Dermatoses among floral shop workers

Contact dermatitis as an adverse reaction to some topically used European herbal medicinal products - part 4: Solidago virgaurea-Vitis vinifera

This review focuses on contact dermatitis as an adverse effect of a selection of topically used herbal medicinal products for which the European Medicines Agency has completed an evaluation up to the end of November 2013 and for which a Community herbal monograph - now (since 2014) called a 'European Union herbal monograph' - has been produced. The present part 4 addresses species from Solidago virgaurea L. to Vitis vinifera L.

Tulipalin A induced phytotoxicity

Tulipalin A induced phytotoxicity is a persistent allergic contact dermatitides documented in floral workers exposed to Alstroemeria and its cultivars.[1] The causative allergen is tulipalin A, a toxic glycoside named for the tulip bulbs from which it was first isolated.[2] The condition is characterized by fissured acropulpitis, often accompanied by hyperpigmentation, onychorrhexis, and paronychia. More of the volar surface may be affected in sensitized florists. Dermatitis and paronychia are extremely common conditions and diagnostic errors may occur. A thorough patient history, in conjunction with confirmatory patch testing with a bulb sliver and tuliposide A exposure, can prevent misdiagnosis. We report a case of Tulipalin A induced phytotoxicity misdiagnosed as an unresolved tinea manuum infection in a patient evaluated for occupational exposure.

Quantification of α-methylene-λ-butyrolactone extracted from different parts ofAlstroemeria wilhelmina and evaluation of it's antigenicity using the guinea-pig maximization test

To detect the type of contact dermatitis caused due to the handling ofAlstroemeria wilhelmina, 1% α-methylene-λ-butyrolactone (α-MBL) dissolved in physiological alien and a five-fold diluted saline solution of original extracts of flowers, leaves and stems of the flower were applied to guinea-pigs for extracts were applied to the animals as the challenge treatment in compliance with the guinea-pig maximization test (GMT). As a consequence, not only primary irritant dermatitis was observed, but also delayed type allergic contact dermatitis due toAlstroemeria wilhelmina was observed. α-MBL determined in the extracts using high-performance liquid chromatography (HPLC) was found to be the biochemical material cause of the contact dermatitis. the flower region contained α-MBL in the highest concentrations compared with those of the leaves and stems. Therefore, the quantification of α-MBL in the extracts was concluded as being a useful evaluating method for contact dermatitis due to the handling ofAlstroemeria.

Clinical patterns of phytodermatitis

Exposure to plants is very common, through leisure or professional activity. In addition, plant products and botanic extracts are increasingly present in the environment. Cutaneous adverse reactions to plants and their derivatives occur fairly frequently, and establishing the correct diagnosis is not always easy. The astute clinician relies on a detailed history and a careful skin examination to substantiate his opinion. This article reviews the characteristic clinical patterns of phyto- and phytophotodermatitis and some less common presentations.

Allergic contact dermatitis to plants in a Spanish dermatology department: a 7-year review

To investigate the incidence of allergic contact dermatitis (ACD) to plants in our area, we reviewed the records of the patients that were studied in the Allergic Contact Unity of our hospital in the last 7 years (2248 patients). We found 69 cases of positive patch tests to plant allergens, representing 3% of all the patients in that period. Diallyl disulfide was the most frequent allergen (47 cases), involving mainly middle-aged housewives with chronic hand eczema. Positive tests to sesquiterpene lactone mix (SL mix) were found in 11 patients, mostly middle-aged rural workmen with an airborne clinical pattern. Other allergens detected were lichens, primin, tulipalin A and wood. These results show a high incidence of ACD to diallyl disulfide that, in our opinion, should be tested in all housewives or cooks with chronic hand eczema. The predominance of the classical airborne pattern of allergy to SL in our study may be because the airborne way of allergen exposure in our area, with a high percentage of rural population, is the most frequent, and it makes it important to remember this possibility in the differential diagnosis of photosensitivity.

Phytodermatitis

BACKGROUND

Most dermatologists can recognize the classic patterns of presentation of plant contact dermatitis; however, few can recognize the offending plants or know the name and chemical structure of the allergens or irritants that they contain.

