Irritant Contact Dermatitis from Plants

Gunjan M. Modi; Christy B. Doherty; Rajani Katta; Ida F. Orengo

Disclosures

Dermatitis. 2009;20(2):63-78. 

In This Article

Treatment and Prevention

Treatment

Most of the conventional treatments used for general ICD are applicable to plant-induced ICD. In the setting of acute ICD, topical corticosteroids remain the mainstay of treatment.[65] Cool compresses made with Burow's solution (aluminum acetate in water), saline, or water have been shown to reduce vesiculation associated with acute ICD and are also thought to reduce inflammation.[66] Steroid-sparing agents such as tacrolimus may also be beneficial by virtue of suppressing the immune response and may be safer to use on areas where more potent topical steroids are contraindicated (eg, the face and genitals).[67]

If the irritation is milder or subacute, lipid-rich moisturizers and barrier creams may be successful in treatment, possibly by helping restore barrier function to irritated skin and by increasing hydration.[68,69] There is also evidence suggesting that topical skin lipid mixtures containing ceramide-3 can be effective for ICD.[70]

Recent animal studies show success in the treatment of ICD with topically applied peroxisome proliferator activated receptor-a agonists (such as clofibrate or linoleic acid).[71]

If the irritation is more chronic, moisturizers, topical steroids, and steroid-sparing agents may be effective for treatment. Chronic ICD has also been successfully treated with psoralen plus ultraviolet A and ultraviolet B light therapy, both of which reduce immune function and the inflammatory response.[67]

If the dermatitis was caused specifically by calcium oxalate raphides, the symptoms may improve simply by aggressively irrigating the affected area to remove the crystals. The benefit of soap and water is equivocal in such instances.[4] The severity of the dermatitis will dictate the aggressiveness of treatment. In severe cases of CICD caused by Dieffenbachia contact or consumption of an irritant, therapy with intravenous steroids, antacid mouthwash, and opioid analgesics may be necessary.[9]

Glochids, trichomes, and spines will often continue to cause irritation as long as they are embedded in the skin. Treatment therefore involves their removal from the skin. In one controlled study evaluating the removal of Opuntia ficus-indica glochids from rabbits, 95% of the implanted glochids were removed in large clumps with forceps, followed by the use of glue and gauze (the gauze was pulled off the skin after the glue dried).[72]

As secondary infections have been associated with plant-based mechanical irritants, therapy also includes educating the patient on the need to monitor the area. Topical antibiotics are sometimes used as well.

Irritation to chili peppers is common among food workers and during household exposures, and home remedies include immersion in oils or cool tap water. In one study of elderly Hispanic women, cool tap water immersion provided some initial relief, but 75 minutes of immersion in vegetable oil (which binds to hydrophobic capsaicin) provided better long-term relief.[73]

Prevention

The most important principle in the prevention of ICD is the avoidance of irritants. In the workplace, a good ventilation system and regular vacuum cleaning are important for the prevention of flower bulb dermatoses among florists and other plant workers.[4] Gloves are similarly important as they may prevent initial contact with the irritant plant. Frequent application of barrier creams and moisturizers may help in the maintenance or replenishment of the skin barrier, which may prevent or delay irritation.[74] Berndt and colleagues found that the actual type of cream used was much less important than the frequency and regularity of application in order to prevent ICD.[74] Similarly, Loffler and Effendy found that education (such as training in the correct application of cream, and knowledge of irritants in the workplace) was the most important measure in the prevention of ICD.[75] For those who handle plants in the setting of food preparation and production, the application of natural vegetable fats of high linoleic acid content (eg, palm plant fats) to the hands prior to the handling of irritant plants has shown significant protective potential.[76]

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