Resident Rounds: Part III - Case Report: Betel Quid Induced Irritant Contact Dermatitis of the Hand

June 2016 | Volume 15 | Issue 6 | Features | 789 | Copyright © June 2016

Regine J. Mathieu BS,a Nikoo Cheraghi MD,b and Marian A. Russo MDb

aNew York Medical College, School of Medicine, Valhalla, NY
bNew York Medical College, Department of Dermatology, New York, NY

table 1
been previously reported.8 Eugenol, the major component of betel leaf containing psychoactive ingredients, has also been reported to cause allergic contact dermatitis.2,10 In our patient, although patch testing was not performed, the clinical appearance and distribution of the rash indicates a contact dermatitis to a component of the betel quid, likely due to the irritating alkaline slaked lime.


The practice of chewing betel nut mixed with slaked lime paste, tobacco, and betel leaf is not common in the United States; however, when faced with a patient with a non-correlating history and physical exam, inquiry into cultural practices is imperative for accurate diagnosis.


The authors have no conflicts of interest to declare.


  1. Raghavan V, Baruah HK. Arecanut: India’s popular masticatory—history, chemistry and utilization. Econ Bot.1958;12(4):315-345.
  2. Nelson BS, Heischober B. Betel nut: a common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands. Ann Emerg Med. 1999;34(2):238-243.
  3. Mankapure PK, Humbe JG, Mandale MS, Bhavthankar JD. Clinical profile of 108 cases of oral lichen planus. J Oral Sci. 2016;58(1):43-47.
  4. Bhat SJ, Blank MD, Balster RL, Nichter M, Nichter M. Areca nut dependence among chewers in a South Indian community who do not also use tobacco. Addiction. 2010;105(7):1303-1310.
  5. Tsai YS, Lee KW, Huang JL, et al. Arecoline, a major alkaloid of areca nut, inhibits p53, represses DNA repair, and triggers DNA damage response in human epithelial cells. Toxicology. 2008;249(2-3):230-237.
  6. Singh G. Betel chewers’ perleche. Br J Dermatol. 1973;89(1):98.
  7. Sharan RN, Mehrotra R, Choudhury Y, Asotra K. Association of betel nut with carcinogenesis: revisit with a clinical perspective. PLoS One. 2012;7(8):e42759.
  8. Wang BJ, Guo YL, Guo HR, Chang HY. Piper betle L. inflorescence causes allergic contact dermatitis of the hands during betel quid assembly. Contact Dermatitis. 2008;58(6):368-370.
  9. Blank M, Deshpande L, Balster RL. Availability and characteristics of betel products in the U.S. J Psychoactive Drugs. 2008;40(3):309-313.
  10. Sánchez-Pérez J, García-Díez A. Occupational allergic contact dermatitis from eugenol, oil of cinnamon and oil of cloves in a physiotherapist. Contact Dermatitis. 1999;41(6):346-347.


Nikoo Cheraghi