exposed, only zirconium and beryllium are known to induce delayed granulomatous hypersensitivity. Historically, axillary granulomas following the application of zirconium-containing stick deodorants1-4 drew attention to this metal as a cause of allergic granulomas.5-8 More recent cases have masqueraded as sarcoidosis.9-11 In this report we describe another instance of presumed sarcoidosis due in fact to granulomatous hypersensitivity to zirconium in a topical remedy for poison oak dermatitis.
Report of a Case
A 16-year-old Japanese girl presented with a nonpruritic papular eruption of four months' duration on the face, forearms, and the dorsum of her hands. The lesions appeared as large, reddish-brown, flat-topped papules, 3 to 6 mm in diameter (Fig 1. Note: No topical therapy was used at this point.). She showed no signs of systemic illness. A biopsy revealed a "noncaseating dermal granuloma consistent with sarcoidosis." The clinical diagnosis was
Epstein WL, Allen JR. Granulomatous Hypersensitivity After Use of Zirconium-Containing Poison Oak Lotions. JAMA. 1964;190(10):940–942. doi:10.1001/jama.1964.03070230076029