Fingertip eczema to pooja flowers: Allergic contact dermatitis to Tabernaemontana divaricata and Tecoma stans.

Sir, A 46‐year‐old woman presented with hyperkeratotic eczema and painful fissuring of the thumb, forefinger and third finger of the right hand (her dominant hand) of several months duration [Figure 1a and b]. Her lesions used to subside with the application of topical corticosteroids, but would reappear on stopping them. Detailed questioning revealed that she was in the habit of plucking certain flowers (crape jasmine and yellow bell) for her daily morning pooja ritual [Figure 2]. The possibility of allergic contact dermatitis to the flowers was considered and she was investigated accordingly. She was patch tested on the upper back with the Indian Standard Series (ISS) ‐ allergens supplied by Systopic Pharmaceuticals, New Delhi, manufactured by Chemotechnique Diagnostics (Sweden), as well as with the concerned flowers and tubular base. Both the single “pinwheel” form and the double‐flowered form of the crape jasmine were tested. These patches were applied using aluminum chambers on micropore tape (Systopic Pharmaceuticals, New Delhi, India) and removed after 2 days. Readings were interpreted as recommended by the International Contact Dermatitis Research Group. Prick testing with the flowers was also carried to rule out type I hypersensitivity, with histamine and saline as positive and negative controls respectively. On day 2, ++ reactions were seen on the sites tested with the flowers and the pedicle of the pinwheel variety [Figure 3], while the sites tested with the Indian Standard Series showed no reactions. The day 4 reading also showed ++ reactions to the flowers [Figure 4]. Prick tests using the flowers were negative.