Occupational allergic contact dermatitis from champignon and Polish mushroom

Capsicum peppers are widespread both in and out the kitchen. "Human hand" is a contact dermatitis resulting from the direct handling of peppers. Capsaicin also is found in topical agents for treatment of postherpetic neuralgia, diabetic neuropathy and arthritis. The oleoresin of capsicum is considered a powerfull irritant capable to induce irritant contact dermatitis and non‐immunological contact urticaria. A 81 year‐old man with a severe itchy macular and papular rash induced by Capsidol® initially located over the shoulder and sudden spread over the thorax is presented. A dense dermal mononuclear cell infiltrate and spongiosis suggested the diagnosis of contact dermatitis. Negative open tests and a positive patch test reaction (++ 96 hours) using the trade cream Capsidol®(capsaicin 5%) led us to contact with the Pharmaceutical Company Viñas. They provided us the components of the cream: capsaicin, isopropyl myristate, estearic acid (DERVACID 3148), propylene glycol, glycerin monomyristate (ESTOL3650GMM), AMPHISOL K, Cetyl alcohol (NACOL 16–85), benzyl alcohol, diazolidinyl urea (GERMALL II), p‐hydroxybenzoate–methylsodium (NIPAGIN M sódic), p‐hydroxybenzoate propyl (NIPASOL M). Capsaicin in benzyl alcohol at 0,075% was open tested with negative results. Only patch test with capsaicin was positive (++) at 48/96 hours and the excipient components at the appropiate concentrations were all negative. Patch test biopsy showed an eczematous pattern. Twenty controls showed negative results. This case is probably an allergic reaction but shows how still remains difficult to distinguish among allergic and irritative cutaneous reactions.