This case just brought to our attention (patient's report with pictures attached). Patient urgently seeking consultation by a local dermatologist who is willing to prove/disprove the alleged etiology. Needed for liability and for adequate medical documentation for publishing the case in a scholarly journal.
The patient's condition is quite common, and could be regarded as prurigo subacuta. The condition is ill defined, and in some cases patients have dermatological delusional symptoms. She needs to be reassured that her condition is the consequens of the contact with burdock pappus hairs. It is impossilble after such a long time. If she insists on it, than she needs a psychiatrist's help.
Thanks, dear colleague, for your practitioner's textbook advice. We had been aware of these relationships. Be assured, it is certainly possible to detect the bristles after this long time!
One must understand the particular nature of this agent. We have tried to provide the necessary background and encourage that you take notice of the attached data and documents. We are confident that a scientific approach towards elucidating the causality will prove the alleged relationship, only that it has to be done. The intention of this Question was that we are looking for a person who is willing to do so! In parallel, one can attempt to alleviate symptoms, of course.
We had already advised the disposal of all clothing, bed sheets, and linens that apparently are still contaminated with the pappal bristles having spread widely. If the prurigo is caused by the burdock bristles then it obviously can be stopped by this measure.
Please read carefully: the readily airborne barbed bristles are about 2-3 mm long and thin as hair, not to be confused with the commonly known involucral hooks of burs. There is a botanical background here without which the case can not be understood!
Dear Theodor,
Were you able to find a Toronto-based dermatologist to help with the case? The way the system works in Canada is that this patient could see a family doctor, and then get referred to her local dermatologist.
It seems like an interesting cause of chronic dermatitis. A few biopsies may help - and I wonder if the material is polarizable? Also, I wonder if tape stripping could be used to make the diagnosis (like in fiberglass dermatitis). I would agree with Marko in that the photos really look like self-induced excoriations without a primary dermatosis. However, you must rule out all other causes before jumping directly to that.
Thanks, Justin, for your expertise and suggestion... fully agree!
I think we should have this moving in the right direction now!
Very best, TED
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