A distinctive flexural eruption implicating Pseudomonas aeruginosa

Conflict of interest: none declared. Outbreaks of Pseudomonas dermatitis regularly occur, and are associated with use of hot tubs and swimming pools. Other cutaneous features of Pseudomonas infection include wound infections, digital intertrigo and ‘green nail’ syndrome.1 We describe six cases of cutaneous Pseudomonas aeruginosa infection (Table 1) with a distinctive clinical appearance. Patient 1 was a 23‐year‐old South Asian woman presented with an exacerbation of atopic eczema (AE) (Fig. 1). She had been using an antiseptic emollient containing chlorhexidine and benzalkonium chloride (Dermol® 500 lotion; Dermal Laboratories Limited, Hitchin, UK), and clobetasol propionate with neomycin prior to the flare. Subsequent patch‐testing was negative, except for a reaction to cobalt. Patients 2 and 3 were siblings. The elder sister had moderately severe AE, requiring use of the same antiseptic emollient (Dermol 500) used by patient 1. She developed an erythematous flexural eruption with marginal brown desquamation, which did not respond to oral erythromycin (Fig. 2). Skin swab cultures grew P. aeruginosa. This patient shared an additional emollient product with her 3‐year‐old sister, who also had dry skin, and subsequently developed a similar rash. This emollient product (Epaderm® ointment; Mölnlycke, Gotëborg, Sweden) a BP formulation consisting of liquid paraffin, emulsifying wax and yellow soft paraffin, was found to be contaminated with P. aeruginosa. Both patients responded to oral ciprofloxacin after new supplies of the emollient were provided.