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Occupational nail diseases
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
Deepika Pandhi, Vandana Kataria
A heightened suspicion of allergic contact dermatitis (ACD) should be maintained for nail patients whose condition is not responding to appropriate treatment. Allergens and/or irritants may find their way through nail plate or periungual skin leading to contact dermatitis. For example, Alstroemeria dermatitis can result in onycholysis, in addition to dermatitis of the thumbs and index fingers.9 Similar changes can also be seen with Hydrangea, Tabernaemontana coronaria, and “Tulip fingers.” “Tulip fingers” is a painful, dry, fissured, hyperkeratotic eczema caused by contact with tulip bulbs and is seen in gardeners and bulb growers10 with a history of contact with Narcissus sap. This irritant sap, as well as many other irritants such as hyacinth dust and pesticides, seemed to be responsible for many nail complaints.10 It starts beneath the free margin of the nails and extends to the fingertips and periungual regions. Suppurative granulating erosions may be seen on the fingertips in long-standing cases. The highest concentration of the allergen, α-methylene-γ-butyrolactone, is to be found in the outermost cell layers of the inner bulbscales.6 Common sensitizers of plant origin have been summarized in Box 21.3.
Tulip Finger
Published in Clinical Toxicology, 2018
Muhammad Masood Khalid, Michael I. Greenberg
Tulip finger is a common occupational problem among florists attributed to an allergic contact dermatitis reaction to tuliposide A. Tuliposide A, a glycoside of tulipalin A, is found in the epidermis of the flower bulb [1]. The concentration of the allergen, tulipalin A is primarily found in the bulbs, stem, leaves, and petals in descending order [2]. Tulip finger typically presents as a scaling, dry, fissured, and erythematous plaque on the fingertips of the dominant hand. It may spread to neck, face, arms, and even to ano-genital region [3]. While type IV contact dermatitis is the most common presentation, type I reactions may occur. Dermatitis usually occurs after collection, peeling, and packaging of the bulbs. While wearing gloves during work may provide some protection, the cornerstone of treatment lies in strict avoidance of the allergen and providing patients a list of plants that may contain the allergen. This clinical entity should be considered in florists, who develop hand dermatitis.