“A 42-year-old Indian man from Bhilai, Chhattisgarh State, presented with a 4-day history of severe itching over the back, starting 2 days after application of diluted marking nut juice over two human figures etched by a knife on his back by a local traditional healer. The healer was attempting to cure the patient of his repeated skin problems induced by exposure to the marking nuts. Cutaneous examination revealed marked erythema around the two human figures etched on the patient’s back (Fig. 1). There were no systemic complaints. He had not used any local or oral medication. Systemic examination was not contributory, and routine hematology and urine examination were normal. The patient had suffered from several episodes of severely itchy facial skin lesions and periorbital edema, developing after exposure to the fumes of marking nuts being boiled in pots by his neighbors (Fig. 2a). On two occasions, he required hospitalization and treatment with hydrocortisone acetate injections and hydroxyzine hydrochloride tablets. Fed up with this, he consulted a traditional healer, who assured him of a cure by etching the figures of his supposed enemies and exposing them to the same allergen. He improved after 3 weeks of treatment with hydrocortisone acetate injections and hydroxyzine hydrochloride tablets, 25 mg twice daily.”
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