Cases of Two Eczema Patients with Psychotic Problems and an Addiction of the Topical Use of Cooking Oil

Abstract

We report the cases of two patients who had psychotic problems and were addicted to the use of cooking oil for eczema treatment. Case 1 was that of a 79-year-old woman who had a bipolar disorder and frequentlyused cooking oil topically when her skin was dry. Pruritic erythema developed in the trunk 3 months before she visited our department. She presented with pruritic, confluent erythematous macules over the trunk and the extremities. Histopathology revealed a mild spongiotic change and liquefaction in the epidermis and perivascular lymphocytic infiltrates in the upper dermis ; we established a diagnosis of eczematous dermatitis due to inappropriate use of cooking oil. She stopped topical use of cooking oil and was topically treated with glucocorticoid ointment and antihistamine, which relieved her symptoms in one week. Case 2 was that of a 39-year-old woman who had a delusional disorder and experienced atopic dermatitis since childhood. She had a steroid phobia ; therefore, she used cooking oil as an emollient for more than 9 years. She was admitted to our hospital at the age of 33-year-old ; her condition improved with the use of a moisturizer ; however, she discontinued moisturizer use thereafter. She was admitted to the psychiatry department in our hospital because her psychiatric condition worsened, as evidenced by the fact that she perpetrated domestic violence on her father. She was then referred to our department. At the visit, she presented with erythroderma and several scratch marks due to irritation caused by topical cooking oil. However, she refused to accept any dermatological treatment, including glucocorticoid ointment. She did not even take antipsychotic drugs, leading to aggravation of her delusional disorder. Meanwhile, her condition improved temporarily with the use of oral cyclosporine. However, she refused treatment again, and the eczema recurred. Eventually, erythroderma persisted with an abuse of cooking oil because her psychiatric condition prevented treatment compliance for the skin disease owing to refusal of advice and suggestions from the dermatologists and co-medical workers.