LETTER TO THE EDITOR
Eczema in loco minoris resistentiae
M. U. Anwar
S. K. Al Ghazal
Received: 2 April 2007 / Accepted: 16 January 2008 / Published online: 20 February 2008
Abstract Eczema is a common skin condition of varied
pathophysiology. Despite being common, under some
circumstances, this diagnosis may be missed due to the
presence of other more obvious signs—namely the pres-
ence of surgical scars.
A 79-year-old lady initially presented with a typical squamous
cell carcinoma (SCC) on the dorsum of the left middle finger,
proximal phalanx. This was treated with excision and full-
thickness skin graft. This healed without consequence. She
was followed up using the standard SCC follow-up routine in
one of our combined dermatology–plastic surgery skin cancer
clinics. Three months postoperatively, at a routine follow-up
visit, she was noted to have a scaly lesion on the skin graft of
the left hand (Fig. 1). Obviously, the initial worry was
recurrence of disease, but because of the short history and
atypical appearance, it was felt that this was eczema within
the skin graft and a course of topical steroids was prescribed.
She was seen again 2 weeks later and the lesion had
completely resolved (Fig. 2). At 2 years postoperatively, the
patient is still being followed up, but she has not had a
recurrence either of the eczema or of the SCC. We plan to
follow the patient for 5 years as per UK guidelines.
There have only been two previous reports in the medical
literature of eczematous changes occurring in loco minoris
resistentiae—“place of decreased resistance.” Shenengeberger
and Anthony in 2004 described it occurring in a 21-year-old
burn scar on the leg. Zuehlke in 1982 described a series of
patients aged between 17 and 67 years with this condition.
The mean time to presentation following the traumatic
incident was 5.4 years, ranging from 2 months to 25 years.
Zuehlke also mentioned three patients with eczema in loco
minoris resistentiae in skin graft sites.
Both the above authors mention missed diagnoses leading
to mismanagement and complications. An eczematous, scaly
or papular eruption in an area of scar tissue might at first be
misinterpreted as a sign of local disease recurrence. Clinicians
involved in skin cancer follow-up need to be well versed in the
physical appearance of local recurrence if dealing with post-
skin cancer excision surgical scars. Apparently cellulitic scars
that do not respond to antimicrobial treatment may be
colonised by resistant microbes, but the diagnosis of eczema
in loco minoris resistentiae must also be considered.
The diagnosis can be confirmed by tissue biopsy which
shows spongiosis and a perivascular lymphocytic infiltrate and
other features of eczema. Spongiosis, however, is not patho-
gnomonic for this condition and is seen in other diseases. Based
on experience, a biopsy may not be necessary, and a trial of
topical steroids may be instituted with appropriate follow-up.
Eczematous changes to surgical scars are rarely reported;
thus, the exact pathogenesis of this condition has not been
studied; however, it is safe to assume that there is some
vascular–immunologic abnormality within the scarred skin
that makes it more susceptible to an eczematous eruption.
Management of post-surgical complications starts with
recognising the condition and consists of topical or oral
steroids for 1 to 2 weeks. Adequate treatment leads to
complete resolution of the condition.
We feel it is important for clinicians involved in the follow-
up of patients who have undergone surgery for skin cancer to
be aware of the possibility of other conditions such as eczema
occurring in a surgical scar due to lower resistance.
Eur J Plast Surg (2008) 31:89–90
M. U. Anwar (*)
S. K. Al Ghazal
Bradford Royal Infirmary,