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Sign of the Kiss Allergic Dermatitis From Black Henna and From Adhesive Tape.

A 15-year-old adolescent girl presented with acute eczema developing within 1 week after application of black henna tattoo on the volar forearm and on the thenar area of the palm, using henna stone powder to obtain black henna paste as previously described. Involvement of the juxtaposed areas on the cheek was striking (Fig. 1). She admitted that she occasionally propped up the cheek with the palm. Patch testing was performed with European baseline series (Chemotechnique Diagnostics, Vellinge, Sweden). Readings performed on days 2, 3, 4, and 7, according to International Contact Dermatitis Research Group criteria, showed +++ positive reaction to p-phenylenediamine (1% in petrolatum). Our second case is a 42-year-old man who presented with acute eczema at the site of a black henna tattoo on the volar forearm as well as on the juxtaposed areas of the face, that is, on the ipsilateral upper eyelid and ala nasi (Fig. 2A). Case 3 is a 26-year-old man, showed kissing lesions on the upper arm juxtaposed to the acute eczematous lesion at the site of black henna tattoo on the volar forearm (Fig. 2B). A symmetry line going through the center of the antecubital fossa was imaginable (Fig. 2B). Patch testing could not be performed on these patients. Case 4 is a 47-year-old man, presented with contact eczematous reaction at the site of adhesive tape that was applied to a surgical incision on the volar surface of the forearm next to the antecubital fossae (Fig. 2C). Sign of the kiss was noticeable on the upper arm. A symmetry line going through the center of the antecubital fossa was imaginable in this case as well (Fig. 2C). He had a history of contact eczematous reaction after the use of adhesive tapes to wounded areas in the past. However, concomitantly used topical antiseptics or antibiotics might have caused the reaction as well. Unfortunately, the culprit agent could not be identified because the patient died unexpectedly because of an acute myocardial infarction. In all patients, the involvement of skin areas juxtaposed to the primary eczematous lesion was a striking finding. The sign of the kiss or ‘‘kissing lesions’’ on the skin or mucosa are defined as secondary involvement of adjacent, touching areas in contact with the primary lesion. It has been described in various infectious, for example, primary syphilis, herpes genitalis, candidiasis, or noninfectious diseases, for example, from spread of pederin in paederus dermatitis and very recently Figure 1. A, Contact eczematous reaction at the sites of black henna tattoo on the tenar area of the right hand and the right volar forearm. B, Sign of the kiss on 2 areas of the right cheek. PEARLS & ZEBRAS