Reflectance Confocal Microscopy as a Diagnostic Aid in Allergic Contact Dermatitis to Mango Sap

The mango tree (Mangifera indica) produces nutrient-dense fruit that is consumed across the world. Interestingly, despite widespread consumption of its fruit and its categorization in the Anacardiaceae family, allergic reactions to the mango tree and its components are comparatively rare, sometimes manifesting as allergic contact dermatitis (ACD). Evaluation of ACD most commonly includes a thorough clinical assessment with diagnostic support from patch testing and histopathologic review following skin biopsy. In recent years, reflectance confocal microscopy (RCM) has shown promising potential to join the repertoire of diagnostic tools for ACD by enabling dynamic and high-resolution imaging of contact dermatitis in vivo. Herein, we present a unique case of mango sap-induced ACD imaged and diagnosed in real time via RCM.