Irritant contact dermatitis, multiple pyogenic granulomas and vitiligo following topical application of tretinoin.

A 65-year-old women presented with sharply demarcated macules and small nodules on her face and neck for 2.5 years. They first appeared on her left face and gradually spread to her whole face and neck. The lesions were slightly pruritic. Her history was remarkable only for a high dose of topical tretinoin cream 0.025% dosage. On the basis of distribution and history, we made the diagnosis of contact dermatitis for the macules. A biopsy of a red papule from her neck revealed characteristics of pyogenic granuloma. However, white patches appear on his face at the third month follow-up after suspension of the tretinoin cream; Wood's lamp examination was consistent with vitiligo. It is the first report of a dose-response variant of this adverse reaction (Contact dermatitis combined with Pyogenic granulomas).