Allergic Contact Dermatitis (ACD) Presenting as Cellulitis an Unusual Presentation Secondary to Marking Nut (Semecarpus anacardium) Application: A Case Report

Background: Semecarpus anacardium also known as marking nut has unsung medical properties. It has been claimed as half physician in Ayurveda. The folklore claims states that Semecarpus anacardium possess medicinal properties like anti carcinogenic, anti-inflammatory, antioxidant, hypoglycemic, antimicrobial and contraceptive properties. In contrary to its biological potentials it has an adverse reaction like contact dermatitis. Case Description: In this report, we present a 36 year old male who was admitted in the hospital with the signs and symptoms of cellulitis and treated in line of same without any improvement. After careful history taking patient revealed history of application of marking nut to the fissure feet day prior to development of symptom complex, which changed the line of management towards treatment of allergic contact dermatitis (ACD). Literature Review: Despite of many significant uses of marking nut there are some adverse reactions like contact dermatitis have been reported. This is due to the presence of a chemical constituent urushiol. Urushiols are oxidized in-vivo generating a quinone form of the molecule which induces delayed type hypersensitivity leading to symptoms such as itching, inflammation, oozing and burning sensation. They act as haptens changing the shape of integral membrane proteins on exposed skin cells. Allergic contact dermatitis is a severe condition that can be caused by the various phytoconstituents and their derivatives. Hence the people should be vigilant and acquire knowledge when they were subjected to the treatment of indigenous system of medicine. Clinical Relevance: Although allergic contact dermatitis secondary to marking nut is known entity, clinical presentation is variable and can be misleading at times to reach final diagnosis.