Contact dermatitis from Hedera helix in a husband and wife

A previously healthy 50-year-old man was admitted in April 1999 with severe eczema on the right upper limb and less florid involvement of the trunk. His wife had simultaneously developed eczema on her trunk. 10 days prior to onset, the patient had scratched his right arm while cutting roses. He subsequently spent time pruning common ivy and his wife helped him to clear the trimmings. 4 days later, the patient’s right arm became itchy and exudative at the site of the scratch. In Accident and Emergency (A & E) a diagnosis of cellulitis was made, for which only oral antibiotics (penicillin and flucloxacillin) were prescribed. The patient felt well in himself and, 3 days prior to admission, completed pruning the ivy plant. He wore the same clothes, which had not been washed, and his wife again assisted in clearing the trimmings. Over the next 3 days, both husband and wife developed the extensive eczema with which they were seen. Their son had shown a less severe reaction to ivy 3 years earlier. On examination, an acute eczema with confluent erythematous vesicular and bullous lesions was noted on the right forearm (Fig. 1), with less severe patchy involvement of the trunk. A linear streak of small vesicles was seen on the dorsum of the right hand. His wife showed less florid vesicular erythematous plaques on the forearm and trunk (Fig. 2). The distribution of the rash and preceding history suggested a diagnosis of allergic phytodermatitis from common ivy. Routine haematological and biochemical tests were normal and blood cultures were negative. He was treated with potassium permanganate soaks and Betnovate CA ointment (betamethasone valerate with clioquinol), with intravenous flucloxacillin and benzyl penicillin to control secondary