Psoriasiform contact dermatitis due to propolis in a beekeeper

Background: More than 250 cases of allergic contact dermatitis due to propolis have been described. A few of these occurred in beekeepers. Objective: To describe a case of psoriasiform dermatitis caused by propolis in a beekeeper who thought that his lesions were related to honeybee stings. Methods: A 45-year-old beekeeper experienced hand dermatitis for the past 5 years. He believed that the lesions occurred and worsened when he was stung by honeybees. He was prescribed topical corticosteroids several times, but because he was stung frequently, the drugs never helped control the lesions. In the past few years, he frequently had contact with propolis during honey collection, but he denied the role of propolis because he was wearing gloves while handling the beehives. For diagnostic evaluation, skin biopsy, skin prick tests (SPTs), identification of specific IgE antibodies, and atopic patch tests were performed. Results: Skin biopsy showed psoriasiform contact dermatitis. Results of SPTs to honeybee and serum specific I-E for Apis mellifera remained negative. Results of the atopic patch test performed using A mellifera SPT material were also negative in the first 20 minutes and on the second and third days. However, propolis showed a positive erythematopapular reaction on day 2. The patient never again worked as a beekeeper, and neither did he, as far as he knew, use any medical or cosmetic products that contained propolis. His hand lesions improved almost completely. Conclusion: Dermatitis due to propolis should never be disregarded in beekeepers, and every effort should be put forth to make a correct diagnosis and to convince the patients of the cause.