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Gofman J, Shapiro L, Elias MD. Recognizing Flagellate Erythema in Skin of Color: A Case of Shiitake Dermatitis. Cureus 2024; 16:e55437. [PMID: 38567230 PMCID: PMC10985566 DOI: 10.7759/cureus.55437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Flagellate erythema, also known as flagellate dermatitis, flagellate hyperpigmentation, or shiitake dermatitis, is a rare multifocal cutaneous eruption characterized by linear erythematous lesions similar to flagellation wounds. This case report details the progressive onset of flagellate erythema in a 31-year-old African American male presenting with pruritic, erythematous, hyperpigmented, linear lesions of the face, trunk, and upper extremities following his consumption of shiitake mushrooms. Classically, this eruption arises subsequent to the ingestion of raw or undercooked shiitake mushrooms. This case underscores the importance of clinical diagnosis, as the role of biopsy as a diagnostic tool is limited due to the nonspecific nature of histological findings. Therefore, proper diagnosis is reliant upon careful history taking, including dietary changes, initiation of any new medications, and progression of symptoms. Most cases are self-limiting, with eruptions persisting for up to three weeks. Treatment aims to provide symptomatic relief through topical corticosteroids and oral antihistamines, reducing associated pruritus and skin changes.
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Affiliation(s)
- Joseph Gofman
- Dermatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Lucas Shapiro
- Dermatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA
| | - Merrick D Elias
- Dermatology, Elias Dermatology, Pembroke Pines, USA
- Dermatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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Ma JY, Liu JW. Shiitake Flagellate Dermatitis. Mayo Clin Proc 2022; 97:2192-2193. [PMID: 36464462 DOI: 10.1016/j.mayocp.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/25/2022] [Accepted: 07/27/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Jin-Yuan Ma
- Second School of Clinical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jia-Wei Liu
- Department of Dermatology, Peking Union Medical College Hospital, State Key Laboratory of Complex Severe and Rare Diseases, Chinese Academy of Medical Science & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, People's Republic of China.
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Al Rawahi A, Al Musalhi B, Abdwani R. Flagellate-like dermatitis in a child with autoinflammatory disorder successfully treated with colchicine. JAAD Case Rep 2022; 34:61-63. [PMID: 36974129 PMCID: PMC10038768 DOI: 10.1016/j.jdcr.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Balasuriya A, Goel A. Shiitake flagellate dermatitis (toxicoderma): A case report. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:161-162. [PMID: 34825546 DOI: 10.25259/nmji_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We report a patient with flagellate dermatitis (shiitake dermatitis) appearing 48 hours after consumption of shiitake mushrooms in a previously healthy 37-year-old man. The skin lesion resolved completely within a week following treatment with antihistamine and topical steroid cream (dexamethasone 0.1%).
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Affiliation(s)
- Achala Balasuriya
- Department of Medicine, Hemas Hospital, No. 389, Colombo-Negombo Road, Wattala 11300, Sri Lanka
| | - Ashish Goel
- Department of Medicine, All India Institute of Medical Sciences, Mohali, Punjab 160055
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Aleisa A, Plotnikova N. Shiitake mushroom-induced flagellate dermatitis: Case report. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2020. [DOI: 10.4103/jdds.jdds_73_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ribeiro CS, Sodré CT, Ramos-e-Silva M. Flagellate Dermatitis by Shiitake Mushroom. Case Rep Dermatol 2019; 11:220-225. [PMID: 31543768 PMCID: PMC6738184 DOI: 10.1159/000498938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 02/08/2019] [Indexed: 11/24/2022] Open
Abstract
The authors present a case of flagellate dermatitis in a previously healthy young male, triggered by the consumption of shiitake mushrooms. Complete remission without complications was obtained within 7 days, simply by the application of dexamethasone cream 0.1%. Considering the growing use of this originally Asian fungus in cookery worldwide, it is likely that we will see increased occurrence of this benign and self-limited condition also in the Western world.
