ARTICLE
Auteur(s) : Semsettin
Karaca1, Mustafa Kulac1, Hudaverdi
Kucuker2
1Department of Dermatology, School of Medicine, Afyon
Kocatepe University, Afyon, TurkeyFax: (+ 90) 272 217 20 29.
2Department of Forensic Medicine, School of Medicine,
Afyon Kocatepe University, Afyon,Turkey
accepté le 26 Octobre 2004
An increasing enthusiasm for “alternative” remedies and “natural”
cosmetics has led to an explosion of plant-derived materials used
in healthcare and beauty products. The dermatitis caused by plants
may have variable appearances. Therefore, a careful history must be
taken to establish the likely source of exposure and also the type
of adverse reaction, that is, phototoxic, irritant, immediate or
delayed hypersensitivity [1].Here, we present phytodermatitis case
caused by using a plant called Ceratocephalus falcatus, used for
relieving knee pain. Ceratocephalus falcatus has laxative
properties and has been used for treating hemorrhoids, rheumatismal
diseases and wounds (( figure 1 )) [2].
Ceratocephalus falcatus is a member of Ranunculacea family and
grows in certain regions of Afyon city such as Sinanpasa and Dinar
regions in Turkey [3, 4].
Case report
A 47-year-old woman was referred to the dermatology clinic for wide
bullae on her right limb which had a burning sensation. As for her
history, she had bruised a plant and applied it on her right knee,
covered with a cloth for 25 min. in order to lessen pain.
After applying this remedy, she had felt burning and tingling
sensations. This had resulted in erythema and subsequently, wide
bulla formation. The patient denied a history of previously
applying another cream or plant on the lesion site. There was no
history of sun exposure on the lesion site.
On examination, there were partially drained, large, slack
bullae surrounded by discrete erythema on the medial aspect of her
right knee (( figure
2 )). The patient’s complaints were started within minutes
of applying the plant and the lesion was limited to the applied
area. So we considered the diagnosis “irritant phytodermatitis”. To
make the diagnosis definite, we suggested the patient apply the
suspicious plant again. But the patient did not accept. Because of
the clear history and ethical responsibility, we did not apply the
plant again.
Treatment was with topical application of mometasone fruate
cream and wet dressing. Her lesion began to recover in 3-4 days.
After ten days complete healing was obtained with marked
hyperpigmentation on the lesion site. The plant sample was
identified as ceratocephalus falcatus by botanic department of the
university.
Discussion
Raunculacea are known to contain the skin-irritating,
blister-causing compound, protoanemonin, in their fresh state [5].
Protoanemonin is a volatile and highly irritant oil, which inhibits
mitosis in plants. In contact with the skin, it produces
subepidermal disjunction and bulla formation by disrupting sulfur
bridges. Protoanemonin polymerizes rapidly to anemonin, its
harmless crystal form. Dried and boiled plants contain no
protoanemonin [6].
Ranunculus may have both antimutagen and antitumor activity [7].
The effect of Ranunculus in vitro may be due to inhibition of DNA
polymerase and increase of oxygen free radicals [8]. The
pharmacological properties of the genus Ranunculus have been
largely attributed to the presence of γ-lactones; protoanemonin,
for example, has been shown to be fungicidal [9], antimicrobial
[10]. For its part, anemonin is a known antipyretic which, along
with protoanemonin, plays a major role in the sedating effect of
this species [11].
Protoanemonin in the ranunculus species is almost certainly the
active principle involved in many of these medicinal applications.
A majority involved the use of the plants as external poultices for
boils, cuts, abrasions and other skin sores [5].
There is scanty dermatological data about phytodermatitis caused
by Ranunculus [6], there is no data about phytodermatitis by
ceratocephalus falcatus. To our knowledge, this is the first case
report caused by Ceratocephalus falcatus. This species should be
kept in mind in phytodermatitis cases that present bullous and/or
vesicular lesions.
References
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2002; 6-3: 148-57.
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