Phytodermatitis.

BACKGROUND: Most dermatologists can recognize the classic patterns of presentation of plant contact dermatitis; however, few can recognize the offending plants or know the name and chemical structure of the allergens or irritants that they contain. OBJECTIVE: Five basic clinical patterns of phytodermatitis are reviewed: 1) allergic phytodermatitis, 2) photophytodermatitis, 3) irritant contact dermatitis, 4) pharmacologic injury, and 5) mechanical injury. The plants responsible for each pattern are presented by families, according to current scientific taxonomy. The chemical structure of the offending substances is described, and principles of investigation, prevention, and treatment are outlined. CONCLUSIONS: Plant contact dermatitis remains an extremely vast and complex topic. Exotic plants and woods are now present in our gardens and homes. The newfound interest in aromatherapy, phytotherapy, and so-called "natural" therapies is the cause of a tremendous increase in exposure to plant products and extracts. This is responsible for the appearance of atypical patterns of plant contact dermatitis with which the practising dermatologist must become familiar.     

Clinical evaluation of patients patch tested with plant series: a prospective study

Background:

Plants are ubiquitous in nature and are essential for human life, though some do have detrimental effects. In India, there are various indigenous and foreign plants that are well known to cause dermatitis, Parthenium hysterophorus being the foremost.

Aims of the Study:

To study the clinical features of patients presenting with plant dermatitis and evaluate plant allergen series patch test results.

Materials and Methods:

50 patients with suspected plant dermatitis were evaluated regarding evolution of dermatitis, precipitating factors and contact with various plants. 31 patients (62%) complained of photo sensitivity and 24 (48%) had involvement of sun-exposed areas. Our provisional diagnoses included allergic contact dermatitis in 16, air borne contact dermatitis in 9, phytophotodermatitis in 7, photodermatitis in 6, airborne contact dermatitis to other causes in 4, phytodermatitis in 3. Patients were patch tested with Indian standard series of allergens as well as plant allergen series consisting of common allergenic plants of local flora in and around Manipal and also with plants strongly suspected by the patient. 35 tested positive with maximum positives (26 patients, i.e., 52%) to Parthenium hysterophorus (Compositae).

Results:

The result of patch testing was correlated with the history and clinical examination and relevance established.

Conclusions:

Majority of the patients with clinically suspected plant dermatitis belonged to 3^rd or 4^th decade and Parthenium was the leading plant allergen Sensitization to Leguminosae plants and Hopea ponga, seen in 9 cases, have not been reported earlier in literature.     

Durch Pflanzen ausgelöste toxische und allergische Dermatitis (Phytodermatitis)

Herbal products are being used increasingly for medical or cosmetic purposes. Many cosmetics contain plant extracts for fragrance. Sensitizing plants in cosmetics are tea tree oil, arnica, chamomile, yarrow, citrus extracts, common ivy, aloe, lavender, peppermint, and others. However, the sensitizing potential of these plants varies. Most of the sensitizing substances are sesquiterpene lactones or terpenes. The present paper reviews the various forms of phytodermatitis, including irritant plant dermatitis, phototoxic and photo-allergic dermatitis, allergic dermatitis, and airborne contact dermatitis.     

Allergic contact dermatitis from exposure to Grevillea robusta in New Zealand

There are a number of reports in the literature of allergic contact dermatitis as a result of exposure to the sawdust and plant parts of Grevillea robusta . While this tree is prevalent in New Zealand, there seems to have been no previous published accounts of contact dermatitis, although anecdotal evidence indicates that such cases may be common. Two brief case reports are provided regarding severe phytodermatitis to G. robusta among professional arborists in New Zealand. As with other common plants capable of inducing allergic contact dermatitis, greater awareness among arborists, orchardists, forestry workers, gardeners, and health professionals will likely result in a reduction of cases.     

Erythema multiforme following application of hair dye

Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction with varying degrees of blistering and ulceration. Common causes of EM are herpes simplex virus infection, mycoplasma infection, drug hypersensitivity, vaccination and drug-virus interaction. EM induced by contact dermatitis is rare. Paraphenylene diamine, a common ingredient in many hair dyes, is well known to produce allergic contact dermatitis. We report a 35-year-old lady presenting with EM following severe contact dermatitis to hair dye. So far as we know, this is the first report from India describing EM following contact dermatitis.     

