title: Surgery for a tree surgeon? Acute presentation of contact dermatitis due to Ailanthus altissima.
abstract: A tree surgeon presented to hospital with multiple blackening, non-blanching regions of skin on both forearms, following exposure to sap from the 'tree of heaven' (Ailanthus altissima). A referral to plastic surgery was made to consider debridement. Following input from the national poisons centre and dermatology, conservative management with emollient was undertaken. The lesions blistered and exfoliated and were treated with topical steroid and oral antihistamines. Resolving erythema was the only symptom at three weeks. A. altissima, also known as the 'tree of heaven' has known toxins in its bark, leaves and flowers but is also commonly used in folk medicine. Two previous cases of contact dermatitis are reported in the literature but not with acute photo documentation of the lesions or with surgical referral. This demonstrates an important lesson that debridement would not be the appropriate management despite the initial presentation.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Derriford Hospital, Derriford Road, Crownhill, Plymouth PL6 8DH, United Kingdom. warben@gmail.com
authors.forename: Warren O
authors.initials: WO
authors.lastname: Bennett
authors.forename: James T
authors.initials: JT
authors.lastname: Paget
authors.forename: Duncan
authors.initials: D
authors.lastname: Mackenzie
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D032268:Ailanthus / Q000009:adverse effects*; D003646:Debridement / Q000379:methods; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D016468:Forestry; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D016273:Occupational Exposure / Q000009:adverse effects*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000305:Adrenal Cortex Hormones; D006633:Histamine Antagonists