OBJECTIVE

Five basic clinical patterns of phytodermatitis are reviewed: 1) allergic phytodermatitis, 2) photophytodermatitis, 3) irritant contact dermatitis, 4) pharmacologic injury, and 5) mechanical injury. The plants responsible for each pattern are presented by families, according to current scientific taxonomy. The chemical structure of the offending substances is described, and principles of investigation, prevention, and treatment are outlined.

CONCLUSIONS

Plant contact dermatitis remains an extremely vast and complex topic. Exotic plants and woods are now present in our gardens and homes. The newfound interest in aromatherapy, phytotherapy, and so-called "natural" therapies is the cause of a tremendous increase in exposure to plant products and extracts. This is responsible for the appearance of atypical patterns of plant contact dermatitis with which the practising dermatologist must become familiar.

Isolation and quantification of tuliposides and tulipalins in tulips (Tulipa) by high-performance liquid chromatography

The content of tuliposides and tulipalins were determined in Tulipa species and cultivars by reversed-phase high-performance liquid chromatography (RP-HPLC), using a water:methanol gradient as mobile phase. The compounds were detected by a diode array detector employed at 208 nm. The investigation revealed, in addition to 1- and 6-tuliposide A, tuliposide D and the lactonized aglycones tulipalin A and (-)-tulipalin B, the new tuliposide F and 6-tuliposide B, the latter being a new acyl derivative of the known 1-tuliposide B. All compounds were isolated by preparative RP-HPLC and identified by NMR and mass spectroscopy. The predominant compounds were 6-tuliposide A and B present in amounts up to 1.5% and 1.3% of fresh weight, respectively. 6-Tuliposide A and tulipalin A seem to be the major allergens in tulips, although tuliposide D and F may also contribute to the allergenic properties. Tulipalin A and (-)-tulipalin B occur in intact tulips and are not only produced in response to fungal attack or after excision of the plants. A few species were found to have very low allergen content and a relatively high level of tuliposide B, indicating it should be possible to breed non-allergenic and disease-resistant tulips.

Occupational dermatitis in Danish gardeners and greenhouse workers (I). Prevalence and possible risk factors

Floristry is considered a hazardous occupation from a dermatological point of view, but there are relatively few epidemiological studies to support this notion. The present investigation set out to assess the prevalence of and association between occupational dermatitis and possible risk factors in Danish gardeners and greenhouse workers. A cross-sectional study, based on a postal questionnaire and subsequent examination and patch testing of those who had occupational eczema from their present work or occupational problems with Compositae, was carried out in 1958 gardeners and greenhouse workers. The response rate was 84.6% and among 301 persons invited for further examination, 253 (84.1%) attended. The lifetime prevalence of occupational eczema in floristry, defined as dermatitis lasting more than 24 h, was 19.6% (95% confidence intervals 17.8-21.3%) among all potential respondents. Occupational mucosal symptoms, working with Compositae plants and a history of previous occupational eczema in floristry were significantly associated with an increased risk of occupational eczema. Sex, age and atopy did not seem to be important risk factors. The results confirm that floristry is a dermatologically hazardous occupation and emphasize the importance of eliciting agents in the working environment rather than personal inherent factors.

The nature and distribution of daffodil pickers' rash

The rash associated with picking daffodils has long been recognized, but the distribution and differing types of lesions have not been explained. This study, from observations in the field, attempts to clarify the position. The method of picking and then gathering the flowers explains the development of the rash at the points of contact of plant sap with skin. Crystals of calcium oxalate in the sap, in conjunction with alkaloids, act as an irritant, and also cause the characteristic sores.

Occupational asthma caused by decorative flowers: review and case reports

Occupational respiratory symptoms caused by decorative flowers are seldom reported in the literature. In the years 1985-1993 four such cases of occupational asthma were diagnosed at the Institute of Occupational Health of Finland. Occupational asthma was caused by freesias (n = 1), chrysanthemums (n = 1), and tulips (n = 2). The diagnoses were based on work-related respiratory symptoms during flower handling in the patients' histories, specific challenge tests, and allergologic examinations. Flower allergy is rare but can even develop into occupational asthma. It usually leads to a change of profession.

Contact dermatitis due to Alstroemeria (Peruvian lily)

Two cases of hand dermatitis due to contact with the plant Alstroemeria (Peruvian Lily) are recorded. This plant has been increasingly used for making floral decorations during the last decade. As it is available throughout the year in Victoria more cases are likely to be discovered in the community.