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• W2108355384 abstract "We report a 48-year-old man with histologically proven lichen planus (LP) involving the left half of his lower face, which was previously affected by herpes zoster. He had undergone a mercuric chloride (HgCl2) amalgam filling in his lower molar tooth before the appearance of LP. We suspect that HgCl2 in the dental amalgam might have triggered an isotopic response at the healed herpes zoster sites. LP caused by dental alloys is a rarely reported entity.1Koch P. Bahmer F.A. Oral lichenoid lesions, mercury hypersensitivity and combined hypersensitivity to mercury and other metals histologically proven reproduction of the reaction by patch testing with metal salts.Contact Dermatitis. 1995; 33: 323-328Crossref PubMed Scopus (63) Google Scholar, 2Laine J. Kalimo K. Forssell H. Happonen R.P. Resolution of oral lichenoid lesions after replacement of amalgam restorations in patients allergic to mercury compounds.Br J Dermatol. 1992; 126: 10-15Crossref PubMed Scopus (88) Google Scholar Our patient presented with multiple, itchy papules over the left side of his face and neck of 5 months' duration. He had herpes zoster affecting the same region 4 months before the appearance of these lesions. Examination revealed multiple, flat, violaceous papules over the left half of his chin and the left mandibular region, extending up to the left earlobe and left side of the neck. There was a sharp midline demarcation (Fig 1). Depressed superficial healed scars of herpes zoster were seen interspersed with these lesions (Fig 2). He had no mucosal involvement. A clinical diagnosis of LP was confirmed by histopathologic examination. He was treated with potent topical corticosteroids and oral antihistamines for 2 months, without any response. The patient was re-evaluated and further exploration of his history revealed that he had dental amalgam fillings done in his second left lower molar tooth 2 months before the appearance of the lesions on the same side of his face. However, his oral mucosa in contact with the dental fillings was grossly normal. At this stage we suspected that the amalgam fillings might have triggered the cutaneous eruption. Patch testing with a battery of materials used for dental amalgam fillings and dental alloys such as HgCl2, gold sodium thiosulfate, copper sulfate, silver nitrate, stannous chloride, zinc chloride, and palladium chloride was carried out. A positive reaction to HgCl2 site was revealed. The patient did not have any other source of exposure to mercury salts. The dental amalgam containing HgCl2 was removed in consultation with the patient's dentist and replaced with a resin substitute. The lesions resolved completely within 6 weeks, leaving behind residual pigmentation.Fig 2Depressed scars of healed herpes zoster interspersed among lichen planus lesions over left mandibular region.View Large Image Figure ViewerDownload (PPT) Reports of lichenoid reactions in the mucosa in contact with dental amalgam restorations have strengthened the association between mercury and LP.1Koch P. Bahmer F.A. Oral lichenoid lesions, mercury hypersensitivity and combined hypersensitivity to mercury and other metals histologically proven reproduction of the reaction by patch testing with metal salts.Contact Dermatitis. 1995; 33: 323-328Crossref PubMed Scopus (63) Google Scholar, 2Laine J. Kalimo K. Forssell H. Happonen R.P. Resolution of oral lichenoid lesions after replacement of amalgam restorations in patients allergic to mercury compounds.Br J Dermatol. 1992; 126: 10-15Crossref PubMed Scopus (88) Google Scholar Most of the reported cases showing association between dental amalgam restorations and LP have dealt with oral lichenoid lesions.1Koch P. Bahmer F.A. Oral lichenoid lesions, mercury hypersensitivity and combined hypersensitivity to mercury and other metals histologically proven reproduction of the reaction by patch testing with metal salts.Contact Dermatitis. 1995; 33: 323-328Crossref PubMed Scopus (63) Google Scholar Cutaneous LP (with or without oral lesions) in association with dental amalgam restorations is a rarity in medical literature. Masuda et al3Masuda R. Shirai K. Akaeda T. Futamura S. Nishijima S. Asada Y. A case of lichen planus apparently induced by dental metal palladium.Hifu. 1986; 28 ([in Japanese]): 267-271Google Scholar reported 1 such case in 1986 related to dental palladium. Koch and Bahmer1Koch P. Bahmer F.A. Oral lichenoid lesions, mercury hypersensitivity and combined hypersensitivity to mercury and other metals histologically proven reproduction of the reaction by patch testing with metal salts.Contact Dermatitis. 1995; 33: 323-328Crossref PubMed Scopus (63) Google Scholar reported a series of 11 patients with oral lichenoid lesions related to mercury and other metal salts in the dental amalgam fillings in 1995; only 1 patient had both cutaneous and mucosal lesions. Our case also fits into this rare group of patients in whom dental amalgam fillings may have led to a cutaneous lichenoid reaction in the absence of any oral mucosal changes. The mechanisms for this phenomenon remain in the realm of speculation. Occurrence of a new skin disorder at the site of another unrelated and already healed skin disease was termed “isotopic response” by Wolf et al4Wolf R. Brenner S. Ruocco V. Filioli F.G. Isotopic response.Int J Dermatol. 1995; 34: 341-348Crossref PubMed Scopus (263) Google Scholar and several types have been described. There are few reports of LP occurring in sites of healed herpes zoster.5Turel A. Ozturkcan S. Sahin T. Turkdogan P. Wolf's isotopic response a case of zosteriform lichen planus.J Dermatol. 2002; 29: 339-33942PubMed Google Scholar" @default.
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• W2108355384 title "Isotopic cutaneous lichen planus possibly related to dental amalgam" @default.
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