Contact Dermatitis With the Homoeopathic Medicine Calendula officinalis: A Rare Case Report

Introduction: Herbal medicines and other traditional medicines are well accepted in India and are readily available as over-the-counter preparations. With their increased use, the safety and quality of homoeopathic medicines have become a major concern for health authorities, pharmaceutical industries, and consumers. It is difficult to assess the adverse effects of homoeopathic medicines due to a lack of scientific evidence regarding their safety and efficacy in clinical trials or post-marketing surveillance. Here, we reported a patient with contact dermatitis due to the homoeopathic medicine Calendula officinalis. Case presentation: A 33-year-old previously healthy woman presented with pruritus, redness, and swelling over the entire face and upper neck. The symptoms developed within about 1 hour after the use of a homoeopathic skin ointment containing 2% Calendula officinalis as the major ingredient in an aqueous base. Cutaneous examination revealed periorbital edema and facial swelling with multiple vesicular eruptions over erythematous edematous plaques on the face. A clinical diagnosis of contact dermatitis was considered. Discussion: Many herbal preparations in India are available without safety data. Calendula officinalis extract (oil expressed from seeds) is used in various skin products. The exact allergens present in Calendula officinalis are unknown, but the flowers reportedly contain a variety of phenolic acids and phenylpropanoids that have elicited contact dermatitis. Conclusion: Anecdotal case reports of accidental exposure/sensitization and experimental studies provide sufficient evidence to confirm the causal relationship between contact dermatitis with Calendula Officinalis. Post-marketing surveillance of all homoeopathic medicines should be mandatory, and the availability of such preparations as over-the-counter drugs must be restricted.