IMAGES IN EMERGENCY MEDICINE
Beware the tree of heaven! (Ailanthus altissima)
Emergency Department, Wycombe General Hospital, Reading, UK
Correspondence to:
Dr R Whiticar, Emergency Department, Wycombe General Hospital, 20 Cadugan Place, Addington Road, Reading RG1 5PN, UK; rwhiticar@doctors.org.uk
Accepted 21 July 2008
| The first 150 words of the full text of this article appear below. |
A 32-year-old tree surgeon presented to the emergency department with an 8-day history of a skin rash, which developed after he was exposed to the sap of the "tree of heaven" at work.
On examination he had a well-demarcated, urticarial, erythematous rash with multiple excoriations on both his forearms (see fig 1). He was discharged home on piriton, with a likely diagnosis of contact dermatitis, after discussion with the National Poisons Centre.
Figure 1 Rash present on patient's forearms on initial presentation to the emergency department.
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He then re-presented within 48 h with spreading of the rash to his genitals, lower abdomen and thighs. He remained systemically well. He was referred to the dermatologists who treated him with a reducing regime of steroids, fusidic cream and dermovate, and the rash resolved within 30 days.
The tree of heaven was brought to Britain from its native China in 1751, and is rapidly
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