Occupational skin problems in construction workers

Background

Construction workers handle cement which has constituents to produce both irritant contact dermatitis and corrosive effects (from alkaline ingredients, such as lime) and sensitization, leading to allergic contact dermatitis (from ingredients, such as chromium).

Aim:

The present study has been carried out among unorganized construction workers to find the prevalence of skin problems.

Materials and Methods:

The present cross-sectional study was conducted in 92 construction workers of Ahmedabad and Vadodara.

Results and Discussion:

All the workers were subjected to clinical examination after collection of information regarding demographic characteristics, occupational characteristics and clinical history on a predesigned proforma. Of them, 47.8% had morbid skin conditions. Frictional callosities in palm were observed in 18 (19.6%) subjects while 4 (4.3%) subjects had contact dermatitis. Other conditions included dry, fissured and scaly skin, infectious skin lesion, tinea cruris, lesion and ulcers on hands and/or soles.

Conclusion

The skin conditions were common in the age group of 20–25 years, males, those having ≥1 year exposure and those working for longer hours. Half of the workers not using personal protective equipment had reported skin-related symptoms.     

Plant dermatitis

This review summarizes the major categories of plant dermatitis: (1) mechanical injury, (2) pharmacologic injury, (3) primary irritant phytodermatitis, (4) allergic phytodermatitis, (5) pseudophytodermatitis, (6) phytophotodermatitis, and (7) pseudophytophotodermatitis. Representative species from this classification are considered. Field characteristics, dermatitis produced, chemical constituents, and diagnosis are discussed.     

Airborne contact dermatitis - current perspectives in etiopathogenesis and management

The increasing recognition of occupational origin of airborne contact dermatitis has brought the focus on the variety of irritants, which can present with this typical morphological picture. At the same time, airborne allergic contact dermatitis secondary to plant antigens, especially to Compositae family, continues to be rampant in many parts of the world, especially in the Indian subcontinent. The recognition of the contactant may be difficult to ascertain and the treatment may be even more difficult. The present review focuses on the epidemiological, clinical and therapeutic issues in airborne contact dermatitis.     

Allergic Urticaria: A Case Report of Rare Skin Allergy with a Common Mouthwash

Chlorhexidine is a widely used antiseptic and disinfectant in medical and non-medical environments. Compared to its ubiquitous use, allergic contact dermatitis from chlorhexidine has rarely been reported and so its sensitization rate seems to be low. Chlorhexidine has been used for more than 50 years but it was only in the last two decades, that reports of immediate- type reactions to chlorhexidine were seen. Reactions ranging from localized urticaria to anaphylactic shock and hypersensitivity reactions, including delayed hypersensitivity reactions such as contact dermatitis, fixed drug eruptions, and photosensitivity reactions, began to appear more frequently. However the prevalence of contact urticaria and anaphylaxis due to chlorhexidine remains to be unknown. In this case report we have reported a case of urticaria due to oral use of chlorhexidine. The adverse reaction was confirmed by a skin prick test.     

Airborne-contact dermatitis of non-plant origin: an overview

Airborne-contact dermatitis (ABCD) represents a unique type of contact dermatitis originating from dust, sprays, pollens or volatile chemicals by airborne fumes or particles without directly touching the allergen. ABCD in Indian patients has been attributed exclusively by pollens of the plants like Parthenium hysterophorus, etc., but in recent years the above scenario has been changing rapidly in urban and semiurban perspective especially in developing countries. ABCD has been reported worldwide due to various type of nonplant allergens and their clinical feature are sometimes distinctive. Preventive aspect has been attempted by introduction of different chemicals of less allergic potential.     

