Allergic contact eczema caused by exotic wood material in sauna interior decoration.

A 45-year-old female teacher was referred to our clinic because of a severe and treatment-resistant dermatitis. She had no previous history of eczema. Dermatitis first appeared in her right elbow and upper arm. Over the next few weeks, the dermatitis spread to her back and left upper arm. We took two skin bunch biopsies from her back. She was told to avoid sauna bathing for 2 weeks because of the stitches. Topical corticosteroid ointment was prescribed for treatment of the dermatitis. During the next 2 weeks, the patient experienced dramatic healing of her skin. Avoiding sauna baths seemed to have a clearly positive impact on her skin condition. This led her to ask whether something in her sauna that had been renovated a few months earlier was irritating her skin. The interior material of the sauna was unvarnished western red cedar. The origin of the wood was confirmed by an expert from the Finnish wood importer, and an independent skilled carpenter was asked to ensure that the wooden material detached from the sauna was western red cedar. Patch tests were performed with a baseline series, a cosmetic series, and western red cedar sawdust from the sauna interior material. Western red cedar sawdust gave a firmly positive (++) reaction (Fig. 1a). Nickel sulfate gave a strong positive reaction (+++), cobalt chloride a positive reaction (+) and formaldehyde an irritant reaction in the baseline series. Histological findings of the skin bunch biopsies suggested eczema-type dermatitis.