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Euphorbia myrsinites Sap-Induced Phytodermatitis

A Prototype of Irritant Contact Dermatitis?

Weber, Benedikt, MD, PhD; Sinz, Christoph, MD; Bauer, Wolfgang M., MD; Kancz, Stefanie, Msc; Kittler, Harald, MD; Kinaciyan, Tamar, MD; Handisurya, Alessandra, MD

doi: 10.1097/DER.0000000000000454

Background A hallmark of Euphorbia myrsinites (EM), a member of the widespread perennial Euphorbia species, is the extrusion of a poisonous, latex-like sap irritant to the skin and eye after contact. The exact mechanisms underlying these effects have not been unraveled so far.

Objectives The aims of the study were to allocate EM sap–induced phytodermatitis to irritant or allergic contact dermatitis (ACD) and to investigate mechanism(s) causing keratinocyte damage.

Methods Cutaneous effects of EM sap on healthy human skin were investigated by clinical scoring and reflectance confocal microscopy analyses and compared with ACD. In addition, the effects of sap exposure to keratinocytes were analyzed in vitro using histological analyses and flow cytometry.

Conclusions We report on 2 cases of EM sap–induced phytodermatitis. Patch testing with fresh EM sap induced dermatitis in 100% of the tested sites with a clinical course following a decrescendo pattern. Compared with ACD, the lesional phenotype was more severe and epidermal disruption was more pronounced. Exposure of human skin tissues and cultivated keratinocytes to EM sap in vitro resulted in a dose-dependent increase in keratinocyte apoptosis. The reported findings support the primarily toxic irritant nature of EM sap–induced phytodermatitis. The contribution of ingenol mebutate to (nontoxic) proinflammatory effects remains to be elucidated.

From the Department of Dermatology, Medical University of Vienna, Austria.

Address reprint requests to Alessandra Handisurya, MD, Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. E-mail:

This study was supported by Austrian Science Fund (FWF), Austria (grant numbers P29619-B30 and P-30615-B30).

The authors have no conflicts of interest to declare.

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© 2019 American Contact Dermatitis Society
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