Autonomic denervation dermatitis

A 68-year-old gentleman presented with itchy, scaly, erythematous papules on the medial aspect of the left lower limb [Figure 1]. He was a known case of insufficiently controlled type 2 diabetes mellitus and ischemic heart disease, who underwent coronary artery bypass graft surgery two years back. Recently, he developed itching and oozing over the great saphenous venous area gradually leading to scaling and erythematous papules. There was no history of application of any agent topically. A clinical diagnosis of autonomic denervation dermatitis following saphenous vein graft harvesting was made. The patient was put on halobetasol propionate 0.05%, fusidic acid 2% cream, and emollient (white soft paraffin and liquid paraffin). The pathomechanism behind the development of autonomic denervation dermatitis is not clear. It is proposed that skin incisions may lead to traumatic transections of dermal nerves causing denervation of various autonomic organs of the skin, especially those responsible for sudomotor and vasomotor responses. It is also assumed that the pathomechanics, which are at play in atopic dermatitis get replayed at postoperative incision sites. However, the exact reason is yet to be discovered.^[1,2] Liberal application of emollients to maintain the integrity of the skin barrier along with the optimum amount of topical steroids is the mainstay of therapy.

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Figure 1:

Eczematous and erythematous papules and scaling over the medial aspect of left lower limb.

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