Acute Kava (Piper Methysticum) Dermatitis With Drug Reaction With Eosinophilia and Systemic Symptoms-Like Features and Sebotropic Inflammation: A Case Series

The kava plant is native to the Pacific Islands. A mildly psychoactive beverage, also referred to as kava, made from the roots and stems of this plant, is widely ingested in these regions for social, cultural, and medicinal purposes. In recent years, kava extracts in various forms have been used in conventional Western and alternative medicine. Although chronic ingestion of large amounts of kava is well known to cause an icthyosiform skin condition, acute reactions are less well described. We report 3 patients of non-Pacific Islander background who developed acute reactions, clinically resembling drug reaction with eosinophilia and systemic symptoms, after commencement of kava ingestion following recent regulatory changes, making this product more widely available. In all 3 patients, skin biopsy revealed a distinctive and unusual pattern of sebaceous adenitis with single cell apoptosis.