Unilateral Hand Pruritus Following Garden Tomato Harvesting

Case at a Glance

A 25-year-old female presents with acute onset unilateral hand pruritus following direct contact with garden tomatoes, with no visible dermatological changes and poor response to antihistamines.

Patient's Story

The patient reported developing intense itching on the dorsum of one hand immediately after harvesting tomatoes from her personal garden. She denied any previous exposure to fresh tomatoes, having only consumed processed tinned varieties. The affected area showed no erythema, edema, or visible lesions. She attempted self-treatment with oral antihistamines without significant relief. The patient expressed concern about possible tomato allergy development.

Initial Assessment

Physical examination revealed isolated pruritus of the dorsal hand surface without accompanying rash, swelling, or other dermatological manifestations. No systemic symptoms were reported. The patient appeared otherwise well with stable vital signs.

The Diagnostic Journey

Initial differential diagnosis included contact dermatitis from tomato plant alkaloids, insect bite reaction, or acute contact sensitivity. The unilateral presentation despite bilateral hand use during harvesting suggested a localized rather than systemic allergic reaction. Patient history revealed no prior fresh tomato exposure, only processed varieties.

Final Diagnosis

Probable contact dermatitis secondary to tomato plant solanine exposure, with consideration for delayed insect bite reaction given the localized unilateral presentation.

Treatment Plan

Symptomatic management with topical corticosteroids and cool compresses. Patient education regarding tomato plant alkaloid sensitivity. Recommendation for supervised re-exposure trial with protective gloves to differentiate between plant sensitivity and coincidental insect bite.

Outcome and Follow-up

Patient advised to monitor for bilateral symptoms with future tomato handling. If symptoms recur with repeat exposure, referral to allergist for formal testing recommended. Follow-up scheduled if symptoms persist beyond 48-72 hours or if systemic symptoms develop.