Allergic contact dermatitis to tea tree oil with erythema multiforme–like ID reaction

Abstract

The commercial production of tea tree oil, extracted from Melaleuca alternifolia Cheel, has considerably increased over the past 15 years in response to a strong demand for natural remedies and aromatic substances. The number of case reports that describe allergic contact dermatitis (ACD) to this essential oil is also on the rise. We report an additional case of ACD to tea tree oil that presented with an extensive erythema multiforme-like reaction. A skin biopsy was performed from a targetlike lesion distant from the site of the initial dermatitis. The patient was treated with systemic and topical corticosteroids. Five months later, he was patch tested to the North American standard series, to his own tea tree oil, to a fresh batch of tea tree oil, and to some related allergens. The skin biopsy showed a spongiotic dermatitis without histological features of erythema multiforme. Patch testing elicited a 3+ reaction to old, oxidized tea tree oil, a 2+ reaction to fresh tea tree oil, a 2+ reaction to colophony, a 1+ reaction to abitol, and a 1+ reaction to balsam of Peru. We believe this is the first report of erythema multiforme-like reaction secondary to ACD from tea tree oil. Other interesting features are the stronger reaction to oxidized than to fresh tea tree oil, and concomitant reactivity to colophony, abitol, and balsam of Peru.

Secondary effects of topical application of an essential oil. Allergic contact dermatitis due to tea tree oil

“…Sin embargo, resulta muy complejo definir con exactitud cuáles de estos componentes son los responsables de la DAC, ya que hablamos de más de 100 sustancias quí-micas, con la dificultad añadida de que el número de éstas y su concentración varían según cada producto, y en muchas ocasiones no se etiquetan con fiabilidad 5 . Se han descrito reacciones cutáneas muy variables tras la aplicación tópica de AAT, tanto irritativas: prurito, eritema, como alérgicas, incluyendo presentaciones tipo eritema multiforme-like, enfermedad IgA lineal, o reacciones sistémicas de hipersensibilidad 1,4,15 . También se han descrito reacciones anafilácticas tras aplicaciones tópicas 1 .…”

Toxic Epidermal Necrolysis Following Allergic Contact Dermatitis Caused by Occupational Exposure to Ultraviolet-cured Inks

“…Although these were EM-like lesions induced by contact dermatitis, presenting clinically as "targeted" lesions typical of EM, there were histopathological signs of spongiotic dermatitis (7). Interestingly, in several reported cases of contact EM, biopsy specimens fi'om positive patch test sites demonstrated various changes, spongiotic dermatitis, vacuolar changes in the basal keratinocytes, and oedema of the papillary dermis, with dilated vessels surrounded by perivascular infiltrate (8)(9)(10). Histopathological examination ofthe site of the positive (3+) patch test to HDDA showed pronounced oedema ofthe papillary dermis, resulting in subepidermal blisters in our case.…”

Éruption bulleuse à l’huile de nigelle

“…Les auteurs ont émis l'hypothèse que le patient s'était sensibilisé par voie cutanée et que la prise orale avait contribué à l'extension des lésions. Des réactions cutanées à type d'érythème polymorphe de contact à d'autres huiles essentielles ont déjà été décrites dans la littérature, notamment avec l'huile de laurier et l'huile d'arbre à thé [13,14]. Ces réactions, cliniquement moins étendues que dans notre cas, ont également été confirmées par patch-tests.…”