Toxic phytodermatitis caused by Euphorbia helioscopia L. (sun spurge)

A 6-year-old patient presented with linear erythema and bullae on the face. The lesions developed after playing with plants the day before. The plant was identified as Euphorbia helioscopia L. (sun spurge). The sun spurge belongs to the Euphorbiaceae plant family. These plants produce a typical milky juice that causes toxic reactions following contact with skin and mucous membranes. In the literature several cases of toxic dermatitis caused by plants of the Euphorbiaeae family have been described. The most important differential diagnosis of these skin lesions is the bullous phototoxic dermatitis caused by psoralens. Plant-induced toxic dermatitis is of increasing importance in dermatology. The exact determination of the causative plants is a prerequisite for the diagnosis of phytodermatitis.     

Toxische Phytodermatitis nach Kontakt mit Euphorbia helioscopia L. (Sonnenwend-Wolfsmilch)

A 6-year-old patient presented with linear erythema and bullae on the face. The lesions developed after playing with plants the day before. The plant was identified as Euphorbia helioscopia L. (sun spurge). The sun spurge belongs to the Euphorbiaceae plant family. These plants produce a typical milky juice that causes toxic reactions following contact with skin and mucous membranes. In the literature several cases of toxic dermatitis caused by plants of the Euphorbiaeae family have been described. The most important differential diagnosis of these skin lesions is the bullous phototoxic dermatitis caused by psoralens. Plant-induced toxic dermatitis is of increasing importance in dermatology. The exact determination of the causative plants is a prerequisite for the diagnosis of phytodermatitis.     

Allergic Contact Dermatitis (Type IV Hypersensitivity) and Type I Hypersensitivity Following Aromatherapy with Ayurvedic Oils (Dhanwantharam Thailam,Eladi Coconut Oil) Presenting as Generalized Erythema and Pruritus with Flexural Eczema

Herbal and Ayurvedic medications, believed to be “mild” and “natural” are usually sought as the first line of treatment before resorting to “stronger” allopathic medication. There are very few reports of adverse reactions to either topical and/or systemic Ayurvedic medications. Massage aromatherapy with ayurvedic oils plays an important role in alleviation of pain, but may cause allergic contact dermatitis. This is the second case report of allergic contact dermatitis to ayurvedic oil.     

Allergic contact dermatitis to plants: understanding the chemistry will help our diagnostic approach

Allergic contact dermatitis due to plants is common. Potentially allergenic plants and plant products are found in many everyday environments, such as the home, the garden, the workplace, and recreational settings. By improving our knowledge of allergenic plant-derived chemical compounds, we will be better positioned to identify novel allergens. We review the most relevant chemical allergens that contribute to plant allergic contact dermatitis and propose a clinical classification system based on 5 major families of chemical sensitizers: α-methylene-γ-butyrolactones, quinones, phenol derivatives, terpenes, and miscellaneous structures (disulfides, isothiocyanates, and polyacetylenic derivates). We also describe the different clinical pictures of plant allergic contact dermatitis and review currently available patch test materials. A better understanding of the specific allergens involved in plant allergic contact dermatitis will help to predict cross-reactivity between different plant species or families.     

Analysis of Food Allergy in Atopic Dermatitis Patients – Association with Concomitant Allergic Diseases

Background:

A few reports demonstrate the comorbidity of food allergy and allergic march in adult patients.

Aims and Objectives:

To evaluate, if there is some relation in atopic dermatitis patients at the age 14 years and older who suffer from food allergy to common food allergens to other allergic diseases and parameters as bronchial asthma, allergic rhinitis, duration of atopic dermatitis, family history and onset of atopic dermatitis.

Materials and Methods:

Complete dermatological and allergological examination was performed; these parameters were examined: food allergy (to wheat flour, cow milk, egg, peanuts and soy), the occurrence of bronchial asthma, allergic rhinitis, duration of atopic dermatitis, family history and onset of atopic dermatitis. The statistical evaluation of the relations among individual parameters monitored was performed.

Results:

Food allergy was altogether confirmed in 65 patients (29%) and these patients suffer significantly more often from bronchial asthma and allergic rhinitis. Persistent atopic dermatitis lesions and positive data in family history about atopy are recorded significantly more often in patients with confirmed food allergy to examined foods as well. On the other hand, the onset of atopic dermatitis under 5 year of age is not recorded significantly more often in patients suffering from allergy to examined foods.

