Journal of the American Academy of Dermatology
Volume 50, Issue 1 , Pages 150-151, January 2004

Contact dermatitis from Rhus toxicodendron in a homeopathic remedy

  • Carla Cardinali, MD

      Affiliations

    • Dermatological Clinic IIa, University of Florence, Florence, Italy
    • ,
  • Stefano Francalanci, MD

      Affiliations

    • Dermatological Clinic IIa, University of Florence, Florence, Italy
    • U. O. Allergological Unitb, Department of Dermatological Sciences, University of Florence, Florence, Italy
    • ,
  • Barbara Giomi, MD

      Affiliations

    • Dermatological Clinic IIa, University of Florence, Florence, Italy
    • ,
  • Marzia Caproni, MD

      Affiliations

    • Dermatological Clinic IIa, University of Florence, Florence, Italy
    • ,
  • Achille Sertoli, MD

      Affiliations

    • U. O. Allergological Unitb, Department of Dermatological Sciences, University of Florence, Florence, Italy
    • ,
  • Paolo Fabbri, MD

      Affiliations

    • Dermatological Clinic IIa, University of Florence, Florence, Italy

Article Outline

 

To the Editor:

The use of homeopathy is increasing, and skin diseases represent one of the most important indications in the employment of plant extracts as medicinal remedies.1, 2, 3, 4, 5 A 45-year-old woman was admitted to our department for widespread dermatitis. Fifteen days before its appearance, having noted the presence of vesicles on the right thigh and on the vulva and presuming them to be herpes lesions, she had applied the mother tincture of Rhus toxicodendron (alcohol solution). The patient had been treating the recurrent herpes with this homeopathic medicine for more than 10 years. After 10 days, she had also taken 7CH micropellets of the same substance (3-5 micropellets more times a day for 4 days). The patient reported that an erythema, limited to the sites of tincture application at first, had extended to the other thigh, the forearms, and the neck and face. Upon examination, a bright erythema with distinct boundaries involved the pubis, the inguinal area, and the inner surface of the thighs. Laboratory investigations revealed leukocytosis and elevated anti-herpesvirus IgG antibodies. Histopathologic examination demonstrated eczematous findings. After remission, the patient underwent patch tests that revealed positive reactions to a balsam of Peru 25%, fragrances mix 8%, and Dermatophagoides mix 30%. An open test, performed on the forearm with the R toxicodendron tincture, showed an erythemato-oedematous response at 48 hours and an erythemato-edemato-vesicular reaction at 96 hours that was still present after 7 days. Patch test with 65° ethyl alcohol gave negative results. The open test performed as control in 8 healthy informed subjects revealed negative responses.

The diagnosis of allergic dermatitis caused by contact and to the oral introduction of R toxicodendron was made. Allergic contact dermatitis caused by R toxicodendron in a phytotherapeutic preparation has been already described in two patients that had applied it for the treatment of muscoloskeletal aches and of herpes lesions.6

Our case can be considered as an allergic eruption caused by R toxicodendron in which the mechanism responsible for sensitization was probably related to the recurrent skin application of the tincture. However, the oral intake of the substance led to the diffusion of the eruption beside the sites of tincture application. The case has been also reported for the rareness of the allergen in our country, where it is uncommon to observe any allergic contact dermatitis to Rhus, unlike in the United States where more allergic contact dermatitis is due to it than to any other cause.7, 8, 9, 10

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References 

  1. Frenkel M, Hermoni D. Effects of homeopathic intervention on medication consumption in atopic and allergic disorders. Altern Ther Health Med. 2002;8:76–79
  2. Schafer T, Riehle A, Wichmann HE, Ring J. Alternative medicine in allergies (prevalence, patterns of use, and costs). Allergy. 2002;57:694–700
  3. Jenaer M, Henry MF, Garcia A, Marichal B. Evaluation of 2LHERP in preventing recurrences of genital herpes. Br Homeopath J. 2000;89:174–177
  4. Granlund H. Treatment of childhood eczema. Pediatr Drugs. 2002;4:729–735
  5. Smith SA, Baker AE, Williams JH. Effective treatment of seborrheic dermatitis using a low dose, oral homeopathic medication consisting of potassium bromide, sodium bromide, nickel sulfate, and sodium chloride in a double-blind, placebo-controlled study. Altern Med Rev. 2002;7:59–67
  6. Sasseville D, Nguyen KH. Allergic contact dermatitis from Rhus toxicodendron in a phytotherapeutic preparation. Contact Dermatitis. 1995;32:182–183
  7. Guin JD, Gillis WT, Beaman JH. Recognizing the toxicodendrons (poison ivy, poison oak, and poison sumac). J Am Acad Dermatol. 1981;4:99–114
  8. Tanner TL. Rhus (toxicodendron) dermatitis. Prim Care. 2000;27:493–502
  9. Cohen LM, Cohen JL. Erythema multiforme associated with contact dermatitis to poison ivy (Three cases and a review of literature). Cutis. 1998;62:139–142
  10. Rietschel RL, Fowler JF. Fisher's contact dermatitis. In: 4th ed. Baltimore: Williams & Wilkins; 1995;p. 114–129

PII: S0190-9622(03)01476-2

doi:10.1016/S0190-9622(03)01476-2

Journal of the American Academy of Dermatology
Volume 50, Issue 1 , Pages 150-151, January 2004