Symmetrical Drug-Related Intertriginous and Flexural Exanthema: Two Cases and Brief Literature Review

It has been reported that there are a range of causative drugs related to symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). The causative drugs reported so far include the following: antibiotics, intravenous immunoglobulin, chemotherapeutic agents, and biologics. In this study, we report two cases of SDRIFE and a review of the previous literature. We believe that our study makes a significant contribution to the literature because it demonstrates that intradermal injection of the Chinese herbal ball, and not its topical application, elicited a reaction that predicted the occurrence of SDRIFE. This finding is important for the diagnosis of SDRIFE in future studies. Our findings also provide evidence for a SDRIFE reaction after exposure to ranitidine and mosapride.

Antibacterial effect of urushiol on E. faecalis as a root canal irrigant

OBJECTIVES: The purpose of this study was to compare the antibacterial activity of urushiol against Enterococcus faecalis (E. faecalis) to that of NaOCl. MATERIALS AND METHODS: The canals of thirty two single rooted human teeth were instrumented with Ni-Ti files (ProTaper Next X1, X2, X3, Dentsply). A pure culture of E. faecalis ATCC 19433 was prepared in sterile brain heart infusion (BHI) broth. The teeth were submerged in the suspension of E. faecalis and were incubated at 37℃ for 7 days to allow biofilm formation. The teeth were randomly divided into three experimental groups according to the irrigant used, and a negative control group where no irrigant was used (n = 8). Group 1 used physiologic normal saline, group 2 used 6% NaOCl, and group 3 used 10 wt% urushiol solution. After canal irrigation, each sample was collected by the sequential placement of 2 sterile paper points (ProTaper NEXT paper points, size X3, Dentsply). Ten-fold serial dilutions on each vials, and 100 µL were cultured on a BHI agar plate for 8 hours, and colony forming unit (CFU) analysis was done. The data were statistically analyzed using Kruskal-Wallis and Mann-whitney U tests. RESULTS: Saline group exhibited no difference in the CFU counts with control group, while NaOCl and urushiol groups showed significantly less CFU counts than saline and control groups (p < 0.05). CONCLUSIONS: The result of this study suggests 10% urushiol and 6% NaOCl solution had powerful antibacterial activity against E. faecalis when they were used as root canal irrigants.

Loeffler's Syndrome Induced by Ingestion of Urushiol Chicken / 결핵및호흡기질환

Eosinophilic lung diseases are heterogeneous disorders characterized by varying degrees of pulmonary parenchyma or blood eosinophilia. Causes of eosinophilic lung diseases range from drug ingestion to parasitic or fungal infection as well as idiopathic. The exact pathogenesis of eosinophilic lung disease remains unknown. Urushiol chicken can frequently cause allergic reactions. Contact dermatitis (both local and systemic) represents the most-common side effect of urushiol chicken ingestion. However, there has been no previous report of lung involvement following urushiol chicken ingestion until now. A 66-year-old male was admitted to our hospital with exertional dyspnea. Serial chest X-ray revealed multiple migrating infiltrations in both lung fields, with eosinophilic infiltration revealed by lung biopsy. The patient had ingested urushiol chicken on two occasions within the 2 weeks immediately prior to disease onset. His symptoms and migrating lung lesions were resolved following administration of oral corticosteroids.

Results of Using the Patch Test with Urushiol in Korea / 대한피부과학회지

BACKGROUND: Allergic contact dermatitis (ACD) due to urushiol is a relatively common phenomenon in Korea. However, there are no recent studies regarding the results of patch tests with urushiol in ACD patients. OBJECTIVE: The purpose of this study was to analyze the results of the urushiol patch test, and to compare current urushiol sensitivity with findings from previous reports. METHODS: Patch test with 0.002% urushiol allergen and a thin-layer rapid use epicutaneous (T.R.U.E.) patch test were performed in 200 patients (67 men and 133 women) who were suspected of having ACD, between July 2011 and July 2013. Patient demographic findings and patch test results were evaluated. RESULTS: Positive reactions to urushiol were observed in 23 patients (11.5%), with a mean age (+/-standard deviation) of 61.4+/-10.8 years, which was significantly older than the mean age of 47.6+/-16.4 years of patients testing negative for urushiol sensitivity (p<0.001). Patients aged 50~59 years had the highest incidence of a positive reaction, and this difference in urushiol sensitivity according to age groups was statistically significant (p<0.005). A total of 8 (11.9%) of the 67 male patients, and 15 (11.3%) of the 133 female patients showed a positive reaction to urushiol. Of the 23 patients with a positive reaction to urushiol, 19 patients (82.6%) had at least one positive reaction to the T.R.U.E. test allergen, with p-phenylenediamine showing the highest sensitization rates (31.6%). The most frequently affected site in urushiol-positive patients was the face (39.1%). CONCLUSION: Based on our study results, urushiol sensitivity among Korean ACD patients is a relatively common occurrence, and a patch test with urushiol would be helpful in identifying the causative allergen in ACD patients.

