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Brief Report
September 2018

Association Between Severe Acute Contact Dermatitis Due to Nigella sativa Oil and Epidermal Apoptosis

Author Affiliations
  • 1Dermatology Department, Assistance publique–Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
  • 2Pathology Department, Assistance publique–Hôpitaux de Paris, Henri Mondor Hospital, Créteil, France
  • 3National Center for Research, Mixed Research Unit 7177, University of Strasbourg, Strasbourg, France
  • 4University of Paris Est Créteil Val de Marne, Université Paris-Est Créteil, Créteil, France
  • 5Reference Center for Severe Cutaneous Adverse Reactions, Créteil, France
  • 6Equipe d'Accueil 7379, Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Créteil, France
JAMA Dermatol. 2018;154(9):1062-1065. doi:10.1001/jamadermatol.2018.2120
Key Points

Question  What are the histologic findings of severe acute contact dermatitis due to Nigella sativa oil?

Findings  This case series describes 3 patients who, after topical use of N sativa oil, displayed extensive lesions mimicking Stevens-Johnson syndrome or toxic epidermal necrolysis, bullous fixed drug eruption, and/or erythema multiforme and histologic features of epidermal apoptosis. Analysis of the N sativa oil showed thymoquinone and p-cymene to be major components; results of patch tests using the patients N sativa oil were positive.

Meaning  Acute contact dermatitis due to N sativa oil is severe, polymorphic, and histologically characterized by epidermal apoptosis.

Abstract

Importance  Nigella sativa oil (NSO) is widely used for cosmetic and culinary purposes. Cases of severe acute contact dermatitis due to NSO are poorly described, with no histologic description.

Objectives  To describe the clinical and histologic features of severe acute contact dermatitis due to NSO and investigate the components responsible for such eruptions.

Design, Setting, and Participants  A case series study of 3 patients with contact dermatitis admitted to the dermatology department between August 21, 2009, and February 19, 2017, was conducted. All patients had been referred to the dermatology department for acute contact dermatitis due to NSO and had patch tests performed.

Main Outcomes and Measures  Clinical and histologic features of the cutaneous eruptions, length of hospital stay, chemical analysis of NSO, and results of patch tests.

Results  Three patients (3 women; median age, 27 years [range, 20-47 years]) were included in the case series. All patients had polymorphic skin lesions spreading beyond the area of NSO application: typical and atypical targets, patches with central blisters, erythematous or purpuric plaques with a positive Nikolsky sign mimicking Stevens-Johnson syndrome, or toxic epidermal necrolysis. Two patients had pustules. They had severe impairment, with more than 15% skin detachment and fever. The results of skin biopsies showed epidermal apoptosis characterized by vacuolar alteration of the basal layer, keratinocyte apoptosis, and a moderate perivascular infiltrate of lymphocytes in the dermis. The results of patch tests using the patients’ NSO were all positive. The results of gas chromatography combined with mass spectrometry performed on the NSO of 1 patient identified several constituent substances, mainly terpenes, thymoquinone, linoleic acid, and fatty acids.

Conclusions and Relevance  These cases suggest that acute contact dermatitis due to NSO may induce topically triggered epidermal apoptosis, previously described as the concept of acute syndrome of apoptotic pan epidermolysis. Thymoquinone and p-cymene may be the main agents involved in the pathophysiologic characteristics of this acute contact dermatitis. Clinicians should be aware of such severe reactions to NSO and report these cases to pharmacovigilance authorities.

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