Chewing-gum preservative induced toxidermic vasculitis

Area of Science:

• Dermatology
• Toxicology
• Immunology

Background:

• Cutaneous eruptions can manifest from various triggers, including dietary factors.
• Identifying the specific causative agent is crucial for effective patient management and treatment.
• The role of food additives in adverse skin reactions requires careful investigation.

Observation:

• A young female presented with a disseminated urticarial eruption.
• The patient reported recent regular consumption of chewing gum containing chlorophyllin (E140), menthol, and butylhydroxytoluene (BHT).
• Immunohistological examination of skin lesions indicated vasculitis.

Findings:

• The patient's skin eruption resolved within one week of discontinuing chewing gum consumption.
• Oral provocation tests confirmed butylhydroxytoluene (BHT) as the trigger for the cutaneous signs.
• The reaction was characterized by the reinduction of skin symptoms a few hours after BHT challenge.

Implications:

• This case highlights butylhydroxytoluene (BHT) as a potential allergen causing cutaneous vasculitis.
• It underscores the importance of considering food additives, like BHT, in the differential diagnosis of unexplained skin rashes.
• Clinicians should inquire about chewing gum and other product consumption when evaluating dermatological adverse reactions.