Case report-baboon syndrome with paracetamol

Adverse drug reaction (ADR) is defined as “any response to drug which is noxious or unintended and occurs at a dose normally used in man for prophylaxis, diagnosis or treatment of diseases or for modification of physiological function”. Among the ADRs reported, cutaneous drug reactions are most common. Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), also known as baboon syndrome (BS), is included in the spectrum of systemically induced allergic contact dermatitis. Characteristics of SDRIFE include a sharply defined symmetric erythema in the gluteal area and in the flexural or intertriginous folds without any systemic symptoms or signs. We present a case of 30-year-old female with baboon syndrome after taking the combination of paracetamol and diclofenac. Awareness of SDRIFE (BS) as an unusual drug reaction is especially important since the connection between skin eruption and drug exposure may easily be overlooked or misdiagnosed.

Clinical Features of Systemic Contact Dermatitis Due to the Ingestion of Lacquer in the Province of Chungcheongnam-do

BACKGROUND: Lacquer contains an allergen, which can cause severe contact dermatitis. Systemic dermatitis resulting from the ingestion of lacquer is quite common in Korea, until now. OBJECTIVE: The purpose of this study is to elucidate the clinical features and laboratory findings of systemic contact dermatitis (SCD), due to the ingestion of lacquer in Chungcheongnam-do. METHODS: We retrospectively reviewed the medical records of 33 patients with SCD, after ingestion of lacquer from Soonchunhyang University Hospital in Cheonan, over a 6-month period. RESULTS: In this study, 33.3% of patients ate lacquer, as a health food, and some (15.2%) by encouragement of friends or spouse. The most common way of ingestion was the lacquer-boiled chicken (48.5%), but many also ate lacquer tree sprouts (42.4%). The skin lesions developed as erythematous maculopapular eruptions, erythema multiforme, erythroderma, purpura, wheals and vesicles. On laboratory findings, 13 patients (52%) exhibited leukocytosis and 11 patients had elevated eosinophil counts. CONCLUSION: The general public is becoming more aware of the toxic effects of lacquer ingestion, but still does not fully understand the dangers of lacquer tree sprouts, and this ignorance is frequently causing SCD in Chungcheongnam-do.

Systemic Contact Dermatitis from Propolis Ingestion

Propolis, also known as bee glue, is a substance collected by worker bees and it is used as a material for constructing and maintaining their beehives. It has been used topically and orally by humans for its anti-inflammatory properties. However, the growing use of propolis has been paralleled by reports of allergic contact dermatitis as a reaction to the substance. Contact dermatitis with generalized cutaneous manifestations elicited by propolis ingestion has not been previously reported. Here we report on the first case of systemic contact dermatitis from propolis ingestion in a 36-year-old woman.

Polymerized Urushiol of the Commercially Available Rhus Product in Korea

BACKGROUND: Systemic contact dermatitis commonly occurs with the intake of rhus (boiled chicken with rhus) as a health food and a folk medicine to cure gastrointestinal diseases in Korea. Rhus companies insist they have the technology for rhus detoxification. However, the numbers of systemic allergic contact dermatitis patients, caused by rhus, have not decreased. The principle of present techniques for rhus detoxification is the induction of the polymerization of urushiol, but polymerized urushiol may still have antigenicity, although to a diminished degree. The Korean Food and Drug Administration (KFDA) has a regulation to control urushiol use as a food. However, the laboratory method that KFDA uses for detection of rhus can only detect the urushiol monomer. OBJECTIVE: We conducted experiments to detect polymerized urushiol in rhus products, which were considered not to include urushiol by the KFDA. METHODS: Rhus product approved by the KFDA was separated with chloroform. The chloroform fractionation was accomplished on a recycle HPLC system. Four peaks were achieved and evaporated to give an amorphous powder. Each powder was analyzed on a NMR system and mass spectrometer. RESULTS: The material considered to be urushiol dimer, with a 638 molecular weight (MW), was detected in one of the four powders as per the HPLC peaks. CONCLUSION: We concluded that commercially available rhus product is comprised of material considered to be urushiol dimer. Therefore, even if the antigenicity of the rhus products is low, this product may cause adverse effects and is not completely detoxified.

Clinical Features in 147 Patients with Systemic Contact Dermatitisdue to the Ingestion of Chicken Boiled with Japanease Lacquer Tree / 대한피부과학회지

BACKGROUND: Systemic contact dermatitis (SCD) due to the ingestion of Japanese lacquer tree (Rhus verniciflua) is pretty common in Korea, and it is on a trend of increment. It is thought that the increase in ingestion of chickens boiled with the lacquer tree has been caused by the regard of the lacquer tree as a health food or herbal medicine for gastrointestinal disease. OBJECTIVE: To review the clinical findings and laboratory findings, and to make people aware of the harmful effects of the lacquer tree. METHODS: We retrospectively reviewed the medical records of 147 patients who had SCD due to chicken boiled with lacquer tree, 98 patients in Wonkwang University Hospital over the last 20 years (1998`2007) and 49 patients in Areumdaun Dermatology Clinic over the past 5 months (August~December, 2007). RESULTS: The sex ratio of patients (male to female) was 1.3:1 and the average age was 44.0 years old (range: 11~76). They ate chicken boiled with lacquer tree as a health food (42.9%) and for the treatment of gastrointestinal disease (22.4%). The mean incubation period was 47.7 hours (range: 30 min~16 days). The first symptoms they had were erythematous maculopapules (42.9%), itching without rash (33.7%), and edematous change (16.3%). The skin lesions developed as maculopapules (50.6%), erythroderma (40.9%), and erythema multiforme-like lesion (8.4%), vesicles, wheals, purpura, and pustules. On laboratory findings, some people had leukocytosis (61.2%), increment of Ig E (26.4%), abnormalities of liver function test (ALT: 16.3%, AST: 4.1%). Sixty percent of patients had a history of contact dermititous contracted via chicken boiled with rhus lacquer ingestion (36.7%) or contact with the lacquer tree. Clinical symptoms were developed by 29.5% who ate chicken boiled with lacquer. Mainly they had been treated with corticosteroids, antihistamines. The mean period needed for treatment was 8+/-2.4 days. CONCLUSION: Systemic contact dermatitis due to ingestion of the lacquer tree was developed in either sensitized or non-sensitized persons. It is suggested that SCD is caused by the highly allergic and toxic effects of lacquer. Physicians need to make people aware of the harmful effects of the lacquer tree and educate people not to ingest it.

Two Cases of Mercury Exanthem / 대한피부과학회지

We herein report two cases of systemic contact dermatitis probably due to inhalation of mercury. The first case is a 13 year-old boy who developed generalized erythema and dyspnea following the use of a coin-bleaching solution of unknown ingredient in his room. And the second case is a 10 year-old boy who developed generalized scarlatiniform eruptions on his trunk and flexural aspect of his extremities after hreaking a clinical thermometer. The typical clinical feature, the inverted triangular shaped erythema on flexural aspect of inner thigh, were appeared in both patients. On patch testing, they showed positive reactions to mercury and other mercury compounds.