When rashes misbehave: the butler didn’t do it

Photosensitive drug eruptions are common adverse reactions to medications such as amiodarone, typically affecting sun-exposed areas. However, atypical presentations or overlapping conditions can complicate diagnosis and management. We present a case illustrating dual pathology in a patient with a facial eruption following initiation of amiodarone.

A 70-year-old woman developed an erythematous facial eruption five days after starting amiodarone for atrial fibrillation. Amiodarone was ceased, and she received a short course of oral prednisolone and topical wet wraps with Sorbelene. Despite this, her rash worsened, spreading to relatively shaded areas of the face. On review, it was discovered she had been using Sorbelene Body Wash under wet compresses instead of the Sorbelene moisturiser, triggering irritant contact dermatitis superimposed on a photoallergic drug eruption. Management included cessation of all topical products, treatment with topical corticosteroid ointment, and short-course antibiotics for secondary infection. Marked improvement was observed within days, with complete resolution by two months.

This case highlights the importance of considering multiple overlapping pathologies when rashes do not respond as expected. It also underscores the value of patient education on correct product use and careful re-evaluation of diagnosis and treatment in atypical or refractory eruptions. Clinicians should maintain a high index of suspicion for dual pathology in complex dermatologic presentations.