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Recalcitrant Ulcer Caused by Embedded Papier‐Mache
Author(s) -
Lee J.
Publication year - 2005
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/j.0303-6987.2005.320dx.x
Subject(s) - medicine , reticular dermis , dermis , eschar , earlobe , dermatology , biopsy , debridement (dental) , necrotic tissue , surgery , pathology
A 47‐year‐old sculptor presented with an ulcer on her neck. She is non‐diabetic and had been on potassium iodide for hyperthyroidism. She developed a pruritic rash (?drug eruption), and her neck had been scratched repeatedly with papier‐mache (PM)‐covered fingers while she worked on PM sculptures for 3 consecutive months. Debrided material from neck ulcer revealed innumerable pieces of refractile PM in various shapes in the background of necrotic tissue and fibrinoid exudate, on polaroscopic examination of H&E sections. Stains for micro‐organisms (for fungi, acid‐fast bacilli, and actinomycosis) were negative. In an attempt to remove residual embedded PM, wide excision of the site and full‐thickness skin graft was done. After initial successful take and healing, the area redeveloped an ulcer. Additional debridement and biopsy from the graft site showed PM clustered around the blood vessels in the reticular dermis. PM is a product of paper pulp commonly used in arts and crafts. Rare cases of lead exposure in PM workers have been reported in the literature, however, no cutaneous problems caused by PM have been reported to date.