Occupational exposure to the nitrogen based fertilizer: A severe case of irritant contact dermatitis

A 19-years-old strawberry picker man was admitted to our clinic with severe vesicular and bullous lesions accompanied with complaints of intensely itching and burning. Lesions were on erythematous base and localized on his both legs (Fig. 1). He had worked in strawberry field approximately 12 hours before onset of lesions. The lesions were limited to uncovered contact area with the leaves. He had applied a nitrogen based liquid fertilizer to the strawberry leaves and shortly after had begun to work in the field. He had a continuously contact with the leaves while he was working. Patient has no history of any allergy, medication or disease include contact or food allergy to the strawberry and strawberry leaves. Patch test was not performed because patient denied. Laboratory investigations were completely with in normal limits. No any microorganism detected in cultures obtained from blisters fluid. Histological examination of biopsy specimen showed lack of epidermis and mixed inflammatory infiltrate of lymphocytes in superficial dermis (Fig. 2). Direct immunofluorescence staining was negative. Based on these findings, we made a diagnosis of irritant contact dermatitis due to nitrogen based fertilizer. Patient treated with a short tapering course of systemic methylprednisolone (40 mg/day, tapered by 5 mg/day), topical wed dressing and topical antibiotic. The lesions resolved completely in 25 days without any complication.