Foreign body granulomatous reaction as bilateral ulcerated infraorbital plaques secondary to topical application of vitamin E

Abstract

Foreign body reaction, is an immune response of the body, usually to an extrinsic substance. This is generally a granulomatous reaction. It can occur as a consequence of direct penetration of the skin by the material itself, or iatrogenically during surgery or by injections.1 Most commonly it presents as red to red-brown papules, nodules or plaques (with or without ulceration) due to its granulomatous nature.  Lichenoid and pseudolymphomatous lesions and fistula formation are some of its unusual clinical presentations.2 Vitamin E, a fat soluble vitamin, is an effective antioxidant. This property has empowered it, to establish its protective role in many diseases like atherosclerosis, malignancies, cataract as well as many dermatological conditions for instance scleroderma, atopic dermatitis, yellow nail syndrome, melasma are few to mention.4,5 Its topical formulations are being used as antiaging creams and in the treatment of burns , scars and wounds.5 We report a case of foreign body granulomatous reaction to topical application of vitamin E in a young male patient who developed bilateral symmetrical ulcerated plaques and oedema in infraorbital area after applying vitamin E following chemical burn.