title: [Bullous rash around a peritoneal dialysis catheter exit site].
abstract: BACKGROUND
  Cutaneous eruption around a peritoneal dialysis (PD) catheter exit site is a rare complication. Herein we report a case of bullous eruption; we discuss the diagnostic approach and the related therapeutic implications.
  
  
  METHODS
  A 63-year-old man presented a bullous periumbilical eruption two months after initiation of PD. Cultures of laboratory samples ruled out an infectious origin and systemic corticosteroids initiated at 0.5mg/kg for suspected eosinophilic peritonitis produced significant improvement of the cutaneous eruption. Recurrence of the bullous eruption was observed upon dose-reduction of the corticosteroid. Skin histology showed a clinical picture of eczema and direct immunofluorescence was negative. Patch testing was carried out using the European Standard Battery comprising antiseptic, cosmetic and plastic series; a semi-open test was performed with the dressing used for PD, and ROAT was carried out on the povidone iodine (Betadine™) 10% used for topical care during PD. The patch testing and ROAT were positive (++), confirming contact dermatitis due to Betadine™. The eruption totally disappeared on substitution of Betadine™ by chlorhexidine for topical antisepsis of the PD catheter, thus enabling PD to be continued rather than instituting hemodialysis.
  
  
  CONCLUSIONS
  Allergic contact dermatitis around a PD catheter is a rare and little-known complication. In the present case, ROAT testing showed sensitization to Betadine™ and enabled an alternative antisepsis solution to be found, allowing PD to be continued.
authors.affiliation: Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
authors.forename: F
authors.initials: F
authors.lastname: Chasset
authors.affiliation: Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
authors.forename: C
authors.initials: C
authors.lastname: Pecquet
authors.affiliation: Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
authors.forename: K
authors.initials: K
authors.lastname: Cury
authors.affiliation: Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
authors.forename: L
authors.initials: L
authors.lastname: Sesé
authors.affiliation: Service d'anatomopathologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
authors.forename: P
authors.initials: P
authors.lastname: Moguelet
authors.affiliation: Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France.
authors.forename: C
authors.initials: C
authors.lastname: Francès
authors.affiliation: Service de néphrologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Gharbi
authors.affiliation: Service de dermatologie et d'allergologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris cedex 20, France. Electronic address: patricia.senet@tnn.aphp.fr.
authors.forename: P
authors.initials: P
authors.lastname: Senet
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D001706:Biopsy; D001768:Blister / Q000139:chemically induced*; D055499:Catheter-Related Infections / Q000175:diagnosis; D057785:Catheters; D017449:Dermatitis, Allergic Contact / Q000188:drug therapy / Q000209:etiology*; D003937:Diagnosis, Differential; D004203:Disinfection; D004485:Eczema / Q000139:chemically induced*; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D010538:Peritonitis / Q000175:diagnosis; D011206:Povidone-Iodine / Q000009:adverse effects*; D012874:Skin Diseases, Infectious / Q000175:diagnosis
chemical_list: D000305:Adrenal Cortex Hormones; D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine
keywords: Allergic contact dermatitis; Antiseptics; Antiseptiques; Bullous eruption; Dialyse péritonéale; Eczéma de contact; Patch test; Patch-test; Peritoneal dialysis; Éruption bulleuse