GENERALIZED HAIR LOSS DUE TO THE INGESTION OF "COCO DE MONO" ()* FRANCISCO KERDEL-VEGAS, M.D., M.S.

After having observed a case of generalized There are only two medical references in "defluvium capillorum" which resulted from theVenezuelan literature relating to this problem ingestion of "Coco de Mono" , we began (5, 6). Both noted hair loss. The depilating action a study of this problem. of "Coco de Mono" was proportional to the "Coco de Mono" is the name used in Venezuelaquantity of seeds ingested and the time in the for various species of the genera Lecythis. Evenpatient's digestive tract prior to vomiting. Dr. though the tree is of great size, it was identified for Luis Dao (7) described two cases of "alopecia the first time by Loefling about 1754 or 1755 inareata" which appeared almost simultaneously the region of Barcelona, State of Anzoátegui,in two brothers and considered "Coco de Mono" which is in the Northeast part of Venezuela.as a possible etiology. According to Ernst the same species occurs in the state of Guárico and Portuguesa. (1). The wood cASE REPORT is very hard and of a reddish yellow color; the H. D. P., a 54 year old Italian born white male, oil extracted from its seeds is considered to be awho had lived in Caracas for many years, con- potent hemostatic agent. The tree is large andsulted us May 5, 1962 because of extensive hair loss which he attributed to ingestion of "Coco de has a rough bark. (Fig. 1.) Mono". He stated that April 20, 1962 he ate 70 to The name "Monkey Pod" has been applied to80 "Coco de Mono" almonds while on a hunting lecythis trees because their fruit is in the formtrip in the Venezuelan State of Portuguesa. of a large wooden ball with a circular opening on That same afternoon he felt nervousness and the lower end, closed by a lid which eventuallyanxiety which was followed within 8 hours by violent chills. Subsequently he developed watery falls away. (Figs. 2—3). "The monkey reachesdiarrhea consisting of 8 movements a day and through the hole, grabs a , then cannot getpersisting for 36 hours. After the fever and diar- his loaded paw out and will let himself be caughtrhea subsided, there was a persistence of anorexia rather than release his grip" (3). and asthenia. He developed arthralgia of all his Jacquin refers to having ingested the "Coco dejoints, with pain in his chest and back. Anorexia, dyspepsia and a sensation of fullness has con- Mono" and found it to have a very agree-tinued to the present time. able taste; however, after thirty minutes he ex- Eight days after having eaten the almonds there perienced nausea, anxiety and vertigo. (2). Thereoccurred a sudden, extensive loss of scalp and body have been 47 species of Lecythis identified on thehair which increased during the following days. On May 3, 1962 he noted a violet streak over American Continent in a vast zone which extendsthe proximal part of his nail plates which dis- from Costa Rica to Brazil. (3). appeared over the succeeding three days. Professor Castelhanos (Botanical Section of In the first few days he lost a great deal of hair the National Museum of Brazil) (4) stated thatfrom his axillae, chest, pubis and thighs. He also about 27 species of Lee ythis exist in Brazil. Thelost his eyebrows, eyelashes and mustache. Within a month the patient lost 4 Kg. He gave a history common belongs to this same familyof diuresis lasting one week after having eaten the of Lee ythidaceae. fruit. He stated that the guide had warned him In Northern Brazil there is a popular sayingthat his hair would fall out, when they found him eating the "Coco de Mono" almonds. On the same that eating the "Sapucaia" (a synonym for "Cocoday that H.D.P. had ingested the almonds a de Mono") causes a loss of hair. Furthermore incompanion also ate a moderate quantity of them the flat lands of Venezuela where the "Coco de(approximately 8 seeds), but did not note any ill Mono" is prevalent, there also exists the populareffects. The guides stated that when monkeys eat belief that the ingestion of its nuts causes hairthis fruit they are found dead in the trees. loss from the scalp as well as from the body. Laboratory studies revealed nothing of interest. *Fromthe Department of Dermatology, Cen- Histopathological Examination tral University of Venezuela and the Department of Dermatology, Vargas Hospital, Caracas, A scalp biopsy from the right temporal-parietal Venezuela. region was reported by H. Montgomery as follows: Received for publication June 24, 1963. "Apparently there are no telogen hairs in the 91 92 THE JOURNAL OF INVESTIGATIVE DERMATOLOGY

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FIG. 1. Photograph of the "Coco de Mono" tree. Its large size can be readily appreciated when com- pared with the man in the lower margin. HAIR LOSS FROM "COCO DE MONO" 93

- 21 31 41 5! 4

Fio.2. The "Coco de Mono" fruit with its "lid" attached — —

FIG. 3. The "Coco de Mono" fruit illustrating the orderly arrangement of almonds within 04 THE JOURNAL OF INVESTIGATIVE DERMATOLOGY

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FIG. 4. A test animal is on the left showing the failure of hair regrowth after 13 days, as compared with a control animal on the right. sections. In the stained sections that you sent meinhibits the anagen phase of hair growth in the hairs were cut a bit on the bias hut the un-white mice has been demonstrated in these al- stained section stained with PAS and alcian blue shows pretty good normal looking hair follicles"monds. (8). REFERENCES 1. PITTIER, H.: Plantas usuales de Venezuela, p. 158. Caracas, Lt. del Comerclo, 1926. Mice were partially depilated over their dorsal2. JACQTJTN: Amer. Pict., p. 109, 1763. surface prior to feeding them an extract of the3. MENNINGER, E. A.: Flowering Trees of the almonds. While there was a normal regrowth of World. New York, Hearthside Press Inc., 1962. hair in the control animals, those which were fed4. Goervss, A. P.: Personal communication to the extract had obvious growth inhibition. (Fig. the author. 5. VEGAs, M.: Acción Depilatoria del Coco de 4). The test animals lost weight and eventually Mono. Rev. Pol. Caracas No. 27, pp. 1843— died if the almond extract was not discontinued. 1845, April 1936. The mechanism of this inhibition and whether or6. V4LRz-BozA, F.: Cuatro observaciones clinicas de los efectos producidos por Ia ingestion de not it is a toxic effect will require further work. las semillas dcl Coco de Mono. Mem. Soc. Cien. Nat. La Salle, afio III, N° 8, p. 28, sUMMARY Sept.—Dec. 1943. 7. DAO, L.: Experiencias sobre enfermedades A ease of defluvium capillorum which resulted tropicales en zonas rurales de Venezuela. Caracas, CorporaciOn Universo, 1958. from the ingestion of "Coco de Mono" almonds8. MONTGOMERY, H.: Personal communication to has been described. An active principle which the author.