Electronic Textbook of Dermatology

 66. Guin JD, Beaman JH. Toxicodendrons of the United States. Clin Dermatol 1986; 4:137-148.  Poison ivy, poison oak, and poison sumac are now classified in the genus Toxicodendron which is readily distinguished from Rhus. In the United States, there are two species of poison oak, Toxicodendron diversilobum (western poison oak) and Toxicodendron toxicarium (eastern poison oak). There are also two species of poison ivy, Toxicodendron rydbergii, a nonclimbing subshrub, and Toxicodendron radicans, which may be either a shrub or a climbing vine. There are nine subspecies of T. radicans, six of which are found in the United States. One species of poison sumac, Toxicodendron vernix, occurs in the United States.  

67. Barkley FA. The Rhus complex. Ann MO Bot Gard 1937; 24:265-498.

 68. Kingsbury JM. Poisonous plants of the United States and Canada. Englewood Cliffs, NJ: Prentice-Hall, Inc. 1964.

 69. Epstein WL. The poison ivy picker of Pennypack Park: the continuing saga of poison ivy. J Invest Dermatol 1987; 88:7s-11s.

 70. Guin JD. The black spot test for recognizing poison ivy and related species. J Am Acad Dermatol 1980; 2:332-333.

 A black, enamel-like deposit is frequently present on injured areas of poison ivy, poison oak, and poison sumac. This finding can also be produced deliberately as a field test for the toxic nature of the plant. Observing proper precautions, one crushes sap from leaves onto a sheet of white paper. The resulting stain should darken on exposure to the air if it came from a Toxicodendron. This test employs only one quality of these plants, and it is not, therefore, a substitute for other proved means of identification.

 71. Resnick SD. Poison-ivy and poison-oak dermatitis. Clin Dermatol 1986; 4:208-212.

 72. Baer H. Chemistry and immunochemistry of poisonous Anacardiaceae. Clin Dermatol 1986; 4:152-159.

 73. Fisher AA. Poison ivy/oak dermatitis. Part I: prevention - soap and water, topical barriers, hyposensitization. Cutis 1996; 57:384-386.

 74. Lampe KF. Dermatitis-producing Anacardiaceae of the Caribbean area. Clin Dermatol 1986; 4:171-182.

 75. Beaman JH. Allergenic Asian Anacardiaceae. Clin Dermatol 1986; 4:191-203.

 76. Rosen T, Fordice DB. Cashew nut dermatitis. South Med J 1994; 87:543-546.

 The urushiol dermatitis caused by plants of the Anacardiaceae family is the most common cause of acute allergic contact dermatitis. We have reported a case of cashew nut urushiol dermatitis due to ingestion of homemade cashew nut butter contaminated by cashew nut shell oil. With the precautions taken today to avoid contamination of food products with cashew urushiols, it is rare to find a case of cashew nut dermatitis in the United States. We have found no other report of contact dermatitis due to cashew nut butter. Moreover, though hinted at in the literature, there has been no previous detailed report of perianal contact dermatitis due to cashew ingestion. The fact that our patient was ill enough to require treatment with 3 weeks of systemic steroid therapy highlights the potential public health hazard of consumption of improperly prepared cashew products. However, the risk of cashew nut dermatitis today remains small, and this should not discourage cashew lovers from enjoying their treats. A final lesson to be learned from this case is that perianal eruptions may be due to materials deliberately applied to the anogenital region or to ingested antigens that remain sufficiently intact within the feces to affect perianal skin.

 77. Hurtado I. Poisonous Anacardiaceae of South America. Clin Dermatol 1986; 4:183-190.

 78. Edwards EK, Jr., Edwards EK, Sr. Spontaneous repigmentation of vitiligo following generalized acute allergic contact dermatitis. Contact Derm 1995; 33:123-141.

 79. Findlay GH. Dermatitis of 'poison ivy' type from an indigenous South African plant - Smodingium argutum E. Mey (Anacardiaceae). S Afr Med J 1963; 37:883-888.

 80. Whiting DA. Smodingium: allergenic Anacardiaceae in South Africa. Clin Dermatol 1986; 4:204-207.

 81. Kawai K, Nakagawa M, Liew FM, Yasung H. Hyposensitization to urushiol among Japanese lacquer craftsmen: results of patch tests on students learning the art of lacquerware. Contact Derm 1991; 25:290-295.