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Affiliation(s)
| | | | - Marcia Ramos-e-Silva
- *Marcia Ramos-e-Silva, Sector of Dermatology and Post-Graduation Course in Dermatology University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rua Dona Mariana 143/C-32, Rio de Janeiro, RJ 22280-020 (Brazil), E-Mail
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Abstract
Flagellate erythema is a distinctive eruption characterized by "whip-like" linear or curvilinear streaks and plaques, occurring mainly on the trunk. It has classically been described in 2 disparate clinical settings: chemotherapy with bleomycin and ingestion of mushrooms (most commonly Shiitake mushrooms). Most of the literature comprises single case reports, often with minimal histological description of rather nonspecific features. We describe in detail the histological features of 3 cases of flagellate erythema (2 related to bleomycin therapy and one related to ingestion of mushrooms) and review the findings described in the literature to define the spectrum of histological changes encountered in this eruption. Our 3 cases showed mild epidermal changes, with spongiosis and variable interface inflammation. All 3 showed a relatively prominent dermal lymphohistiocytic infiltrate, with features suggestive of a lymphocytic vasculopathy extending to at least the mid-reticular dermis. Eosinophils were a prominent component of the inflammatory infiltrate in 2 cases. Our review of the literature identified a total of 45 publications, representing reports of 46 patients, containing histological information. As well as bleomycin- and mushroom-related cases, similar eruptions have been reported in the context of connective tissue disease and other drugs. Although cases related to connective tissue disease show features of the underlying condition, cases secondary to drugs or mushrooms predominantly show features compatible with common patterns of exanthematous/morbilliform drug reaction. In particular, subtle spongiosis and/or interface dermatitis combined with a dermal lymphocytic infiltrate that includes increased numbers of eosinophils is a common finding. Features of a lymphocytic vasculopathy may be seen in a subset of these cases.
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Fang S, Bajoghli A, Bajoghli M. Shiitake mushroom-induced flagellate dermatitis. Ann Allergy Asthma Immunol 2017; 119:462-463. [PMID: 29150072 DOI: 10.1016/j.anai.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/06/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Serena Fang
- University of Utah School of Medicine, Salt Lake City, Utah.
| | - Amir Bajoghli
- Virginia Commonwealth University School of Medicine, Inova Health System, Mclean, Virginia
| | - Mehdi Bajoghli
- Georgetown University School of Medicine, Mclean, Virginia
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Santos N, Silva PM, São Bráz MA. A Case of Flagellate Dermatitis After Ingestion of Shiitake Mushrooms. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:647-648. [PMID: 28970086 DOI: 10.1016/j.jaip.2017.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/30/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Natacha Santos
- Allergy and Clinical Immunology Department, Centro Hospitalar do Algarve, Portimão, Portugal.
| | - Pedro Morais Silva
- Allergy and Clinical Immunology Department, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Maria Antónia São Bráz
- Allergy and Clinical Immunology Department, Centro Hospitalar do Algarve, Faro, Portugal
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Mendonça FMI, Márquez-García A, Méndez-Abad C, Rodriguez-Pichardo A, Perea-Cejudo M, Ríos Martín JJ, Camacho FM. Flagellate dermatitis and flagellate erythema: report of 4 cases. Int J Dermatol 2017; 56:461-463. [PMID: 28102584 DOI: 10.1111/ijd.13523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 08/21/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ana Márquez-García
- Department of Dermatology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Cristina Méndez-Abad
- Department of Dermatology, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Manuel Perea-Cejudo
- Department of Dermatology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Juan J Ríos Martín
- Department of Pathology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Francisco M Camacho
- Department of Dermatology, Hospital Universitario Virgen Macarena, Seville, Spain
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Nguyen AH, Gonzaga MI, Lim VM, Adler MJ, Mitkov MV, Cappel MA. Clinical features of shiitake dermatitis: a systematic review. Int J Dermatol 2017; 56:610-616. [DOI: 10.1111/ijd.13433] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/21/2016] [Accepted: 07/08/2016] [Indexed: 02/06/2023]
Affiliation(s)
| | - Maria I. Gonzaga
- Department of Biology; Frank R. Seaver College of Science and Engineering; Loyola Marymount University; Los Angeles CA USA
| | | | | | - Mario V. Mitkov
- Department of Dermatology; Mayo Clinic Florida; Jacksonville FL USA
| | - Mark A. Cappel
- Department of Dermatology; Mayo Clinic Florida; Jacksonville FL USA
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Stephany MP, Chung S, Handler MZ, Handler NS, Handler GA, Schwartz RA. Shiitake Mushroom Dermatitis: A Review. Am J Clin Dermatol 2016; 17:485-489. [PMID: 27566177 DOI: 10.1007/s40257-016-0212-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Shiitake mushroom dermatitis is a cutaneous reaction caused by the consumption of raw or undercooked shiitake mushrooms. Symptoms include linear erythematous eruptions with papules, papulovesicles or plaques, and severe pruritus. It is likely caused by lentinan, a heat-inactivated beta-glucan polysaccharide. Cases were initially reported in Japan but have now been documented in other Asian countries, North America, South America, and Europe, as this mushroom is now cultivated and consumed worldwide. Shiitake mushroom dermatitis may result from mushroom ingestion or from handling, which can result in an allergic contact dermatitis.
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Affiliation(s)
| | - Stella Chung
- Dermatology Department, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | | | - Glenn A Handler
- Dermatology Department, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Robert A Schwartz
- Dermatology Department, Rutgers New Jersey Medical School, Newark, NJ, USA
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