title: Dermal Titanium Dioxide Deposition Associated With Intralesional Triamcinolone Injection.
abstract: Cutaneous discoloration secondary to dermal deposition of titanium dioxide (TiO2) particles is recognized but seldom reported in the literature. In this report, the authors describe the case of a 61-year-old gentleman, with a long history of alopecia areata, who presented with numerous, discrete dark blue macules on the scalp. Scanning electron microscopy with energy dispersive x-ray spectroscopy analysis ultimately identified the macules as deposits of TiO2. The patient had a history of intralesional triamcinolone injections for management of alopecia areata. A sample of generic 0.1% triamcinolone acetonide paste was analyzed and found to contain many TiO2 particles analogous to those seen in the patient's biopsy sample. To the authors' knowledge, this is the first reported case of TiO2 deposition in the dermis likely resulting from topical combined with intralesional triamcinolone injection.
authors.affiliation: *Department of Dermatology, University of Southern California, Keck School of Medicine, Los Angeles, CA; †Center for Dermatology Care, Thousand Oaks, CA; ‡Department of Pathology, SUNY Upstate Medical University, Syracuse, NY; and §Central Coast Pathology, San Luis Obispo, CA.
authors.forename: Brandon E
authors.initials: BE
authors.lastname: Cohen
authors.forename: Sameer
authors.initials: S
authors.lastname: Bashey
authors.forename: Christine
authors.initials: C
authors.lastname: Cole
authors.forename: Jerrold L
authors.initials: JL
authors.lastname: Abraham
authors.forename: Bruce
authors.initials: B
authors.lastname: Ragsdale
authors.forename: Binh
authors.initials: B
authors.lastname: Ngo
mesh_terms: D000279:Administration, Cutaneous; D000506:Alopecia Areata / Q000188:drug therapy*; D001706:Biopsy; D004339:Drug Compounding; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000737:chemistry*; D006801:Humans; D015552:Injections, Intralesional; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D012535:Scalp / Q000737:chemistry* / Q000648:ultrastructure; D012867:Skin / Q000737:chemistry* / Q000648:ultrastructure; D013052:Spectrometry, X-Ray Emission; D014025:Titanium / Q000032:analysis*; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000737:chemistry*
chemical_list: D005938:Glucocorticoids; C009495:titanium dioxide; D014025:Titanium; D014222:Triamcinolone Acetonide