HPI: The patient has has a five week history of a dermatitis on the face, torso and lower legs. He is in good general health and on no new medications. Only oral med is lisinopril. For the past two months he has been working indoors mainly with Western Knotty Cedar and has been exposed to dust from that. He wondered if this could be a cause. He's had cbc, chem profile done by his nurse practitioner and all was normal.
O/E: Fiery erythema of face (sparing lower lids), chest, back (sparing axillary vaults) and less advanced dermatitis of legs. Doubly covered areas appear spared. Generalized scaling on the scalp.
Clinical Photos (shown with patient's permission):
Diagnosis: The patient's suspicion may be right. This could fit with airborn allergic contact dermatitis from cedar.
Reference:1. Allergic contact dermatitis from cedar wood (Thuja plicata) Bleumink E, Mitchell JC, Nater JP. Br J Dermatol. 1973 May;88(5):499-504.
SUMMARY: A case of allergic contact dermatitis caused by the heart-wood of western red cedar (Thuja plicata) is reported. The workman, after exposure to woods for 2 years in a mill, developed an acute dermatitis of his face, hands and arms. Avoidance of contact with wood cleared the symptoms. Patch tests with extracts of nineteen different wood species revealed a strong reaction to western red cedar. Patch tests with the various components present in the wood showed positive reactions to gamma-thujaplicin, y-hydroxy-isopropyltropolone and also to thymoquinone. Although thymoquinone was found to be a strong skin irritant, tests performed in two other patients with eczema indicated thymoquinone to be a potent allergcnic component as well.
2. Airborne contact dermatitis - current perspectives in etiopathogenesis and management. Handa S, De D, Mahajan R. Indian J Dermatol. 2011 Nov;56(6):700-6. Full Free Online
Source: Departments of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India .
Abstract: The increasing recognition of occupational origin of airborne contact dermatitis has brought the focus on the variety of irritants, which can present with this typical morphological picture. At the same time, airborne allergic contact dermatitis secondary to plant antigens, especially to Compositae family, continues to be rampant in many parts of the world, especially in the Indian subcontinent. The recognition of the contactant may be difficult to ascertain and the treatment may be even more difficult. The present review focuses on the epidemiological, clinical and therapeutic issues in airborne contact dermatitis.
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