Shiitake mushroom dermatitis

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Shiitake mushroom dermatitis (also known as "Flagellate mushroom dermatitis,"[1] "Mushroom worker's disease,"[1] and "Shiitake-induced toxicoderma"[1]) is an intensely pruritic dermatitis characterized by disseminated 1mm erythematous micropapules seen in a linear grouped arrangement secondary to Koebnerization due to patient scratching.[1] It is caused by the ingestion of shiitake mushrooms and was first described in 1977 by Nakamura.[2] Although it is rarely seen outside of China and Japan due to a lower incidence of shiitake consumption outside these regions, there is a well-established association between flagellate dermatitis and shiitake mushroom (Lentinula edodes) ingestion. Bleomycin ingestion may also cause similar findings. On physical exam, one key difference between the two is that post-inflammatory hyperpigmentation changes are usually seen with bleomycin-induced flagellate dermatitis and are not typically present with shiitake mushroom induced flagellate dermatitis.[3] The median time of onset from ingestion of shiitake mushrooms is typically 24 hours, ranging from 12 hours to 5 days. Most patients completely recover by 3 weeks, with or without treatment.[4] Although the pathogenesis of shiitake induced flagellate dermatitis is not clear, the theory most argued for is a toxic reaction to lentinan, a polysaccharide isolated from shiitake mushrooms.[2] However, Type I and Type IV allergic hypersensitivities have also been supported by the 24 hour median time of onset, clearance in 3-21 days, severe pruritus, benefit of steroids and antihistamines, and lack of grouped outbreaks in people exposed to shared meals containing shiitake mushrooms. [2],[4] Most cases reported shortly after its discovery were due to consumption of raw shiitake mushrooms, but several cases have since been reported after consumption of fully cooked mushrooms.[3]

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  1. ^ a b c d Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0. 
  2. ^ a b c Nakamura, T (1992). "Shiitake (Lentinus edodes) dermatitis". Contact Dermatitis 27 (2): 65–70. PMID 1395630. Retrieved August 18, 2015. 
  3. ^ a b Chu, EY; Anand, D; Dawn, A; Elenitsas, R; Adler, DJ (2013). "Shiitake dermatitis: a report of 3 cases and review of the literature". Cutis 91 (6): 287–290. PMID 23837150. 
  4. ^ a b Boels, D; Landreau, A; Bruneau, C; et al. (2014). "Shiitake dermatitis recorded by French Poison Control Centers - new case series with clinical observations". Clin Toxicol (Phila) 52 (6): 625–628. PMID 24940644.