VIGNETTE IN CONTACT DERMATOLOGY Occupational contact dermatitis to hydrangea Marius Rademaker Dermatology Department, Waikato Hospital, Hamilton, New Zealand SUMMARY Two female commercial hydrangea growers, from separate nurseries, presented with similar hand and facial dermatitis. Both had a hand dermatitis affecting particularly the first three fingers and backs of both hands and complained of a recurrent facial dermatitis affecting the forehead, around both the eyes and bridge of nose. They related their dermatitis to their work. Patch tests confirmed allergy to all components of hydrangeas including petal, leaf and stem. Avoidance resulted in resolution of their dermatoses. Allergy to hydrangeas has been reported previously although infrequently. Key words: allergic contact dermatitis, Hydrangea macrophylla, phytodermatitis. INTRODUCTION Phytodermatitis is well recognized in Australia and New Zealand. With increasing ease of international transport, new plant cultivars are beginning to be grown commercially in Australasia. Two cases of occupationally acquired phyto- dermatitis from hydrangea are reported. Case 1 A 35-year-old commercial hydrangea grower presented with a 2-year history of a hand dermatitis. This affected initially the tips of the thumb, index and middle fingers but then spread to affect all of the fingers and the backs of both hands. Over time the rash spread to involve the forehead and cheeks of the face. She had worked as a commercial hydrangea grower for 7 years, initially as a picker and then as a packer. The rashes would clear in the off-season and when she went on holiday. In New Zealand, hydrangeas are planted in June and July (winter) and harvested in December to April (summer). Gloves did not seem to help greatly. No pesticides or fungicides were used. She was patch tested using IQ chambers (Chemotechnique Diagnostics, Malmo, Sweden) with readings at 48 and 96 hours, using the International Contact Dermatitis Research Group (ICDRG) criteria. She had a modified standard series applied (Chemotechnique Diagnostics) as well as specific series of agricultural pesti- cides (Trolab, Reinbeck, Germany), plants and woods, and tars and balsams. Components of her hydrangeas (stem, flower/petals, and leaf) were tested as is (1 cm 2 slithers of plant), as well as the petals prepared in water and olive oil (minced petals vigorously shaken in water or olive oil for 5 min, the liquid then applied onto an IQ chamber). She had a 1+ reaction at 48 hours and 2+ reaction at 96 hours to the petal (as is, in water, and in olive oil), leaf and stem of her hydrangea. In addition she had an equivocal reaction to thiram (48 and 96 hours), and a 1+ reaction to manganese ethylene bis-dithiocarbamate (Maneb) at 96 hours (equivocal at 48 hours). Treatment included hand care, polyvinyl gloves, several potent and super-potent topical corticosteroids, and topical hand PUVA (photochemotherapy). This resulted in only modest improvement. It was only when she avoided all contact with hydrangea (by switching to office work) that her dermatitis settled. Case 2 A 48-year-old commercial hydrangea grower presented with a 12-month history of a dermatitis affecting her fingers and backs of hands. In addition she had a recurrent dermatitis of the face (forehead, around the eyes and nose). She had been a commercial hydrangea grower for 3 years, previously having grown orchids commercially for 6 years. No pesti- cides were used although they occasionally used an organic mixture of garlic and paraffin oil. The hydrangeas were grown for the cut-flower trade. The rash would appear within 1–2 days of contact with hydrangeas. She had no problems in the off-season. She was patch tested as the previous case, with a 1+ reaction at 48 hours and 2+ reaction at 96 hours to leaf, inner stem and outer stem. She also had a 1+ reaction to nickel (48 and 96 hours), an equivocal reaction to ethylenediamine (signifi- cance unclear) and a 1+ reaction to colophony (historical reaction to Elastoplast). Correspondence: Assoc. Prof. Marius Rademaker, Dermatology Department, Waikato Hospital, Hamilton, New Zealand. Email: rademaker@xtra.co.nz. Marius Rademaker, FRACP. Manuscripts for this section should be submitted to Assoc. Prof. M Rademaker. Submitted 5 February 2003; accepted 27 March 2003. Australasian Journal of Dermatology (2003) 44, 220–221