In vitro Antibacterial and Morphological Effects of the Urushiol Component of the Sap of the Korean lacquer tree (Rhus vernicifera Stokes) on Helicobacter pylori

Eradication regimens for Helicobacter pylori infection have some side effects, compliance problems, relapses, and antibiotic resistance. Therefore, alternative anti-H. pylori or supportive antimicrobial agents with fewer disadvantages are necessary for the treatment of H. pylori. We investigated the pH-(5.0, 6.0, 7.0, 8.0, 9.0, and 10.0) and concentration (0.032, 0.064, 0.128, 0.256, 0.514, and 1.024 mg/mL)-dependent antibacterial activity of crude urushiol extract from the sap of the Korean lacquer tree (Rhus vernicifera Stokes) against 3 strains (NCTC11637, 69, and 219) of H. pylori by the agar dilution method. In addition, the serial (before incubation, 3, 6, and 10 min after incubation) morphological effects of urushiol on H. pylori were examined by electron microscopy. All strains survived only within pH 6.0-9.0. The minimal inhibitory concentrations of the extract against strains ranged from 0.064 mg/mL to 0.256 mg/mL. Urushiol caused mainly separation of the membrane, vacuolization, and lysis of H. pylori. Interestingly, these changes were observed within 10 min following incubation with the 1 x minimal inhibitory concentrations of urushiol. The results of this work suggest that urushiol has potential as a rapid therapeutic against H. pylori infection by disrupting the bacterial cell membrane.

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.

A Case of Systemic Allergic Contact Dermatitis with Erythema Multiforme-like Eruptions Due to Urushiol / 대한피부과학회지

Dermatitis occurring after ingestion of urushiol chicken is quite common in Korea. Allergic contact dermatitis is well established as a type IV immune reaction. The severity and acuteness of the inflammation determines the clinical appearance of allergic contact dermatitis. The prototype is poison ivy, which has urushiol, the pentadecacatechol produced by several related plants in the Rhus genus. Unlike erythema multiforme, the erythema multiforme-like eruption is considered to be an id-like reaction occurring with powerful sensitization, penetration-enhancing substances, high concentrations or repeated application of allergens. A 34-year-old female patient presented with multiple iris or annular shaped maculopapular eruption appeared on the margin of skin lesion of systemic allergic contact dermatitis.

Epidemiologic Study on Systemic Contact Dermatitis Due to Ingestion of Rhus / 대한피부과학회지

BACKGROUND: Dermatitis occurring after ingestion of the urushiol chicken is quite common in Korea. Although many cases of the systemic contact dermatitis due to urushiol chicken have already been reported, systemic study on its epidemiology is not done yet. OBJECTIVE: To elucidate the demography of the eaters of the urushiol chicken with its general understandings in society and the incidence of the resultant systemic dermatitis. METHODS: By the help of the patients who developed the dermatitis, all the persons who ate it together with the patients were interviewed. RESULTS AND CONCLUSION: l. 171 eaters of the urushiol chicken(125 male and 46 female) were enrolled in this study(M:F= 3.1:1). The age group in 4th decade was the most common in male, the 5th decade in female. The age prevalence of the systemic contact dermatitis corresponded to the age prevalence of the eater. 2. Incidence rate of systemic contact dermatitis among the eaters was 32.2% (55/171). Incidence rate according to each age group were as follows : 0% in 2nd decade, 33.3% in the 3rd decade, 32.4% in 4th decade, 32.8% in 5th decade, 33.3% in 6th decade, 25% in the 7th decade. 3. One third (57/171) of the eaters ate the urushiol chicken to strengthen their internal organs, especially stomach, which they believed to be weak 70 persons (40.9%) ate it at home, 101 persons (59.1%) ate it at a restaurant. 4. Out of 67 persons having past history of allergic contact dermatitis to Rhus tree, 28 persons (41.8%) showed systemic contact dermatitis. Out of 104 persons without past history of allergy to Rhus, 27 persons (26.0%) showed systemic contact dermatitis.

Immunohistochemical Study on Allergic Contact Dermatitis and Systemic Contact Dermatitis to Urushiol (Rhus verniciflua) / 대한피부과학회지

BACKGROUND: The rhus has been known to be such a potent allergen that it causes severe contact dermatitis, and mary studies have tried to reveal the mechanism of allergic contact. dermatitis to urushiol. However, the mechanism of systemic contact dermatitis to urushiol is not, well-known, though the consumption of rhus as a health product and for desensitization is not unconmon in Korea. OBJECTIVE: The purpose of this study was to evaluate the niechanism of systernic contact dermatis, and we carried out irnmunohistochemical stainings un the two strands of dermatitis (systemic arid,llergic contact dermatitis). METHODS: The patients of systemir, contact dermatitis were divided into three groups by duration and severity of the illness according to the desired criteria. We perfor med immunohistor,hernical staining of the tissues from the patients with anti CD4, CD8, CDla, ICAM-1, IL-2R monoclorial antibodies. RESULTS: 1. The results were as follows. 1. The immunohistochemical staining showed that CD8 positive cell numbers in systemic contact dermatitis(18+/-10) were significantly lower than those of allergic contact der matitis(37 +/- 13) ( p0.05). CONCLUSION: The result suggest that lower numbers of CDH positive T cell in systemic contact dermatitis caused a reduation in the suppressor effect to the urushiol mediated immune rection and CD8 positive T cells play an important role in systemic contact dermatitis due to rhus.