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Fig 2. Diffuse, erythematous, and edematous papules and To the Editor: We read with great interest the case report by Brown-Joel et al, Inflammatory sebotropic reaction associated with kava kava ingestion. The authors discuss an unusual sebotropic eruption thought to be caused by kava ingestion. We wanted to reinforce these characteristic clinicohistologic features by describing a similar presentation at our hospital center. A 26-year old man without a significant medical history presented to the emergency department with a progressive cutaneous eruption for 1 week. Physical examination found diffuse, erythematous, and edematous papules and plaques on the face, neck, upper trunk, and proximal upper extremities (Figs 1 and 2). Two weeks prior, he started drinking an herbal tea supplement, kava. Similar to the case reported by Brown-Joel et al, the patient had mild neutrophilia (8.9 k/ L) and transaminitis: alanine aminotransferase, 91 (10-40 U/L); and aspartate aminotransferase, 55 (10-30 U/L). Two punch biopsies of the right upper back and arm revealed changes of suppurative folliculitis with perifolliculitis (Figs 3 and 4). Similar to the Brown-Joel et al case, presence of neutrophils was also noted within the hair follicles, particularly concentrated within the sebaceous glands. Given the clinical presentation and histology, acute cutaneous kava toxicity was the most likely etiology. Of note, unlike the prior report in which the patient did not benefit from prednisone and was started on cyclosporine, our patient responded to a 4-day course of oral prednisone (30 mg) and topical hydrocortisone 2.5% lotion with complete resolution. It is well-established that chronic use of kava can cause a reversible ichthyosiform pellagroid dermopathy; however, detailed individual reports of cutaneous reactions to kava in an acute setting are sparse in the literature. Among the reported cases, significant similarity in primary cutaneous lesion morphology and histopathology is described; specifically, edematous papules and plaques tend to plaques on the upper trunk.

Kava-induced acute cutaneous toxicity: An increasingly recognized characteristic clinicohistologic pattern