milii-related ICD has not been described before, it may induce keratoconjunctivitis causing burning pain, photophobia, lacrimation, and even decreased visual acuity. 4 Although one study testing sap or herb extracts from 60 different species in the Euphorbia genus on mice ears for the irritant effects concluded that 7 species including E. milii failed to produce irritation, the phorbol esters (one of the contents in croton oil), milliamines, euphorbol, and euphorbin in the sap were actually irritants to human skin. 1,5 Weber et al 3 suggested that Euphorbia sap-induced dermatitis is the result of a complex of cytopathogenic and proinflammatory effects. The direct pH-induced cytotoxicity of phorbol esters may induce corrosive effect leading to keratinocytes necrosis, whereas ingenol mebutate may cause recruitment of immune cells and augment the irritant reaction. 3 This report highlights the first case of ICD caused by E. milii with an atypical presentation as purpuric patches and provides an explanation of possible underlying pathophysiologic mechanisms.
ZEBRAThe sap of E. milii is a potential source of ICD, and protective measures are necessary during handling these ornamental plants.
ACKNOWLEDGMENTThe patient in this article has given written informed consent to publication of case details.