A report describes a case of a 35-year-old Caucasian male who presented to the Allergy clinic with a new rash on his flank. Four days before the development of the rash, the patient enrolled himself in a smoking cessation program utilizing transdermal nicotine patches. After 2 days, he noted a rash and discontinued the treatment. 

Examination revealed a well-demarcated, erythematous papular patch measuring approximately 20 ×10 cm. The patient also reported a history of undergoing treatment for a presumed Group A Streptococcus throat infection diagnosed 1 week prior.

Diagnosed as an allergic contact dermatitis to the nicotine patches, the patient received a medium-potency topical steroid. However, his rash worsened and began to involve other areas of his skin as well. Patch testing on unaffected skin came negative for three standard panels of epicutaneous patch testing and a new nicotine patch. Biopsies of the original rash and one distal from the original eruption revealed psoriasiform and superficial perivascular dermatitis with mounds of parakeratosis and neutrophils, consistent with guttate psoriasis. The patient received treatment with UV light and high-potency topical steroids with improvement, though he occasionally experiences flares.

Source: LaRochelle JM, Dimitriades VR. At first glance: psoriatic response to transdermal nicotine patch application. Dermatopathology (Basel). 2019;6(4):237-40.