Patch testing in allergic contact dermatitis caused by topical Chinese herbal medicine

Li, L.-F.; Wang, J.

doi:10.1034/j.1600-0536.2002.470308_3.x

Cited by 13 publications

(1 citation statement)

References 5 publications

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“…6,7 Myrrh present in medicated plasters for external use has previously been reported to cause contact allergy reactions. 8 Similar contact reactions ascribed to myrrh have been observed following the topical use of pain-relieving TCM formulations 9 and formulations used by bonesetters. 10 The cases presented here are skin eruptions that occurred following the oral administration of myrrhcontaining TCM formulations, diagnosed by patch testing.…”

Section: Discussionmentioning

confidence: 70%

Patch test diagnosis of non‐immediate cutaneous reaction to myrrh following oral intake of a traditional Chinese medicine decoction

Xuan

et al. 2018

Contact Dermatitis

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Cutaneous delayed adverse reactions both to externally applied and to orally administered traditional Chinese medicines (TCMs) have been reported. 1-3 However, it is challenging for physicians to identify the causative agent(s), because of the complexity of TCM formulations. CASE REPORTCase 1: A 47-year-old female (patient 1) was prescribed a TCM decoction containing 14 ingredients to treat shoulder pain. She presented with an eruption 24 hours after taking the decoction. She experienced facial swelling, itchiness and erythema starting on her arms, later spreading to her entire body within 4 days.Case 2: A 42-year-old male (patient 2) presented with a generalized purpuric rash on the trunk and extremities 36 hours after taking a TCM decoction containing 29 ingredients, which had been prescribed to treat his backache.In both patients, the cutaneous eruptions were provisionally diagnosed as TCM-induced adverse drug reactions. To identify the responsible TCM ingredient(s), skin tests were performed with all the individual ingredients as provided by the patients. In patient 1, prick tests were performed on the left forearm with a decoction prepared from each individual ingredient in her prescribed TCM formulation. No reaction was observed after 30 minutes. However, 24 hours later, an itchy and erythematous vesicular rash developed at the site of the prick test with myrrh ( Figure 1). Closed patch testing was then carried out on the upper back of each patient with extracts prepared from the individual components of their TCM formulations. The preparation of patch test materials is described in Appendix S1. Results were evaluated according to ESCD guidelines on day (D) 2 and D3. 4 In patient 1, + and ++ reactions to dilution series of myrrh and the mixture containing myrrh were observed. Patient 2 had a ++ reaction to myrrh (Figure 1).Patch tests with myrrh extracts gave negative results in 10 healthy controls who had no history of allergic reactions. Provocation tests with orally administered myrrh, with a view to confirming the diagnosis of a myrrh-induced adverse drug reaction, were not performed.Thus, myrrh was identified as the ingredient to have most likely caused the observed skin reactions in the two patients. Neither patient could recall whether they had previously used TCMs containing myrrh.Their skin lesions improved on treatment with oral corticosteroids. The patients were advised to avoid TCMs containing myrrh in the future.Volatile oils, which are some of the main components of myrrh, serve as aromas that are also commonly used in daily consumer products, for example, toothpaste and perfume. Therefore, people who are hypersensitive to myrrh should also pay attention to ingredient specifications of such products.

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