The Johns Hopkins Medical Institutions, Baltimore, MD.
A 36-year-old white woman presented with nasal obstruction and nasal deformity (Figure 1). She had undergone 4 previous rhinoplasties by 2 other surgeons. Her medical history was unremarkable and, other than her chief complaints, she had no complications from the previous surgeries. A revision rhinoplasty was performed via an open approach. A conchal cartilage graft was harvested from her right ear and along with a septal cartilage graft was used to create spreader grafts, alar buttresses, and a tip graft. No nasal packing was used. A preparation containing gum mastic (Mastisol; Ferndale Labs, Ferndale, Mich) and surgical adhesive strips (Steri-Strips; 3M Minnesota, Mining and Manufacturing Co, Minneapolis, Minn) were applied to the nose, as is the senior author's (I.D.P) usual practice. Five days after surgery, the patient complained of moderate to severe nasal tenderness and pain. The majority of the dressing had fallen off, with a sloughing of superficial skin. She was instructed to remove the remaining dressing and was seen in the office the following day. She had a severe maculopapular, erythematous rash covering her entire nose and extending to her cheek in the exact pattern of the Mastisol application (Figure 2). A 1-week tapering course of oral methylprednisolone (4-mg tablets) and 2-week course of topical 1% hydrocortisone were prescribed. At 3 weeks after surgery, the patient had an 80% resolution of her symptoms (Figure 3), and at 6 weeks she had no residual symptoms, discoloration, or edema.
Mabrie DC, Papel ID. An Unexpected Occurrence of Acute Contact Dermatitis During Rhinoplasty. Arch Facial Plast Surg. 1999;1(4):320-321. doi: