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Images/Instrument in Dermatology/Dermatosurgery
2022
:2;
80
doi:
10.25259/CSDM_86_2022

Prurigo nodularis-like pattern of Parthenium dermatitis

Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Corresponding author: Rojita Akham, Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. rojitaakham2512@gmail.com
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Akham R, Khuraijam S. Prurigo nodularis-like pattern of Parthenium dermatitis. CosmoDerma 2022;2:80.

A 34-year-old female presented with generalized, intensely pruritic papules and nodules of 20 years duration, with a history of exacerbation in the past 5 years. Detailed history revealed exposure to the Parthenium plant and personal history of atopy. Cutaneous examination revealed multiple papules and nodules over the dorsa of hands, extensors of the upper and lower extremities, and abdomen [Figure 1a and b]. The diagnoses of prurigo nodularis, prurigo nodularis-like pattern of Parthenium dermatitis, and hypertrophic lichen planus were kept in the differential.

Figure 1:: (a and b) Prurigo-like nodules on upper and lower extremities. (c) Patch test (Indian Standard Series) reading, 3+ at day 3. (d) Histopathology (H&E stain, ×40) showing compact hyperkeratosis, parakeratosis, and mild spongiosis with perivascular lymphocytic infiltrate.

Patch test done with an Indian Standard Series showed a blister formation over an erythematous base to the Parthenium allergen (15% extract in petrolatum) on day 3 [Figure 1c] and an erythematous indurated plaque with a central hemorrhagic crust on day 5.

Skin biopsy revealed compact hyperkeratosis, parakeratosis, mild spongiosis, irregular acanthosis, and patchy perivascular dermal lymphocytic infiltrate which are consistent with chronic dermatitis [Figure 1d]. A diagnosis of prurigo nodularis-like pattern of Parthenium dermatitis was made. The patient was started on oral azathioprine 100 mg daily, antihistamines, and topical steroids and responded favorably. She was counseled to avoid exposure to the Parthenium plant and to use physical protection measures.

Parthenium dermatitis accounts for 40% of patients attending contact dermatitis clinics and is the most common cause of plant dermatitis in India.[1] This allergic contact dermatitis has a trend of changing its clinical pattern over time. The common presentations of Parthenium dermatitis include airborne contact dermatitis pattern, chronic actinic dermatitis, mixed pattern, exfoliative, and widespread dermatitis.[1] Prurigo nodularis-like Parthenium dermatitis is often difficult to diagnose due to sparing of typical sites of airborne contact dermatitis. Patch testing with plant allergen is a useful scientific diagnostic tool that unravels the causative allergen. The plant allergen can be extracted in different solvents, including water, acetone, alcohol, ether, acid, and alkali, and then used for patch testing. Parts of fresh, frozen, and dried plants can also be used for patch testing, but this carries a significant risk of false-positive irritant reactions and occasionally a risk of test sensitization.[1] We hereby stress the importance of detailed history and patch test while investigating atypical manifestations of any suspected allergic contact dermatitis, for example, in this case, a prurigo nodularis-like pattern of Parthenium dermatitis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , . Parthenium dermatitis in India: Past, present and future. Indian J Dermatol Venereol Leprol. 2012;78:560-8.
    [CrossRef] [PubMed] [Google Scholar]

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