Refractory postoperative eczematous dermatitis after total auricular reconstruction, temporally associated with povidone–iodine: a case report

A 9 year and 4 month old female patient underwent stage I and stage II total auricular reconstruction using the Nagata technique. Following each procedure, she developed localized postoperative eczematous dermatitis involving the reconstructed auricle (and, after stage II, also the abdominal donor site), most consistent with contact dermatitis (allergic vs. irritant) on compromised postoperative skin and temporally associated with local povidone–iodine exposure. Initial management with saline cleansing/irrigation, antihistamines, topical therapy, and systemic antibiotics/corticosteroids produced minimal improvement. Two short, tapering courses of oral tacrolimus were therefore administered (1 mg twice daily initially; total course 17 days for each episode), with clinical improvement noted by day 5 and complete clearance by day 13 during the first course, and improvement by day 3 with complete clearance by day 10 during the second course. Blood pressure and renal/hepatic function were monitored on tacrolimus day 5 and day 10 during both courses and remained within normal limits; tacrolimus trough levels were not measured. No adverse events or infections occurred, and no recurrence was observed at 3-month follow-up.