Title : Exploring SKINTED: A delayed onset dermatitis following total knee arthroplasty
Abstract:
Total knee replacement surgery may uncommonly result in a specific dermatological condition termed SKINTED. This term denotes "Surgery to the Knee, injury to the Infrapatellar branch of the saphenous Nerve, Traumatic Eczematous Dermatitis," representing an autonomic denervation dermatitis stemming from iatrogenic nerve injury, typically occurring on the lateral aspect of the anterior knee following total knee arthroplasty. Characterised by eczematous lesions emerging postoperatively, SKINTED warrants careful distinction from other diagnoses such as post-traumatic eczema, contact allergy dermatitis, and neuropathic dermatitis.
We present the case of a seventy-three-year-old woman who developed dermatitis on her left knee five weeks after total knee arthroplasty. Initially diagnosed with scabies due to pruritic linear lesions lateral to the surgical scar, she was prescribed 5% permethrin to which she had a mild response. Subsequent corticosteroid therapy was later prescribed which resulted in resolution of the dermatitis within 6 days with no subsequent recurrence. Additionally, we conducted a literature review to analyse SKINTED's presentation patterns and underlying pathophysiology. Consequently, we discuss a potential explanation as to why a variance is observed in the initial presentation of our patient's case. We assert that enhanced awareness amongst dermatologists and orthopaedic surgeons regarding SKINTED can mitigate postoperative concerns and anxieties.
