Shiitake dermatitis L30.9

Nakamura, 1977

Stripy dermatitis (see also flagellant dermatitis) after eating the edible mushroom shiitake (Lentinus edodes). Auricularia auricula-judae, the Judas ear, a beta-glucan-containing saprophytic fungus from the class of agaricomycetes, can also cause similar clinical symptoms.

Lentinan, a (thermolabile! water-soluble) polysaccharide from Lentinus edodes, which is also used for tumor therapy in Japan, is assumed to be the triggering agent. Dermatitis has also been described here. It is probably a toxic reaction. Apparently, more type IV reactions are detected than type I reactions. In mushroom growers with allergic contact dermatitis, positive immediate reactions were triggered in prick tests (Wagner G 2011).

neck, trunk (see picture), extremities, rare face

Hours after eating a dish containing shiitake, appearance of streaky, flagellate-like, very itchy erythema, which is answered with violent scratching reactions. Streaky, parallel, persistent erythema develops in the scratch marks, which develop into correspondingly arranged papulo-vesicles. Skin symptoms persist for weeks. They heal without post-inflammatory hyperpigmentation. Also fever, diarrhea and mucosal ulcers.

Melanodermia factitia (skin changes due to bleomycin)

Systemic antihistamines, such as desloratadine 5 mg p.o. once a day or levocetirizine 5 mg p.o. once a day. For highly acute courses, short-term systemic glucocorticoids such as prednisolone (Decortin H) initially 100-150 mg/day p.o., phasing out within a week.

The shiitake mushroom is the second most common cultivated mushroom in the world, is similar in taste to the porcini mushroom and is used fresh, steamed or dried, especially in Asian cuisine. Its cap grows up to 20 cm wide and is brown-grey to brown in color with pressed, triangular scales. Its lamellae are white-brownish, the spores colorless.

1. Haas N et al (2001) Shiitake dermatitis. Dermatologist 52: 132-135
2. Hiernickel C et al. (2015) Shiitake dermatitis: an impressive case report. Dermatologist 66: 455-456
3. Lang N (2016) Streaky, whiplash-like erythema and succulent papules: flagellate dermatitis after consumption of Auricularia auricula-judae. JDDG 14: 303-304
4. Nakamura T (1977) Toxicoderma caused by shiitake (Lentinus edodes) in Japan. Jpn Clin Dermatol 31: 65-68
5. Wagner G et al. (2011) Shiitake dermatitis. Linear grouped erythema and papules on the upper trunkand décolleté. J Dtsch Dermatol Ges 9: 555-557.
6. https://www.bfr.bund.de/cm/343/gesundheitliches_risiko_von_shiitake_pilzen.pdf
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8. Nguyen AH et al. (2017) Clinical features of shiitake dermatitis: a systematic review. Int J Dermatol ;56(6):610-616. doi: 10.1111/ijd.13433. Epub 2017 Jan 4. PMID: 28054338.