Objectives: To describe a case of Allergic Connate Dermatitis (ACD) triggered by an allergen present in lettuce in a food handler, in whom the test with the fresh vegetable was relevant for diagnostic confirmation.
Introduction: Hand contact dermatitis is considered the most common occupational dermatosis, causing morbidity and functional impairment. The diversity of allergens in the workplace makes it difficult to determine the causative substrate, making the patch test (CT) essential for diagnosis. A 46-year-old man, a general services assistant in a fruit and vegetable store, with no history of previous allergies, reported blisters, exudation and itching on his hands for four months (Fig. 1A). Worsened when handling green vegetables. Treated with moisturizers, corticosteroids and antibiotics, without results.
Materials / method: A patch test was performed with a Latin American battery, which showed positivity for sesquiterpene lactones (SLs). Due to reports of worsening with the handling of leaves, CT was also applied to fresh vegetables (cilantro, chives, parsley, watercress, leaves and stems of American and curly lettuce) prepared with a drop of bidistilled water and applied to the skin under occlusion for 48 hours (Fig. 2A). The results were positive for both types of lettuce tested (Fig. 2B).
Results: The findings corroborated the diagnosis of ACD with an occupational link, with lettuce being the causal agent. The patient was taken off work for thirty days and medicated with emollient and topical corticosteroid, with the lesions resolving. He returned to work, but without direct exposure to vegetables and without recurrence of the condition (Fig. 1B).
Conclusion: ACD caused by lettuce is rarely reported in the literature, considering its high rate of consumption and cultivation. There is a possibility of cross-reactions with other plants of the Compositae family, including hygiene and dermocosmetic products that contain SLs in their formulation. It is important to emphasize that, in addition to the causative substrate, other mechanisms that trigger eczema must be identified in order to improve the functionality of patients affected by this condition.
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