Contact dermatitis caused by brazilin in Caesalpinia sappan

A 49-year-old woman presented with an eczematous reaction on her hands that which had appeared 5 days previously. To treat her wrist sprain, she had applied hot compresses with a herbal water decoction of multi-ingredient formulations on her hands for half an hour, and bathed her hands in this decoction for another 20 min. After 1 day, her hands became erythematous, with burning and itching (Fig. 1a, b). The ingredients of the decoction are Caesalpinia sappan, myrrh, Crocus sativus L., and Panax notoginseng. Two years previously, she had experienced similar dermatitis after applying herbal plasters impregnated with C. sappan, myrrh, Cr. sativus L., pseudo-ginseng, and Ligusticum chuanxiong Hort. Patch tests were performed on the patient’s back with the plant materials involved. Each material was ground