Two types of pemphigus vegetans must be distinguished. Induction of pemphigus (also vegetans) is an accepted side effect of captopril. The effect of enalapril on pemphigus is still in debate. To the best of our knowledge, this is the first time that a patient with pemphigus vegetans and a simultaneously occurring internal malignancy is described.
A 15‐year‐old girl developed perioral dermatitis and swelling of the lips, having played a flute made of cocus wood for 2 years. Patch tests with wood shavings, as well as with subsequently isolated constituents named focus 1 and focus II. were Strongly positive. Alter complete purification, bolt
Contact allergens were identified as isoflavan derivatives, While Cocus 1 was shown to be 7,8‐dihydroxy‐2,4,5trmethoxyisoflava, the structure of focus II could not be elucidated exactly. It could have been Either 7,8,3′‐trihydroxy 2,4 dimethoxyisoflavan or 7,8,2‐trihydroxy‐3′,4‐dime‐thoxyoflavan The exact position of the hydroxy and methoxy group in C‐2 and C‐3 can be determined only by complete synthesis Of both compounds or by isolation of greater amounts of focus II for further oxidation experiments. Due t0 the stronger patch lest reaction and the higher yield cocus I in the wood, this hydroxyisoflavan must be recognized as the main contact allergen.
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