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Dermatosis Due to Plants (Phytodermatosis)*

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Dermatosis Due to Plants (Phytodermatosis)* 479 REVISÃO L Dermatoses provocadas por plantas (fitodermatoses) * Dermatosis due to plants (phytodermatosis) Vitor Manoel Silva dos Reis 1 Resumo: As dermatoses causadas por plantas são relativamente comuns no nosso meio e podem ocorrer por diversos mecanismos patogênicos. São descritas dermatoses por trauma físico, por ação farmacológica, mediadas por IgE, por irritação, por ação conjunta da luz e por sensibilização. Também são descritas na introdução desta revisão as pseudofitodermatoses causadas por elementos veiculados pelas plantas e, por isso, aparentemente causadas pelas plantas. Palavras-chave: Alergia e imunologia; Dermatite; Dermatopatias; Plantas Abstract: Dermatosis caused by plants is relatively common and may occur by various pathogenic mechanisms. Dermatitis due to physical trauma, pharmacological action, irritation, sensitization, mediated by IgE and induced by light are described. Pseudophytodermatosis caused by plant-delivered elements is also described in the introduction to this work. Keywords: Allergy and immunology; Dermatitis; Plants; Skin diseases INTRODUÇÃO Dermatoses provocadas por plantas Também é preciso lembrar que há dermatoses (Fitodermatoses) que ocorrem como resultado de contato com as plan- Fitodermatoses são dermatoses causadas por tas, mas que, na realidade, têm como causa algum con- plantas. Na maioria das vezes, são causadas pelo conta- taminante presente na planta, como inseticidas, agro- to direto e apenas por isso, mas, eventualmente, ocor- tóxicos e artrópodes contaminantes, como acontece rem sem contato com a planta, ou, então, eventualmen- com o ácaro da coceira da palha (Pyemotes ventricosus te, necessitam da ação conjunta do sol. É interessante ou Pyemotes tritici), encontrado em grãos de cereais e salientar que há possibilidade de que as substâncias outros vegetais e que provocam quadro cutâneo muito existentes nas plantas capazes de causar dermatoses pruriginoso, que sói afetar fazendeiros, funcionários entrem em contato com a pele sem que o indivíduo de fazenda, veterinários e outros.3-5 tenha contato com a planta. É o caso da aroeira-brava, Outros exemplos são as fitofotodermatoses, que provoca “aroeirite” em pessoas sensibilizadas aos provocadas por furocumarinas produzidas por fungos fenóis de cadeia larga produzidos pela planta (Lithraea contaminantes de plantas (por exemplo, o Sclerotinia molleoides) apenas por passar ou deitar sob a árvore. sclerotiorium), ou quadros dermatológicos muito Esse fato explica-se pela dispersão pelo ar de gotículas pruriginosos produzidos por micuins, larvas do carra- contendo a substância alergênica.1 pato-estrela (Amblyomma cajennensis), presentes em Outra possibilidade de fitodermatoses sem con- arbustos dos quais se soltam, albergando-se na pele tato com as plantas ocorre com indivíduos sensibiliza- do animal ou do homem que neles esbarra. dos a substâncias derivadas de plantas utilizadas, na Os líquenes, que não são exatamente plantas, indústria, como perfumes, cremes, cosméticos.2 É o mas uma associação de fungos com algas, produzem caso da maioria dos perfumes usados como tais ou ácido úsnico, o qual vem sendo utilizado, comumen- incorporados a produtos cosméticos e com outros te, em vários cosméticos e protetores solares tópicos fins, como o bálsamo-do-peru, com todas as substân- e tem se tornado importante agente que pode provo- cias como eugenol, isoeugenol, aldeído da canela, car dermatite de contato por sensibilização. Pelo fato colofônio, terebintina e outros. de poderem fixar-se não somente em pedras úmidas, Aprovado pelo Conselho Editorial e aceito para publicação em 26.03.2010. * Trabalho realizado na Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) - São Paulo, Brasil. Conflito de interesse: Nenhum / Conflict of interest: None Suporte financeiro: Nenhum / Financial funding: None 1 Doutor. Médico do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP) - São Paulo (SP), Brasil. ©2010 by Anais Brasileiros de Dermatologia An Bras Dermatol. 2010;85(4):479-89. 