Conclusion:

Atopic dermatitis patients suffering from food allergy suffer significantly more often from allergic rhinitis, bronchial asthma, persistent eczematous lesions and have positive data about atopy in their family history.     

Aeroallergen Patch Testing in Patients of Suspected Contact Dermatitis

Background:

Aeroallergens are airborne substances present in the environment with the potential to trigger an allergic reaction in the respiratory tract, mucosae, or skin of susceptible individuals. The relevance of aeroallergens in the pathogenesis of atopic dermatitis has been reported by many investigators. However, very few studies have been conducted to investigate their role in the production of allergic contact dermatitis (ACD).

Aims:

To determine the prevalence of aeroallergen patch test positivity in patients of suspected ACD and to study the clinical characteristics of patients testing positive with aeroallergens.

Materials and Methods:

Patients presenting to our department with suspected contact allergy and undergoing patch testing with Indian Standard Series (ISS) between January 2010 and June 2011 were studied. After a detailed history and clinical examination, patients were patch tested with ISS and aeroallergen series. Based on the history and clinical suspicion, patients were additionally patch tested with 15% Parthenium. Prior tape stripping was done in some patients.

Results:

Out of total 114 patients, 26 (22.8%) showed sensitivity to aeroallergen series. Parthenium was the commonest aeroallergen being positive in all 26 patients followed by Xanthium in two. None reacted to other allergens. Although positivity was more in patients with prior tape stripping, the difference was not statistically significant.

Conclusion:

Most common aeroallergen found to be positive in our study was Parthenium hysterophorus. In view of low positivity to other allergens, routine aeroallergen patch testing in patients with suspected contact dermatitis may not be necessary.     

Allergic contact dermatitis to plant extracts in patients with cosmetic dermatitis

Cosmetic contact allergy is commonly seen in patients undergoing patch testing, with fragrance one of the most frequently implicated ingredients. Many cosmetics contain plant extracts either as a fragrance or for medicinal properties. With a vogue for natural products there is an increase in their use. We have performed a prospective study over a 2-year period looking at the prevalence of contact allergy to plants in patients diagnosed with cosmetic dermatitis. In addition, we have performed a review of the products of two popular cosmetic companies, examining product labelling and the prevalence of use of plant extracts. We suggest that patients allergic to fragrance be advised to avoid plant extracts, which are separately labelled, in their personal care products.     

LATE REACTION, PERSISTENT REACTION AND DOUBTFUL ALLERGIC REACTION: THE PROBLEMS OF INTERPRETATION

The standard method of patch test reading is to read the test site for any positive allergy at 48 hr and then again at 72/96 hr. A late reading on the seventh day is also advised to exclude the irritant reaction (IR) and to notice some delayed development of allergic reaction. However, multiple visits are often difficult for the patient; therefore, this late reading is sometimes omitted. Here a case of plantar hyperkeratosis, due to allergic contact dermatitis, is reported with some insight into interpretation of the patch test. The patient showed delayed patch test reaction to formaldehyde and colophony, which has never been reported before.     

Contact allergy to Compositae plants in patients with summer-exacerbated dermatitis

16 patients with summer-exacerbated dermatitis were examined by patch testing and photopatch testing with a battery of Compositae and standard allergens. IgE and RAST, and the thresholds to UVA and UVB, were determined. 6 female and 2 male patients showed allergic contact reactions to one or more Compositae extracts from flowers common in Sweden, also used in skin care products. The study points to the importance of including testing with Compositae allergens in patients with summer-exacerbated dermatitis. This group comprises patients with multiple contact reactions, photosensitivity and flares of atopic dermatitis.     

Contact dermatitis from plants of the caper family, Capparidaceae

Plants of the caper family (Capparidaceae), which is the tropical relative of the mustard family (Cruciferae), yield ‘mustard oil’ (iso thiocyanate). A review has been made of reported effects on the skin and mucous membranes of some of these plants, of their geographical distribution, and of some opportunities for human contact with them. Plants which yield iso thiocyanates can produce irritant dermatitis and some probably can produce allergic contact dermatitis. The Capparidaceae family provides an example of the necessity of recording botanical names rather than common names for plant species, when reporting contact dermatitis from plants.