Case and Research Letters
Allergic Contact Dermatitis Due to Dittrichia viscosa
Dermatitis alérgica de contacto por Dittrichia viscosa
A. Calderón-Komáromy
, N. Puente-Pablo, S. Córdoba, J. Borbujo
Corresponding author
Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain
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"apellidos" => "Calderón-Komáromy" "email" => array:1 [ 0 => "komaromy20@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Puente-Pablo" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Córdoba" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Borbujo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis alérgica de contacto por <span class="elsevierStyleItalic">Dittrichia viscosa</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1756 "Ancho" => 1800 "Tamanyo" => 281839 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Vesiculobullous lesions with a bloodstained content on the dorsum and palms of the hands, with some areas of erosion and desquamating erythematous plaques on the wrists.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Plant-induced allergic contact dermatitis (ACD) is a common disorder that can arise in numerous situations and places during daily life.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Diagnosis is often challenging due to our lack of experience in its management.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 51-year-old woman with a long-standing history of rheumatoid arthritis on treatment with leflunomide. She consulted for an outbreak of pruritic lesions that had arisen 2 days earlier on her hands. Two weeks earlier she had developed lesions of similar characteristics that had resolved within a few days, after the application of topical corticosteroids. She stated that for the previous 2 months she had been applying an infusion of a plant called yellow fleabane (also known as sticky fleabane or false yellowhead) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) once a week to her hands to control pain. She prepared the infusion at home. Examination revealed multiple vesiculobullous lesions with a blood-stained content on a background of normal skin on the dorsum, palms, and fingers of both hands; in addition, she had desquamating erythematous plaques on both wrists (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Treatment with oral and topical corticosteroids and discontinuation of the application of the infusion led to complete resolution of the lesions and there have been no recurrences. The unknown irritant capacity of the plant led us to perform semi-open patch testing, applying fragments of the plant (stem, leaf, and flower) to the patient's forearm, covering the samples with porous tape and removing them after an hour. At 48<span class="elsevierStyleHsp" style=""></span>hours, 2+ positive reactions were observed in the area of application of the leaf and stalk, with reactivation of the lesions previously present on the hands; these manifestations started to appear 24<span class="elsevierStyleHsp" style=""></span>hours after performing the test. Control tests were performed on 10 healthy patients using the same technique with dry leaves and stalks, with negative results. Patch testing was also performed with the standard series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC), the Martitor plant series, and the infusion of yellow fleabane in water. A 2+ positive reaction to the infusion of the plant was observed at 48 and 96<span class="elsevierStyleHsp" style=""></span>hours. All patch testing was performed in accordance with the criteria of the International Contact Dermatitis Research Group.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Yellow fleabane—scientific name <span class="elsevierStyleItalic">Dittrichia viscosa</span>, a plant species of the <span class="elsevierStyleItalic">Asteraceae/Compositae</span> family—is an aromatic Mediterranean shrub. This plant is widely used in homeopathy for its medicinal properties as it contains biologically active substances that act as modifiers of the inflammatory response,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> though they also have allergenic potential. These substances are the sesquiterpenic lactones (SL), a group of metabolites found in the oil-resins released from the leaves, flower stalk, and possibly from the polen.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> There are around 1350 identified varieties of SLs and approximately 50% of them have allergenic potential.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Although the concentration of SLs varies between plant species, small similarities in their molecular structure can give rise to crossreactions.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> Identical SLs from different plant species can be responsible for false crossreactions. This situation, together with the few standardized tests for the study of this pathology, makes it difficult to study plant-induced ACD. Two preparations are available for patch testing. The “SL mix”, which contains 3 forms representative of the 3 main structural groups,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> only enables us to identify 60% of cases of SL sensitization. An alternative preparation for diagnosis is the “Compositae mix”, based on a mixture of multiple plant extracts; this has a considerably higher sensitivity (85%) than can be achieved with SL mix, although specificity is low.