Primrose dermatitis - Altmeyers Encyclopedia

Synonym(s)

Primrose disease

Definition
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Acute allergic contact eczema due to primrose contact mainly on the face, hands, but also on the whole integument and even on the oral mucosa is possible.

Occurrence/Epidemiology
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Women are preferentially affected. Occupational primrose allergy in florists and gardeners is still reported in individual cases.

The sensitization rates in different collectives were between 0. The sensitization rates were between 0.3 - 1.0% in different collectives when Primin was routinely tested. In a Danish study from 1984 to 1989, the sensitization rate was 1.8% (57 of 3075).

In a larger (Italian) collective of patients with potential contact sensitization (n=24,000), Bongiorni L et al. (2015) were able to demonstrate a primin sensitization rate of 1.9%, with women being sensitized more frequently (2.6%) than men (0.5%). In certain areas of Italy (Pordonne), even higher rates of sebisbilization (up to 6%) were detected.

Cross-reactions with structurally similar quinones found in other plants or wood species, e.g. Dalbergia species, teak woods, teak (Tectona grandis) or Pao ferro (Macherium skleroxylon), primroses (Primula veris), tansy, bee pasture, East Indian rosewood (Dalbergia latifolia), ornamental orchids, alkyl quinone-containing bath sponges, Primin-containing sea urchins, stone urchins are possible, but are rarely observed.

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Etiopathogenesis
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Primin is one of the strongest known allergens. It was therefore often used as a model substance for studying allergic reactions in humans. Sensitization is achieved by contact with the glandular hair secretion of Primula obonica (poison primrose, cup primrose). The allergenic effect depends on the content of primine.

Remark: The medically used primula species contain almost no primin (see below primrose = primula veris).

Therapy
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Avoidance of the allergen (remove primroses from the home), stage-appropriate treatment of eczema, corresponding to the allergic contact eczema.

Note(s)
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The epicutaneous test is recommended with synthetic primin in vaseline at a concentration of 0.01%.

Literature
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Bongiorni L et al. (2015) Primin sensitization in north-eastern Italy: a temporal trend from 1996 to 2012. Contact Dermatitis 73:108-112.
Hervella-Garcés M et al. (2016) en representación del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea (GEIDAC).The Spanish standard patch test series: 2016 update by the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC). Actas Dermosifiliogr 107:559-566.
Zachariae C et al. (2007) Primin in the European standard patch test series for 20 years. Contact Dermatitis 56:344-346
Montag A (2023) Plants and skin. Springer-Verlag GmbH. pp. 817-820, https://doi.org/10.1007/978-3-662-63014-3_7