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ALLERGIC CONTACT DERMATITIS TO NIGELLA OIL EXPRESSING AS
ERYTHEMA MULTIFORME
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Nguyen Thi Mai Huong1,2,3
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1: Hanoi Medical University, Hanoi, Vietnam
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2: Department of Dermatology, Saint Louis Hospital, Paris, France
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3: National Hospital of dermatology et venereology, Hanoi, Vietnam
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Background
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Nigella oil, extracted from the seeds of black cumin, is traditionally used for its cosmetic
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and culinary properties. Modern-day laboratory studies have shown its varying
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composition according to geographical origin and its various pharmacological
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properties(1). This oil and essential oils in general, are known to be responsible for
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eczematous contact dermatitis, sometimes severe reactions, which have been poorly
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described, can occur. Herein we report a case of severe acute contact dermatitis due
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to Nigella oil, clinically showing polymorphic lesions that mimicked erythema
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multiforme.
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Observation
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A previously healthy 29-year-old woman was admitted to the dermatology department
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for suspicion of drug eruption. 10 days before admission, she had a pilonidal sinus in
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the cleft at the top of her buttocks. She self- treated at home with application of
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betadine and Nigella oil. 4 days after, the lesion worsened with large erythematous
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macule and formation of an abscess. She went to the hospital. The abcess was then
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drained and she was prescrit Augmentin 3g per days for 7 days. She continued to
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apply Nigella oil to te buttock and her back. The abscess regressed after 5 days of
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antibiotic therapy but skin eruption gradually spread to the thighs, legs, chest, hands,
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arms amd face, associated with moderate prurit. She reported no fever, no
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gastrointestinal and respiratory signs. She was referred to dermatology service for
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suspicion of drug-induced erythema multiforme by Augmentin. Initial clinical
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examination found typical and atypical target-like lesions, compatible with an erythema
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multiforme, without Nikolski’s sign, nor mucosal involvement. Detailed health history
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found repetation use of Augmentin before without any reaction.
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Biology examinations (blood count, plasma urea, creatinine and ionogram, liver test)
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were also normal. The EBV, CMV, HIV, HHV6 and HHV8 serologies were negative.
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A diagnosis of severe acute contact dermatitis showing severe polymorphic lesion that
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mimicked erythema multiforme due to Nigella oil was made. With cessation of Nigella
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sativa oil and topical corticosteroid, lesions healed within 1 month, but her skin
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exhibited post-inflammatory hyperpigmentation. Patch tests, performed 2 months after
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resolution, revealed positivity at 72 hours with Nigella oil and stayed negative with
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betadine. Allergy testing with an oral amoxicillin 250mg challenge was negative.
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Discussion
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Nigella sativa oil extracted from the seeds of N. sativa or black cumin, found in
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Southern Europe, North Africa, Mideast, Bangladesh, India is traditionally used for its
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cosmetic and culinary properties. Its main active components are thymoquinone and
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terpenes, but the exact composition of commercial oil and the proportion of its
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constituents are highly variable(1). Many studies have shown the positive effects of
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Nigella oil for the treatment and prevention of a variety of diseases and conditions that
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include eczema, asthma, hypertension, diabetes, inflammation disorders(1) and more
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recently for neurology(2) and oncology diseases(3).
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However, skin reactions after topical use of Nigella oil have been reported in medical
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literature, with a variaty of clinical magnifestation, from eczema(4,5), erythema
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multiforme(6) to Stevens Johnson-like syndrome(7). In our case, the diagnosis of
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erythema multiforme due to Nigella oil was made before the erythemas present mostly
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on the contact areas with the present of typical and atypical target lesions. It was then
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confirmed by the positivity of patch test. Otherwise, the extension of the lesions away
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from the area of application, even after topical use alone suggests a systemic effect of
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Nigella oil, this phenomenon was observed in other case reports(6,7). In our patient,
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the onset of skin lesions is difficult to determined exactly because she had an erythema
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of the pilonidal sinus before application of Nigella oil. In other reports, the time between
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application of oil and the onset of disease varied from 1 day to 4 months (4–8). All the
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cases reported had a complete regression after treatment of topical or short-term
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systemic corticoid. Our patient was succesfully treated with the use of very strong
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topical corticosteroids (clobetasol propionate).
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The pathogenesis of acute contact dermatitis by Nigella oil is not well understood.
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Thymoquinone and terpenes are the main pharmacologically active compounds(1)
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Thymoquinone is shown to induce apoptosis, regulates the levels of pro- and anti-
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apoptotic in several cancers (9), but its role in epidermal apotosis is unclear. p-cymene
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is a monoterpene contained in Nigella oil that acts as a penetration enhancer by
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disrupting the stratum corneum lipid structure, thus facilitating the transport of drugs
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through the skin(10). These elements may promote epidermal apoptosis by topical
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toxic and/or a hypersensitivity.
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Finally, it is interesting to note the great number of non-scientist websites and tutorial
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talking in Vietnamese about Nigella oil and how to use it. While the black cumin is not
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cultivated in Vietnam, the key word black cumin oil in Vietnamese (“dầu hạt thì là đen”)
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find 7 320 000 results on Google search. These sources demonstrate the great interest
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of non-medical population in Vietnam about this product. Conversely, to our
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knowledge, there isn’t any scientist article in Vietnam talking about skin reaction after
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application of this oil.
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Conclusion
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In conclusion, Nigella oil can be a cause of erythema multiforme. A careful interrogation
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and patch test should be done before cases of erythema multiforme with undetermined
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causes. In term of treatment, the use of systemic corticoid is not obligatory because in
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certain cases, topical corticosteroids are sufficient.
a
b
c
Figure 1. Erythematous macules in the zone of application of Nigella oil ( a and b)
Typical and atypical target lesions away from the area of application (c)
Figure 2: Patch test positive with
Nigella oil
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Referrences
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