Shiitake mushroom dermatitis

Shiitake mushroom dermatitis 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]

Shiitake mushroom dermatitis
Other namesFlagellate mushroom dermatitis,[1] Mushroom worker's disease,[1] and Shiitake-induced toxicoderma[1]
Symptoms on back and leg. Stripes appear when skin is scratched or spontaneously in friction or contact zones.
SpecialtyDermatology

See also

References
  1. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  2. Nakamura, T (1992). "Shiitake (Lentinus edodes) dermatitis". Contact Dermatitis. 27 (2): 65–70. doi:10.1111/j.1600-0536.1992.tb05211.x. PMID 1395630.
  3. 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. 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. 52 (6): 625–628. doi:10.3109/15563650.2014.923905. PMID 24940644.


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