 8 subjects learning the art of lacquerware were patch tested to urushiol before and after contact with lacquer, in order to document whether hyposensitization to urushiol occurred among Japanese lacquer craftsmen. Simultaneously, we performed patch tests on 2 urushiol-sensitized controls who had no contact with lacquer during the investigation. Lacquer is made from the sap of the Japanese lacquer tree and raw lacquer is composed of 60-65% urushiol and its oligomer. 5 of the 8 subjects showed positive reactions to urushiol 1 month after their first contact. They became negative or less positive after prolonged (9 or 10 months) exposure to lacquer. As reactions to urushiol decreased, dermatitis became less severe. Controls showed consistently high reactions. However, 1 subject showed persistently strong reactions to urushiol. Unlike the other 7 subjects, he was previously sensitized to urushiol before the first contact with lacquer. The remaining 2 subjects showed no reaction throughout our investigation. These results strongly suggest that hyposensitization to urushiol does occur among Japanese lacquer craftsmen.

82. Nakamura T. Ginkgo tree dermatitis. Contact Derm 1985; 12:281-282.  

83. Tomb RR, Foussereau J, Sell Y. Mini-epidemic of contact dermatitis from ginkgo tree fruit (Ginkgo biloba L.). Contact Derm 1988; 19:281-283.

 3 cases of contact dermatitis from ginkgo fruit are reported. Swelling of the prepuce can be the only clinical sign of intolerance, as was observed in 1 case. Diagnosis of contact dermatitis to ginkgo fruit should be made in cities where female ginkgo trees grow, in Chinese, Japanese and South-East Asian subjects, who are aware of the ginkgo nut's culinary qualities within the fruit, as well as in children who play with the fallen fruits as "marbles".

 84. Lepoittevin J-P, Benezra C, Asakawa Y. Allergic contact dermatitis to Ginkgo biloba L.: relationship with urushiol. Arch Dermatol Res 1989; 281:226-230.

 A Ginkgo biloba L. fruit extract was prepared and purified. Three groups of guinea pigs were sensitized to the crude extract, anacardic acids 1, and cardanols 2 respectively, using the FCAT method, and the fourth group to urushiol using the epicutaneous route. Each group was tested for reaction to the primary sensitizer and to the different main aromatic compounds isolated from Ginkgo fruits. Anacardic acids were found to be good sensitizers, while cardanols failed to induce allergic contact dermatitis (ACD). No cross-reactions were observed among the compounds tested. Ginkgolic acids 1 seem to be the main allergens of Ginkgo biloba L. and the hypothesis of a biotransformation of 1 into catechol 4 is not supported by experiment.

85. Fisher AA. Poison ivy/oak/sumac. Part II: specific features. Cutis 1996; 58:22-24.

 86. Mallory SB, Hurwitz RM. Black-spot poison-ivy dermatitis. Clin Dermatol 1986; 4:149-151.

 87. Guin JD, Beaman JH. Plant dermatitis. Clin Dermatol 1986; 4:(2)1-226.

 88. Kligman AM. Poison ivy (rhus) dermatitis. Arch Dermatol 1958; 77:149-180.

 89. Watson ES. Toxicodendron hyposensitization programs. Clin Dermatol 1986; 4:160-170.

 90. Marks JG, Fowler, Jr., Sheretz EF, Rietschel RL. Prevention of poison ivy and poison oak allergic contact dermatitis by quaternium-18 bentonite. J Am Acad Dermatol 1995; 33:212-216.

 BACKGROUND: Poison ivy and poison oak are the most common causes of allergic contact dermatitis in North America.
OBJECTIVE: We investigated whether a new topical lotion containing 5% quaternium-18 bentonite prevents experimentally induced poison ivy and poison oak allergic contact dermatitis.
METHODS: A single-blind, paired comparison, randomized, multicenter investigation was used to evaluate the effectiveness and safety of quaternium-18 bentonite lotion in preventing experimentally induced poison ivy and poison oak allergic contact dermatitis in susceptible volunteers. One hour before both forearms were patch tested with urushiol, the allergenic resin from poison ivy and poison oak, 5% quaternium-18 bentonite lotion was applied on one forearm. The test patches were removed after 4 hours and the sites interpreted for reaction 2, 5, and 8 days later. The difference in reactions between treated and untreated patch test sites was statistically analyzed.
RESULTS: Two hundred eleven subjects with a history of allergic contact dermatitis to poison ivy and poison oak were studied. One hundred forty-four subjects had positive reactions to urushiol. The test sites pretreated with quaternium-18 bentonite lotion had absent or significantly reduced reactions to the urushiol compared with untreated control sites (p < 0.0001) on all test days. When it occurred, the reaction consistently appeared later on treated than on control sites (p < 0.0001). One occurrence of mild, transient erythema at the application site was the only side effect from the quaternium-18 bentonite lotion.
CONCLUSION: Quaternium-18 bentonite lotion was effective in preventing or diminishing experimentally produced poison ivy and poison oak allergic contact dermatitis.  