480 Reis VMS mas também em troncos velhos e outros vegetais, DERMATITES POR AÇÃO FARMACOLÓGICA podem levar a quadros aparentemente causados por A dermatite por ação farmacológica pode ocor- plantas.6,7 rer em qualquer indivíduo, mesmo sem predisposi- A esporotricose, micose profunda causada pelo ção, pois é decorrente da penetração na pele de subs- Sporotrix schenkii, tem nos vegetais, particularmente, tâncias farmacologicamente ativas. nas roseiras, o seu meio mais comum de veiculação A urtiga8 (Urtica dióica ou Urtica urens), plan- do agente causal, assim como alguns casos de para- ta que é encontrada em matagais próximos a trilhas coccidioidomicose podem ter o agente etiológico frequentadas pelo homem ou por outros animais e (Paracoccidioidis brasiliensis) veiculado por vege- mesmo em jardins, como “erva daninha”, é capaz de tais, ou seja, aparentemente causada por plantas. provocar quadros papulopruriginosos nas áreas da Apesar de todas as possibilidades existentes, a pele que tocarem a planta, semelhantes a um surto de forma mais comum de fitodermatose é a dermatite de urticária (é dessa planta que vem o nome da doença). contato e o quadro dermatológico que mais ocorre é As folhas e as hastes dos talos dessas plantas o eczema. Uma forma de dermatite de contato, em possuem na, sua superfície, pequenos pelos urtican- geral não eczematosa, por substância derivada de tes, em formato de agulha, cuja extremidade distal de planta é a alergia ao látex produzido pela seringueira silicone se rompe após penetrar superficialmente na (Hevea brasiliensis), que se caracteriza por determi- pele. Ao se romperem, liberam na derme o seu con- nar reação imunológica do tipo I, dependente de IgE, teúdo composto por histamina, serotonina, acetilcoli- podendo ocasionar quadros de urticária de contato e na e outras substâncias vasoativas. fenômenos anafiláticos respiratórios. Também nesse Descritas no nosso meio há as plantas conheci- caso se tem o contato com substância de origem vege- das como cansanção, Cnidosculos urens, Fleurya aes- tal de uso ubiquitário, sem o contato com a planta tuans, Loasa rupestris, ou a favela, nome popular do que o origina. Cnidosculos phyllacantus. Também há relatos da urti- Para facilitar o entendimento do assunto fito- ga-cipó, trepadeira, ou urtiga-mamão, a Dalechampia dermatoses, dividiremos as reações cutâneas ao con- scandens. Os marmeleiros preto, branco, prateado, tato com plantas pelo mecanismo: sabiá, velames, canela- do-mato, mucunã-brava ou cabeluda (Mucuna urens) são outras plantas recober- Dermatites por trauma físico; tas por pelos urticantes. Dermatites por ação farmacológica; Dermatites mediadas por IgE; DERMATITES MEDIADAS POR IgE Dermatites por irritação; Um número muito grande de plantas pode Dermatites por ação conjunta do sol; desencadear quadros de urticária ou mesmo de ecze- Dermatites por sensibilização. ma após contato com a pele, por mecanismo mediado por IgE. As proteínas dessas plantas seriam os desen- DERMATITES POR TRAUMA FÍSICO cadeadores dessa reação, como já foi descrito, na lite- Algumas plantas têm mecanismos próprios de ratura, com o quadro produzido pelo contato com o defesa representados por espinhos verdadeiros, acú- látex das luvas de uso regular entre os trabalhadores leos, dentes serrilhados, terminações de folhas em da saúde. forma aguda, farpas que podem ferir a pele ao entrar Essas dermatites (de contato por proteína), em em contato com as plantas, como ocorre na manipula- geral, restringem-se às áreas de contato com as plan- ção das mesmas ou em casos de contato acidental sem tas, mas pode haver sintomas sistêmicos no âmbito proteção da pele. Dentre elas podemos citar as rosei- respiratório e digestório (síndrome da urticária de ras, as laranjeiras, os limoeiros, as primaveras ou contato). Atopia predispõe a esses quadros de urticá- buganvílias, os cactos e pseudocactos, as euforbiáceas, ria de contato. Surgem dentro de 30 minutos após o como a coroa-de-cristo. Outras, ao serem manipuladas, contato prurido, eritema e edema e, eventualmente, esmagadas ou sofrerem pequenas fraturas ou cortes vesículas. nas suas estruturas, liberam substâncias irritantes, A lista de plantas, frutos, vegetais, madeiras é como seivas, pequenas farpas ou mesmo microscópicas muito grande. Julga-se que todas as plantas possam espículas ou cristais que, em contato com a pele, provocar urticária de contato, mas exige-se uso fre- podem levar a quadros inflamatórios intensos e graves. quente e contínuo para que isso aconteça. O melhor Da família das cactáceas temos vários gêneros, exemplo seria o aipo (Apium graveolens).9 como: Opuntia, Cereus, Cephalocereus, Em geral, essas dermatites ocorrem em traba- Acanthocereus,Echinicereus, dos quais podemos citar lhadores da indústria alimentícia, cozinheiros, jardi- o mandacaru (Cereus jamacuru) e o xiquexique neiros e floristas.10 (Pilocereus gouneli). An Bras Dermatol. 2010;85(4):479-89. Dermatoses provocadas por plantas (fitodermatoses) 481 DERMATITES POR IRRITAÇÃO Aráceas Ocorrem em qualquer indivíduo sem necessi- Nesta família há plantas como a Dieffenbachia dade de haver predisposição, bastando o contato dire- picta (comigo-ninguém-pode), que é muito utilizada to com determinadas plantas ou, mesmo, por macera- como planta ornamental, conhecida como planta de ção de plantas que liberam, com isso, substâncias irri- escritório; é vistosa, com suas grandes folhas, e não tantes ou cáusticas. A capacidade
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