Contact dermatitis presenting as non-healing wound: case report

Acriflavine lotion is a topical antiseptic solution yellow or orange in colour, mainly used for minor wounds, burns, and infected skin. Although used in dilution (0.1%) for medical purposes, this agent has been documented to produce potential skin itchiness, irritation or burning sensation upon contact. Nevertheless, it is still widely used for wound dressing by health professionals and remains a popular topical antiseptic agent purchased over-the-counter.We report a case of a 73 year old man presenting with a non healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer was seen on his right forearm with surrounding erythema and erosion. There was a yellow crust overlying the center of the ulcer and the periphery was scaly (Figure 1). Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. He could not recall using the solution in the past and did not seek any medical advice prior to the current visit. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Acriflavine usage was stopped and the ulcer was treated with daily non-occlusive saline dressing. The lesion improved a week later looking noticeably dry, less inflamed and smaller in diameter (Figure 2). At the end of two weeks, there was complete resolution of the ulcer, leaving a residual post-inflammatory hyperpigmentation. A patch test using Standard European series (Chemotechnique) containing 28 different allergens and acriflavine was done seven months later. The result showed a positive reaction (2+) to acriflavine while the rest were negative.Acriflavine or commonly known as Flavin, is an acridine derivative of proflavin used as a topical antiseptic agent. It is a yellow or orange colour solution which stains the skin and may cause irritation, inflammation or blister upon contact [