91. Warshaw EM, Zug KA. Sesquiterpene lactone allergy. Am J Contact Derm 1996; 7:1-23.

Sesquiterpene lactones are a large, diverse group of chemicals found in several plant families that cause allergic contact dermatitis. The biological, botanical, allergenic, and structural significance of sesquiterpene lactones is explored as well as the clinical characteristics of cutaneous reactions. The association with UV-light sensitivity and proposed mechanisms for this relationship as well as new developments in patch test methods and treatment are reviewed.

 92. Wrangsjo K, Ros AM. Compositae allergy. Semin Dermatol 1996; 15:87-94.

 93. Menz J, Winkelmann RK. Sensitivity to wild vegetation. Contact Derm 1987; 16:169-173.

 74 patients suspected of having allergic contact dermatitis to wild vegetation were patch tested with either extracts of 13 plants of the family Compositae and 7 other weeds or trees. Anthemis cotula (dog fennel) and Xanthium strumarium (cocklebur) gave the most frequent positive results, demonstrating a change of frequency in sensitivity compared to the 1950s, when Ambrosia artemisiifolia (ragweed) was recognized as the most frequently sensitizing weed. The reasons for these changes of incidence and clinical patterns are examined.

 94. Guin JD. Sesquiterpene-lactone dermatitis. Immunol Allergy Clin North Am 1989; 9:447-461.

 95. Ducombs G, Benezra C, Talaga P, Andersen KE, Burrows D, Camarasa JG, et al. Patch testing with the "sesquiterpene lactone mix": a marker for contact allergy to Compositae and other sesquiterpene-lactone-containing plants. Contact Derm 1990; 22:249-252.

 6278 patients were patch tested with a sesquiterpene lactone mix (SL-mix) in 10 European clinics. 4011 patients were tested only with 0.1% SL-mix, 63 (approximately 1.5%) of whom were positive, with 26 (41%) of these cases being considered clinically relevant. There were no cases of active sensitization, though 5 cases of irritation were reported. 22 irritant reactions and 22 cases of active sensitization occurred when testing also with 1% and 0.33% concentrations of SL-mix. SL-mix 0.1% pet. is shown to be an important patch test and many relevant sensitizations will be missed without routine screening with such a mix. Most patients with SL-mix sensitivity presented with hand and/or face dermatitis, apparent photodermatitis or more generalised eczema.

 96. Davies MG, Kersey PJW. Contact allergy to yarrow and dandelion. Contact Derm 1986; 14:256-257.

 97. Mitchell JC. Compositae and Frullania phytodermatitis. Acta Derm Venereol Stockh 1987; Suppl. 134:69-76.

 98. Fisher AA. Esoteric contact dermatitis. Part III: Ragweed dermatitis. Cutis 1996; 57:199-200.

 99. Schmidt RJ. Compositae. Clin Dermatol 1986; 4:46-61.

 100. Fisher AA. Esoteric contact dermatitis. Part IV: devastating contact dermatitis in India produced by American Parthenium weed (The scourge of India). Cutis 1996; 57:297-298.

 101. Lovell CR, Rowan M. Dandelion dermatitis. Contact Derm 1991; 25:185-188.

 7 subjects, each giving a history suggesting dandelion dermatitis, were patch tested with extracts of dandelion as well as with other common members of the Compositae and to the sesquiterpene-lactone-mix. All were positive to dandelion extracts but only 2 reacted to the sesquiterpene-lactone-mix. Although the mix is a useful screening test for chrysanthemum dermatitis, it may miss dandelion allergy.

 102. Mitchell JC. Frullania (Liverwort) phytodermatitis (Woodcutter's eczema). Clin Dermatol 1986; 4:62-64.

 103. Paulsen E, Andersen KE. Compositae dermatitis in a Danish dermatology department in 1 year (II). Clinical features in patients with Compositae contact allergy. Contact Derm 1993; 29:195-201.