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Ten cases of <span class="elsevierStyleItalic">D. viscosa</span>-induced ACD have been published. As in our case, those reports described positive patch testing to fragments of the plant. Additionally, positive reactions to extracts from other plant and to substances included in the perfumes series were observed in some cases, which supports the high probability of crossreactions.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8,9</span></a> Negative patch testing to SLs, as in our case, does not exclude the diagnosis because of the test's low sensitivity.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The study of plant-induced ACD is a significant challenge, mainly because the majority of patients do not identify the specific trigger. This is further complicated by the high probability of crossreactions with substances obtained from other plants and the low specificity of standardized tests. The specific substance to which the patient has been exposed, if it can be identified, must be included in the study, avoiding tests with fresh plants or plant extracts due to the high risk of irritation or sensitization.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> We also draw attention to the importance of studying healthy controls using the same techniques, in order to classify the type of reaction as allergic or irritant.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This case highlights the need for dermatologists to recognize this type of reaction and the difficulties that can arise during its investigation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Calderón-Komáromy A, Puente-Pablo N, Córdoba S, Borbujo J. Dermatitis alérgica de contacto por <span class="elsevierStyleItalic">Dittrichia viscosa</span>. Actas Dermosifiliogr. 2016;107:77–79.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 508 "Ancho" => 1000 "Tamanyo" => 98660 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dry yellow fleabane <span class="elsevierStyleItalic">(Dittrichia viscosa)</span> provided by the patient.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1756 "Ancho" => 1800 "Tamanyo" => 281839 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Vesiculobullous lesions with a bloodstained content on the dorsum and palms of the hands, with some areas of erosion and desquamating erythematous plaques on the wrists.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Allergic contact dermatitis to plants: Understanding the chemistry will help our diagnostic approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 7 | 18 |
| 2024 October | 85 | 45 | 130 |
| 2024 September | 81 | 27 | 108 |
| 2024 August | 110 | 56 | 166 |
| 2024 July | 106 | 30 | 136 |
| 2024 June | 77 | 25 | 102 |
| 2024 May | 79 | 35 | 114 |
| 2024 April | 72 | 21 | 93 |
| 2024 March | 65 | 30 | 95 |
| 2024 February | 64 | 32 | 96 |
| 2024 January | 52 | 29 | 81 |
| 2023 December | 59 | 15 | 74 |
| 2023 November | 85 | 35 | 120 |
| 2023 October | 84 | 17 | 101 |
| 2023 September | 72 | 30 | 102 |
| 2023 August | 52 | 17 | 69 |
| 2023 July | 61 | 35 | 96 |
| 2023 June | 61 | 17 | 78 |
| 2023 May | 51 | 20 | 71 |
| 2023 April | 52 | 29 | 81 |
| 2023 March | 68 | 28 | 96 |
| 2023 February | 60 | 24 | 84 |
| 2023 January | 30 | 37 | 67 |
| 2022 December | 49 | 48 | 97 |
| 2022 November | 42 | 32 | 74 |
| 2022 October | 39 | 32 | 71 |
| 2022 September | 21 | 29 | 50 |
| 2022 August | 23 | 39 | 62 |
| 2022 July | 23 | 36 | 59 |
| 2022 June | 31 | 22 | 53 |
| 2022 May | 54 | 36 | 90 |
| 2022 April | 55 | 56 | 111 |
| 2022 March | 48 | 49 | 97 |
| 2022 February | 44 | 33 | 77 |
| 2022 January | 55 | 42 | 97 |
| 2021 December | 50 | 43 | 93 |
| 2021 November | 49 | 39 | 88 |
| 2021 October | 67 | 55 | 122 |
| 2021 September | 52 | 40 | 92 |
| 2021 August | 58 | 60 | 118 |
| 2021 July | 37 | 43 | 80 |
| 2021 June | 37 | 24 | 61 |
| 2021 May | 36 | 32 | 68 |
| 2021 April | 74 | 40 | 114 |
| 2021 March | 62 | 21 | 83 |
| 2021 February | 62 | 21 | 83 |
| 2021 January | 57 | 14 | 71 |
| 2020 December | 43 | 12 | 55 |
| 2020 November | 30 | 26 | 56 |
| 2020 October | 21 | 9 | 30 |
| 2020 September | 37 | 11 | 48 |
| 2020 August | 29 | 18 | 47 |
| 2020 July | 31 | 11 | 42 |
| 2020 June | 37 | 32 | 69 |
| 2020 May | 33 | 24 | 57 |
| 2020 April | 40 | 16 | 56 |
| 2020 March | 46 | 22 | 68 |
| 2020 February | 6 | 5 | 11 |
| 2020 January | 6 | 1 | 7 |
| 2019 December | 8 | 1 | 9 |
| 2019 November | 4 | 0 | 4 |
| 2019 October | 0 | 3 | 3 |
| 2019 September | 4 | 0 | 4 |
| 2019 August | 6 | 0 | 6 |
| 2019 July | 4 | 0 | 4 |
| 2019 June | 4 | 0 | 4 |
| 2019 May | 7 | 2 | 9 |
| 2019 April | 3 | 0 | 3 |
| 2019 March | 4 | 3 | 7 |
| 2019 February | 1 | 0 | 1 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 2 | 0 | 2 |
| 2018 October | 10 | 0 | 10 |
| 2018 September | 6 | 0 | 6 |
| 2018 April | 0 | 1 | 1 |
| 2018 March | 0 | 1 | 1 |
| 2018 February | 23 | 1 | 24 |
| 2018 January | 43 | 7 | 50 |
| 2017 December | 46 | 8 | 54 |
| 2017 November | 29 | 3 | 32 |
| 2017 October | 29 | 7 | 36 |
| 2017 September | 22 | 12 | 34 |
| 2017 August | 36 | 13 | 49 |
| 2017 July | 34 | 10 | 44 |
| 2017 June | 27 | 20 | 47 |
| 2017 May | 27 | 10 | 37 |
| 2017 April | 32 | 14 | 46 |
| 2017 March | 18 | 49 | 67 |
| 2017 February | 17 | 12 | 29 |
| 2017 January | 16 | 9 | 25 |
| 2016 December | 37 | 19 | 56 |
| 2016 November | 36 | 18 | 54 |
| 2016 October | 28 | 17 | 45 |
| 2016 September | 0 | 1 | 1 |
| 2016 August | 0 | 1 | 1 |
| 2016 June | 0 | 1 | 1 |
| 2016 May | 0 | 1 | 1 |
| 2016 April | 0 | 6 | 6 |
| 2016 March | 0 | 1 | 1 |
| 2016 February | 0 | 2 | 2 |
| 2016 January | 0 | 1 | 1 |
Show all
