CD22 Spice dermatitis: an unusual occupational hazard

Abstract

A 63-year-old woman presented with a 2.5-year history of recurrent facial erythema, with episodes affecting the eyelids, neck, chest and flexural aspects of the arms. The erythema was associated with pruritus, burning and tightness, with subsequent desquamation. The rash was relieved with the use of topical corticosteroids. She worked in food packing for a local company and regularly handled herbs and spices. Our patient had wondered whether turmeric was the causative agent for the rash as she had noticed a possible relationship between exposure and flares. Prior to her appointment, she had taken precautions to avoid turmeric, and her symptoms had improved as a result. She had also stopped eating food products containing turmeric but reported no oral or systemic symptoms, suggesting immediate IgE-mediated reaction. She was patch tested to the British Society for Cutaneous Allergy standard series, cosmetics series, baker series and diluted ground turmeric 2% in petrolatum. She had a strong positive reaction to turmeric. All other patch test results were negative. Turmeric (Curcuma longa) belongs to the ginger family, Zingiberaceae. It is a rhizome that is frequently used in South Asian and Middle Eastern cuisine. It has long been used in traditional medicine as an anti-inflammatory agent and more recently in health products and the wellness industry. Much of the literature on contact dermatitis to turmeric originates from Southern India, where its topical application has important cultural and religious significance. It is custom among certain communities to apply kumkum – a mixture of turmeric and slake lime – as ‘bindi’ between the eyebrows or ‘sindoor’ along the hair parting. It is also used to dye the thread on mangalsutra, a nuptial string to signify marriage. This case highlights the importance of identifying an uncommon airborne allergen as a cause of occupational dermatitis.