Gardenia Fruit–Related Blue-Gray Skin Pigmentation

Abstract

patient reported 75% improvement in her rating of overall disease severity and its effect on functioning (Figure, B). Her affected BSA was reduced by 50%, and she was able to travel, which she previously could not. After 18 months of treatment, the patient continued to take dupilumab biweekly with continued improvement.Discussion | Netherton syndrome is caused by a mutation in the SPINK5 (serine protease inhibitor Kazal-type 5) gene, which encodes LEKTI (lymphoepithelial Kazal-type-related inhibitor), a serine protease inhibitor. 2 In the epidermis, LEKTI deficiency causes uncontrolled proteolysis, loss of skin barrier function, and overproduction of pro-Th2 cytokines. 1,3 Treatment may include topical emollients, glucocorticoids, calcipotriol, narrowband UV-B phototherapy, psoralen-UV-A photochemotherapy, and retinoids, with variable effectiveness. 1 Topical therapies are limited by their potential for systemic absorption.Biologics offer a targeted treatment approach for NS. 2,4 Dupilumab, a monoclonal antibody to the α chain of the IL-4 receptor, blocks the biologic effects of IL-4 and IL-13. Its notable results in the treatment of atopic dermatitis may be linked to its action on pro-Th2 cytokines. 5 The significant atopic diathesis and Th2 cytokine profile of NS may explain the improvement we observed in this condition with dupilumab. Studies are warranted to support the efficacy and safety profile of dupilumab in patients with NS.

Case of hyperpigmentation associated with the use of Morinda citrifolia (noni)

“…Previously reported hyperpigmentation caused by G. jasminoides showed similar histopathological features, with increased melanin and melanophages; however, the presence of liquid degeneration was unknown. 4 Considering the above-mentioned mechanism of action of G. jasminoide, a similar species containing iridoid, in our case, hyperpigmentation owing to excessive noni intake was more strongly considered.…”

“…Previously reported hyperpigmentation caused by G . jasminoides showed similar histopathological features, with increased melanin and melanophages; however, the presence of liquid degeneration was unknown 4 . Considering the above‐mentioned mechanism of action of G .…”

“…Noni comprises iridoids, alkaloids, anthraquinone, and potassium 2 . Although no report of skin lesions associated with noni exists, few cases with similar pigmentation have been associated with Gardenia jasminoides (Sanshishi) intake, a member of the same Rubiaceae family 3,4 . Geniposide, a type of iridoid and main ingredient of G .…”

“…3,4 Geniposide, a type of iridoid and main ingredient of G. jasminoide,causesmesenteric phlebosclerosis, which is characterized by bronze F I G U R E 1 Clinical and histological examination. (A) Clinical findings at the time of the first visit to our hospital.…”