Sebotropic eruption associated with use of oral kava kava supplement

Kava-induced dermatitis: A detailed histopathological analysis

Kava induced dermatitis has been reported in previous case series, however the histology has rarely been described. This case report details an erythematous eruption associated with Kava ingestion and the associated folliculocentric sebaceous inflammation found on histological analysis.

Case reports and narrative fallacies: the enigma of black swans in dermatology

Narrative fallacy is a problematic heuristic that leads us to make inaccurate cause-effect relationships. They are a particular issue in case reports because of the limited scope of these papers, the perpetuated biases they proffer and the misperception of 'black swan' events. This article highlights the negative effects of these fallacies in dermatological practice through three case studies: the use of epinephrine with lignocaine at distal sites, the difference between once-daily and twice-daily application of topical steroids, and the effect of sterile gloves for skin surgery on infection rates. Awareness of the biases in case reports and the employment of metacognition may help us to avoid falling victim to narrative fallacies. Given the potential problems with this heuristic, Clinical and Experimental Dermatology (CED) utilizes case reports to further medical education and offer different clinical perspectives, rather than as a driver of medical knowledge.

[Sebotropic drug eruption after ingestion of bee pollen]

INTRODUCTION

The medical literature contains five cases of exanthema with sebaceous tropism induced by consumption of kava-kava extract filed under the name of sebotropic drug reaction. Herein we report a new case following consumption of bee pollen.

PATIENTS AND METHODS

A 37-year-old man consulted for erythemato-papular and fixed plaques of the face, upper trunk and shoulders present for 3 days. Standard blood tests were normal except for neutrophil leukocytosis at 9.8 G/l and eosinophilia at 1.4 G/l. Cutaneous biopsy of a facial plaque revealed folliculocentric lesions with necrosis of sebocytes in the sebaceous gland, associated with an eosinophil-rich infiltrate. The patient had begun consuming bee-pollen granules 3 weeks before the onset of symptoms. The rash regressed within 3 weeks of cessation of pollen consumption. Patch tests (ICDRG battery, propolis 1% Vaseline dilution and bee pollen provided by the patient, both pure and in a 30% dilution in Vaseline) were negative at 48 and 72h.

DISCUSSION

The clinical-pathological correlation was consistent with a diagnosis of sebotropic drug reaction induced by the consumption of bee pollen. The diagnosis was based on papular exanthema of the seborrheic zones occurring 2 to 3 weeks after initial intake of the offending substance, with histological evidence of inflammatory necrosis of the sebaceous glands.

CONCLUSION

We report what is to our knowledge the first case of sebotropic drug reaction following ingestion of bee pollen.

Contemporary Pacific and Western perspectives on `awa (Piper methysticum) toxicology

In 2010, a National Science Foundation project in Hawai`i assembled a collaboration of Pacific indigenous scientists, Hawaiian cultural practitioners and scientists trained in Western pharmacology. The objective of the collaborative project was to study Kava, a culturally significant Pacific beverage, and to address and ultimately transcend, long-standing barriers to communication and collaboration between these groups. Kava is a product of the `awa plant (Piper methysticum) that has been used ceremonially and medicinally throughout the history of Pacific Island cultures, and is now in widespread recreational and nutraceutical use in the US. This project, culminating in 2015, has enriched the participants, led to published work that integrates cultural and Western pharmacologic perspectives and established a paradigm for collaboration. This review paper integrates cultural and Western perspectives on efficacy, toxicity and the future cultural and commercial significance of `awa in the Pacific. Here we present a detailed review of traditional and non-traditional kava usage, medicinal efficacy and potential toxicological concerns. Recent mechanistic data on physiological action and potential pathological reactions are evaluated and interpreted.