Abstract
IMPORTANCE: Although Pyemotes species have been known to cause dermatitis, recent reports are rare. During the past 30 years, only 3 outbreaks of dermatitis caused by Pyemotes ventricosus have been reported. OBJECTIVE: To analyze the causative agent of skin changes in employees of a company that produced herbal medicines. DESIGN, SETTING, AND PARTICIPANTS: This case series includes 18 patients (8 men, 10 women; mean age, 44 years) who contracted unusual dermatitis after an occupational exposure in July and August of 2012 while working for a company that produced herbal medicines. The patients were examined at the Lower Silesia Regional Centre of Occupational Medicine in Wroclaw, Poland. EXPOSURES: Workers weighed and packed 1 part of the Helichrysum arenarium herb. MAIN OUTCOMES AND MEASURES: We hypothesized the causative agent to be P ventricosus. An examination of the herbal specimens for ectoparasites confirmed the diagnosis. RESULTS: Initially 16 employees developed pruritic skin changes. Skin lesions with pruritic vesicles on an erythematous base with surrounding swelling and edema were observed. Several employees also developed a flulike illness. After 44 days, 2 new employees presented with the same skin changes. The analysis of working conditions showed that the same part of the H arenarium herb was weighed and packed at that time. CONCLUSIONS AND RELEVANCE: We found that changing the time when the herbs were weighed and abandoning gas fumigation containing methyl bromide resulted in the recurrence of an almost forgotten disease.