 During our first year of routine testing with Compositae allergens and extracts, contact allergy to Compositae was frequently found in eczema patients (4.5%), especially in middle-aged or elderly persons. Based on clinical patterns, patch test reactions and the long-term course of the disease, 4 groups of patients were recognized: (a) a small group with localized eczema; (b) another with classic Compositae dermatitis of exposed skin; (c) a 3rd group, the largest, with localized eczema that suddenly one summer turned into a widespread dermatitis; (d) a 4th group with a vesicular hand eczema and more-or-less widespread dermatitis with seasonal variation from the beginning. 65% of the patients had vesicular hand eczema at some time, partly reflecting the frequency of atopy (25%) and metal allergy (44%). 75% of the patients had contact allergy to > or = 1 compounds besides Compositae. Thus, Compositae allergy may be primary, e.g., in young patients with occupational plant contact, or secondary to other contact allergies, perhaps as a result of increased individual susceptibility. The clinical patterns in the latter patients were most often a widespread dermatitis with summer exacerbation. The variability in the clinical picture makes routine patch testing with Compositae allergens recommendable.

 104. Manzano D, Aguirre A, Gardeazabal J, Oleaga JM, Izu R, Zabala R, et al. Airborne allergic contact dermatitis due to wild plants. Contact Derm 1994; 31:188-189.

 105. Sharma SC, Tanwar RC, Kaur S. Contact dermatitis from chrysanthemums in India. Contact Derm 1989; 21:69-71.

 32 patients (24 male, 8 female) with contact dermatitis from Chrysanthemum morifolium are reported. 24 (75%) patients gave a history of seasonal variation and 16 (50%) of photoaggravation and/or photosensitivity. Exposure to chrysanthemums was occupational in 18 and recreational in 12. The common clinical presentations were hand and face dermatitis in 13 (41%) and airborne contact dermatitis in 10 (31%) patients. All 32 patients demonstrated positive patch tests to ethanolic extracts of the flowers, 30 to the leaves, 28 to the whole plant, and only 6 to the stems, in that order of intensity.

 106. Sharma SC, Kaur S. Airborne contact dermatitis from Compositae plants in northern India. Contact Derm 1989; 21:1-5.

 60 patients (45 male and 15 female) with suspected airborne contact dermatitis from Compositae (Asteraceae) plants and 20 age-matched controls (15 male and 5 female) were investigated. Patch tests were performed with ethanolic plant extracts of 4 Compositae plants, Parthenium hysterophorus, Chrysanthemum morifolium, Dahlia pinnata and Tagetes indica, all prevalent in northern India. 55 (92%) patients showed positive patch tests, with 35 (64%) demonstrating positive tests to extracts of only 1 of the 4 plants tested. No positive patch tests were seen in the controls. Parthenium hysterophorus (78%) was the most frequent plant reacting, followed by Chrysanthemum morifolium (42%), Dahlia pinnata (18%) and Tagetes indica (7%).

 107. Ross JS, du Peloux Menage H, Hawk JLM. Sesquiterpene lactone contact sensitivity: clinical patterns of Compositae dermatitis and relationship to chronic actinic reticuloid syndrome. Contact Derm 1993; 29:84-87.

 A mix of 3 sesquiterpene lactones (SL) (SL mix 0.1%) was evaluated over a 4-year period. Of 7420 patients with eczema investigated by patch testing, 135 (68 male, 67 female) (1.8%) demonstrated positive reactions, 114 (84%) considered clinically relevant. Females outnumbered males until the age of 60, after which men were more commonly affected. The clinical patterns varied from patients presenting with generalized eczema (20%) or eczema of the hands and face (24%), to patients with hand (36%) or facial eczema (11%) alone. 48 patients were investigated for suspected photosensitivity and 29 (21 male, mean age 69 years, and 8 female, mean age 66 years) had abnormal cutaneous monochromatic irradiation tests. These results highlight the varied clinical presentation of SL contact dermatitis and its association with chronic actinic dermatitis. The SL mix proved reliable and safe, supporting its inclusion in the European standard series of contact allergens.

 108. Frain-Bell W, Johnson BE. Contact allergic sensitivity to plants and the photosensitivity dermatitis and actinic reticuloid syndrome. Br J Dermatol 1979; 101:503-512.

 Contact allergic sensitivity to oleoresin extracts from Compositae plants was found to be usually present in individuals suffering from the photosensitivity dermatitis and actinic reticuloid syndrome. It was demonstrated in forty-seven out of fifty-five examples of this syndrome. These results provide support for the view that contact allergic sensitivity is an important aspect of the state of chronic photosensitivity in the middle-aged and elderly male.

 109. Murphy GM, White IR, Hawk JLM. Allergic airborne contact dermatitis to Compositae with photosensitivity - chronic actinic dermatitis in evolution. Photodermatol Photoimmunol Photomed 1990; 7:38-39.

