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Allergic occupational dermatitis due to Ceropegia woodii (string of hearts)

A 54-year-old female gardener was referred to the Department of Occupational and Environmental Medicine because she had developed eczema after working in a greenhouse nursery. Her past medical history included contact dermatitis from rubber and positive patch test reactions to cobalt chloride, carba mix, and thiuram mix. Prick test in 1991 showed positive reactions to grass and mugwort pollen and cat dander, and the patient still developed conjunctivitis when exposed to cats. At the beginning of her employment at the greenhouse nursery she tied up the long branches of C. woodii (Fig. 1) along a steel wire (Fig. 2), a process that usually took about 30 seconds, and she repeated the procedure many times an hour. Her fingers got purple from the sap during this process, and the stains could only be removed by soap containing abrasive. She also bundled (Fig. 3) the Ceropegia plants in plastic bags, and in this way her forearms got in contact with the long branches of Ceropegia. She never used any kind of gloves during her work. After 2 weeks, she developed a severe oedematous rash on her forearms and hands that later progressed to the face resulting in swelling of the face and eyelids. She felt a burning pain and severe itching on her arms that she circumvented by blowing cold air from the vacuum cleaner on her skin. She also suffered from a stinging irritation in the eyes. The patient was treated with topical and systemic corticosteroids and antihistamines with a good result. She started working again but with other pot plants, namely Ulmus and Dischidia, part of the time using latex gloves with cotton gloves underneath. After