Nigella Sativa (Black Cumin) Oil: A Case Report and Analysis Exploring Severe Cutaneous Manifestations and Implications for Patient Care­

J Clin Aesthet Dermatol. 2024;17(12):42–44.

by Elina Zhivov, DO; Cassidy Johnston, DO; and Sarah Shangraw, MD

Dr. Zhivov is with Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine in Miami, Florida. Drs. Johnston and Shangraw are with Frontier Dermatology in Salem, Oregon.

ABSTRACT: In the past three decades, there has been a remarkable surge in the popularity and use of herbal medicines. However, despite their widespread use, herbal remedies remain inadequately regulated, exposing consumers to potential adverse effects. This case series examines eight patients with severe cutaneous manifestations resulting from the topical application of Nigella sativa (black cumin) oil, emphasizing the critical significance of patch testing, thorough history-taking regarding exposures and herbal supplement usage, and the necessity for enhanced regulatory measures. Additionally, it delves into various treatment modalities, offering valuable insights for clinicians managing similar cases.

Keywords: Nigella sativa sjs, natural remedies studies, nigella sativa remedy, black cumin oil

Over the past thirty years, there has been a significant upswing in both interest and demand for herbal medicines.^1,2 Many individuals have incorporated these remedies into their daily routines, attracted by the promised potential health benefits. Despite their growing popularity, these herbal treatments remain largely untested and are poorly regulated, leaving many unaware of potential adverse side effects.¹ One such natural remedy under scrutiny is Nigella sativa (black cumin) oil (NSO), believed to offer medicinal benefits for various chronic conditions, including neurological/mental illnesses, cardiovascular disease, infertility, oncologic conditions, and infectious diseases.³ This case series, which includes our case as well as seven cases obtained from literature review, aims to elucidate eight instances where patients applied NSO topically and encountered severe cutaneous manifestations, ranging from generalized maculopapular exanthem to the formation of bullae and desquamation resembling Stevens-Johnson syndrome/toxic epidermal necrolysis.

Case report

A 36-year-old male with no known allergies (NKA) applied NSO topically to most of his body, including the groin and buttocks. Shortly after, he developed pruritic red papules (Figure 1), evolving into vesicles and bullae with groin edema (Figures 2 and 3) and fever, resulting in desquamation one day later (Figure 4). The patient had no mucosal involvement. Histological examination revealed dyskeratosis, blurring of the dermal-epidermal junction, intraepidermal blisters with inflammatory cells (Figure 5). A positive patch test for NSO was observed. Treatment included intravenous methylprednisolone followed by transition to oral prednisone, and triamcinolone 0.1% ointment, resulting in significant improvement, with discharge on the seventh hospital day.

Discussion

To date, the literature contains only a few reported cases of NSO-induced contact dermatitis. However, the cases discussed here shed light on the diverse range of cutaneous manifestations associated with NSO-induced contact dermatitis, many of which are severe and extend beyond the initial application site, necessitating hospitalization. The variability in presentations suggests that more cases may be occurring, either going underreported or being misdiagnosed. 

Gelot et al⁴ described a case of a 53-year-old female, with an unspecified allergy history, who applied NSO topically and ingested it, leading to a febrile rash with erythematous plaques, vesicles, and bullous lesions. Histology indicated toxic epidermal necrolysis. The patient tested positive for NSO on patch testing. While the treatment was not specified, lesions healed slowly, leaving persistent depigmented macules.

Gaudin et al reported a series of three female patients between the ages of 20 and 47 years, with undisclosed allergy histories, presenting with polymorphic skin lesions beyond the NSO application site. Various manifestations included typical and atypical targets, patches with central blisters, and erythematous or purpuric plaques, mimicking Stevens-Johnson syndrome or toxic epidermal necrolysis. Histology revealed epidermal apoptosis. All three patients tested positive for NSO on patch testing, with no details on treatment or outcome provided.⁵

Howard et al⁶ described a 39-year-old male patient with an undisclosed allergy history, experienced non-painful pruritus shortly after applying NSO topically. The rash progressed into vesicles, bullae, diffuse erythema, and desquamation. Histology showed dyskeratosis and superficial necrosis. Treatment involved supportive care in the burn unit, including triamcinolone 0.1% ointment, SilvaSorb cream, daily dressing changes, Foley catheter placement, and cetirizine/hydroxyzine for pruritus, resulting in substantial improvement over two weeks.⁶

Lellig et al⁷ described the case of a 58-year-old female patient with an undisclosed allergy history, who applied NSO topically, presenting with erythroderma spreading to the face and the entire body, accompanied by anasarca and facial edema. Histology revealed spongiform dermoepidermatitis. The patient tested positive for NSO on patch testing and was treated with systemic corticosteroids and diflucortolone valerate cream, experiencing a favorable clinical evolution with no rash recurrence.

Fargeas et al⁸ described the case of a 28-year-old female patient, with an undisclosed allergy history, developed extensive exanthema, edema of extremities, and enlarged lymph nodes after topical NSO application. Histology showed eosinophilic spongiosis. The patient tested positive for NSO on patch testing and was treated with systemic corticosteroids, resulting in complete regression of the exanthema within one month.⁸

Conclusion

Our case report and the previously published cases discussed here emphasize the importance of patch testing, especially for unregulated products, and the significance of inquiring about topical exposure and supplement use during patient history assessments. Additionally, it’s worth noting that while systemic corticosteroids are commonly used therapeutically, supportive care with topical steroids offers an equally effective approach and helps minimize potentially dangerous side effects, particularly in patients with conditions such as diabetes mellitus, cardiovascular disease, and a history of gastrointestinal bleeding.

References 

1. Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol. 2014;4:177.
2. Herbal Supplements Market Share | CAGR 7.10%. Market.us. October 2023. Accessed 1 Nov 2023. https://market.us/report/herbal-supplements-market/
3. Yimer EM, Tuem KB, Karim A, et al. Nigella sativa L. (Black cumin): A promising natural remedy for wide range of illnesses. Evid Based Complement Alternat Med. 2019;2019:1528635.
4. Gelot P, Bara-Passot C, Gimenez-Arnau E, et al. Éruption bulleuse à l’huile de nigelle [Bullous drug eruption with Nigella sativa oil]. Ann Dermatol Venereol. 2012;139(4):287–291.
5. Gaudin O, Toukal F, Hua C, et al. Association between severe acute contact dermatitis due to nigella sativa oil and epidermal apoptosis. JAMA Dermatol. 2018;154(9):1062–1065.
6. Howard K, Peng S. Severe contact dermatitis mimicking stevens-johnson syndrome. Presented at Hospital Medicine 2020;  Virtual.
7. Lellig E, Pinault AL, Vaillant A, et al. Syndrome d’hypersensibilité médicamenteuse (DRESS) secondaire à l’application d’huile de nigelle. EM-Consulte. Accessed 25 Oct 2023. https://www.em-consulte.com/article/1409267/syndrome-d-hypersensibilite-medicamenteuse-dress-s
8. Fargeas M, Calugareanu A, Ben-Said B. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after topical use of Nigella sativa (black cumin) oil. Contact Dermatitis. 2022;87(2):203–204.