Shiitake dermatitis L30.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Flagellant dermatitis; shiitake dermatitis

History
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Nakamura, 1977

Definition
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Stripy dermatitis after consumption of the edible mushroom shiitake (Lentinus edodes). Auricularia auricula-judae, the Judas ear, a beta-glucan-containing saprophytic fungus of the class of agaricomycetes, can also cause analogous clinical symptoms.

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Occurrence/Epidemiology
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About 100 cases have been described worldwide, mostly in Japan. In Europe only very rarely occurring.

Etiopathogenesis
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Lentinan, a (thermolabile! water-soluble) polysaccharide from Lentinus edodes, which is also used in Japan for tumour therapy, is assumed to be the triggering agent. Dermatitides have also been described here. This is probably a toxic reaction. Apparently, more type IV reactions than type I reactions are detected. In mushroom growers with allergic contact dermatitis positive immediate reactions could be triggered in prick tests (Wagner G 2011).

Localization
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neck, trunk (see picture), extremities, rare face

Clinical features
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Hours after consumption of a dish containing shiitake, occurrence of flat, massively itching erythema, which is answered with violent scratching reactions. In the scratch marks, striped, parallel arranged, persistent erythema develop, which develop into correspondingly arranged papulo-vesicles. Skin symptoms persist for weeks. They heal without postimflammatory hyperpigmentation.

Histology
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Cancellous dermatitis with dense perivascular and interstitial lymphomonocytic infiltrates with eosinophilia in the upper and middle dermis.

Differential diagnosis
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Melanodermia factitia (skin changes caused by bleomycin)

External therapy
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Topical glucocorticoids, possibly under occlusion.

Internal therapy
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Systemic antihistamines such as desloratadine (Aerius) once/day 5 mg p.o. or levocetirizine (Xusal) once/day 5 mg p.o. In the case of highly acute courses, systemic glucocorticoids such as prednisolone (Decortin H) initially 100-150 mg/day p.o. for a short time, creeping out within one week.

Note(s)
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The shiitake mushroom is the second most common cultivated mushroom in the world, has a similar taste to the porcini and is used in fresh form, steamed or dried, especially in Asian cuisine. Its cap grows up to 20 cm wide and is brown-grey to brown in colour with pressed triangular scales. Its lamellae are white-brownish, the spores colourless.

Literature
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Haas N et al (2001) Shiitake dermatitis. Dermatologist 52: 132-135
Hiernickel C et al (2015) Shiitake dermatitis: an impressive case report. dermatologist 66: 455-456
Lang N (2016) Striated, whiplash erythema and succulent papules: Flagellate dermatitis after consumption of Auricularia auricula-judae. JDDG 14: 303-304
Nakamura T (1977) Toxicoderma caused by shiitake (Lentinus edodes) in Japan. Jpn Clin Dermatol 31: 65-68
Wagner G et al (2011) Shiitake dermatitis. Linear grouped erythema and papules on the upper trunk and décolleté. J Dtsch Dermatol Ges 9: 555-557.