Flagellate Mushroom (Shiitake) Dermatitis and Photosensitivity

Abstract

Flagellate skin lesions occur in some patients after eating the mushroom Lentinus edodes, and they are called shiitake dermatitis in Japan. We describe a 44-year-old man with such skin lesions on his trunk after eating L. edodes, who developed as well photosensitive skin lesions on exposed areas. Skin phototesting with UVB did not show a decreased minimum erythema dose; UVA irradiation provoked an erythematous lesion with nonspecific histological changes. Analysis of the case histories of 94 Japanese patients with shiitake dermatitis revealed that 44 (47%) also developed dermatitis on the skin exposed to sunlight. UVA photodermatitis has not been emphasized in previous reports. The relationship to bleomycin flagellate dermatitis is discussed.

Flagellate dermatitis after consumption of Shiitake mushrooms

“…Chemically speaking, lentinan is a polysaccharide and supposedly has an immunomodulating and antiproliferative effect, for which reason it has been administered in Japan since 2000 as an adjuvant cancer therapy [7]. Moreover, lentinan induces the production of the inflammation-promoting signal substance IL-1 and has a vasodilatative effect [8–10]. However, the precise pathogenesis of Shiitake dermatitis is not yet completely understood.…”

Shiitake Dermatitis – Now Also in Poland

“…It is regarded as toxic reaction caused by lentinian, a thermolabile mushroom polysaccharide. Skin testing with shiitake mushroom extract (patch test, prick-test) or specific IgE levels are usually negative, but general IgE level may be sometimes elevated (1,7,8). Clinical picture and history of shiitake mushroom consumption are crucial for diagnosis.…”

“…Furthermore, the history, time course and clinical manifestation were very characteristic for shitake dermatitis, thus we did not perform this test. It is also postulated that lentinian may increase the secretion of interleukin-1, produce vasodilatation and petechiae (8). The predominance of T helper lymphocytes and time course of the reaction may also suggest haematogenous delayed type hypersensitivity as an underlying mechanism.…”

Shiitake-Dermatitis

“…Eine Lichtempfindlichkeit, wie sie Hanada bei 40% der in Japan aufgetretenen Fälle fand (dem Erstbeschreiber selbst war dieser Zusammenhang entgangen), lag bei unserem Patienten nicht vor [4]. Dieser nahm jedoch wegen eines arteriellen Hypertonus den ACE-Hemmer Captopril und den Sulfonamidabkömmling Hydrochlorothiazid ein.…”

“…Im engli-schen Schrifttum werden Termini wie "flagellate dermatitis" neben "flagellate" oder auch "flagellated erythema" benutzt [2,4]. Im engli-schen Schrifttum werden Termini wie "flagellate dermatitis" neben "flagellate" oder auch "flagellated erythema" benutzt [2,4].…”