 110. Srinivas CR, Balachandran C, Shenoi SD, Acharya S. Azathioprine in the treatment of Parthenium dermatitis. Br J Dermatol 1991; 124:394-395.

 111. Delaney TA, Donnelly AM. Garlic dermatitis. Australas J Dermatol 1996; 37:109-110.

 Allergic contact dermatitis to garlic usually has a typical clinical presentation but this is often masked if it presents concurrently with another form of hand dermatitis. Patch testing with 1% diallyl disulfide in petrolatum is recommended when garlic allergy is suspected.

 112. Canduela V, Mongil I, Carrascosa M. Garlic: always good for the health? Br J Dermatol 1995; 132:161-162.

 113. Acciai MC, Brusi C, Francalanci S, Giorgini S, Sertoli A. Allergic contact dermatitis in caterers. Contact Derm 1993; 28:48

 114. Valdivieso R, Subiza J, Varela-Losada S, Subiza JL, Narganes MJ, Martinez-Cocera C, et al. Bronchial asthma, rhinoconjunctivitis, and contact dermatitis caused by onion. J Allergy Clin Immunol 1994; 94:928-930.

 115. Gette MT, Marks JG. Tulip fingers. Arch Dermatol 1990; 126:203-205.

 116. Marks JG. Allergic contact dermatitis to Alstroemeria. Arch Dermatol 1988; 124:914-916.

 117. Rycroft RJG. Dermatitis in florists. Semin Dermatol 1996; 15:83-86.

 118. Apted JH. Contact dermatitis due to Alstroemeria (Peruvian Lily). Australas J Dermatol 1990; 31:111-113.

 119. Santucci B, Picardo M, Iavarone C, Trogolo C. Contact dermatitis to Alstroemeria. Contact Derm 1985; 12:215-219.

 120. Bateman PP. Contact dermatitis to an Australian native plant. Med J Aust 1986; 144:670

 121. Knight TE, Hausen BM. Melaleuca oil (teat tree oil) dermatitis. J Am Acad Dermatol 1994; 30:423-427.

 122. Rasmussen JE. Contact dermatitis from orchids. Clin Dermatol 1986; 4:31-35.

 123. MacAulay JC. Orchid allergy. Contact Derm 1997; 112-113.

 124. Epstein E. Primula contact dermatitis: An easily overlooked diagnosis. Cutis 1990; 45:411-416.

 125. MacFarlane AW. Cross reaction to a Christmas tree. Br Med J 1987; 295:1660-1661.

 126. Santucci B, Picardo M. Occupational contact dermatitis to plants. Clin Dermatol 1992; 10:157-165.

 127. O'Malley MA, Thun M, Morrison J, Mathias CGT, Halperin WE. Surveillance of occupational skin disease using the supplementary data system. Am J Industr Med 1988; 13:291-299.

 128. Bethea LK, Schuman SH, Smith-Phillips SE, Kelly JW. South Carolina florists dermatitis: case report and survey results. J South Carolina Med Assoc 1988; 446-448.

 129. Hoogasian C. Dermatitis concerns spark industry study. Florist 1988; 21:95-99.

 130. Periera F. Hand dermatitis in florists. Contact Derm 1996; 34:144-145.

 131. Thiboutot DM, Hamory BH, Marks JG. Dermatoses among floral shop workers. J Am Acad Dermatol 1990; 22:54-58.

 132. Merrick C, Fenney J, Clarke EC, Hodnett T, Fletcher G. A survey of skin problems in floristry. Contact Derm 1991; 24:306

 133. Hausen BM, Oestmann G. Untersuchungen uber die Haufigkeit berufsbedingter allergischer Hauterkrankungen auf einem Blumengrossmarkt. Dermatosen In Beruf und Umwelt 1988; 36:117-124.

 134. Anonymous. Phytophotodermatitis among grocery workers - Ohio. MMWR 1985; 34:11-12.

 135. Epstein WL. Occupational poison ivy and oak dermatitis. Dermatol Clin 1994; 12:511-516.

 136. Oltman J, Hensler R. Poison oak/ivy and forestry workers. Clin Dermatol 1986; 4:213-216.

 137. Pecegueiro M, Brandao FM. Airborne contact dermatitis to plants. Contact Derm 1985; 13:277-279.

[185]. Green C, Ferguson J: Sesquiterpene lactone mix is not an adequate screen for Compositae allergy. Contact Derm 1994;31:151-153.

[184]. Hausen BM: A 6-year experience with compositae mix. Am J Contact Dermat 1996;7:94-99.