Kava dermopathy

What is kava?

The kava plant is a member of the black pepper family (Piper methysticum) that is traditionally used in the South Pacific to make a psychotropic beverage consumed in cultural ceremonies and also socially — the drink is also called kava.

Kava is made by infusing the dried roots of the kava plant in water, or less commonly, in coconut milk.

Kava leaves 

Kava root 

Preparing kava 

What is kava dermopathy?

Kava dermopathy is a skin condition that occurs in patients who regularly consume kava [1]. In Fiji, kava dermopathy is known as kanikani [2], while in Australia it is also known as crocodile skin [4].

Acquired ichthyosis in kava drinker 

Who gets kava dermopathy?

Kava dermopathy occurs in people who are regular or heavy consumers of kava [2,3].

It most commonly occurs in the South Pacific and the Indigenous population of northern Australia [4].

What causes kava dermopathy?

The cause of kava dermopathy is unknown; however, there are many hypotheses including [2]:

• Interference with cholesterol metabolism
• Accumulation of kavalactones or flavopigments
• Allergic systemic contact dermatitis
• Defective cytochrome P450 enzymes [4].

What are the clinical features of kava dermopathy?

• The rash from kava dermopathy often begins on head, face and neck, and gradually becomes more generalised [4].
• The rash is ichthyosiform (resembling ichthyosis); that is, rough, dry and scaly.
• The scales are polygonal in shape.
• The rash lacks erythema [2].
• It may be more evident in areas of skin exposed to the sun [3].
• There is often associated palmoplantar keratoderma [2].
• Facial swelling and hair loss may also occur [3].
• Some patients complain of flushing.
• Kava dermopathy may have an associated peripheral neuropathy, resulting in numb or tingling hands and feet.

How is kava dermopathy diagnosed?

Kava dermopathy is usually a clinical diagnosis, taking into account the physical features and the history, including a history of regular kava consumption, in addition to the resolution of the rash on the cessation of kava consumption [4].

What is the differential diagnosis for kava dermopathy?

Other ichthyotic disorders may appear similar to kava dermopathy. Ichthyotic disorders can be distinguished based on the patient’s history.

Inherited ichthyosis will usually occur at a much younger age and may be congenital (eg, ichthyosis vulgaris and recessive X-linked ichthyosis).

Other causes of acquired ichthyosis include [5]:

• Malignancy
• Abnormality of vitamin and lipid absorption
• Medications (eg, cholesterol-lowering drugs, nicotinic acid)
• Infections, such as human immunodeficiency virus (HIV), leprosy, human T-cell lymphotropic virus type 1 (HTLV-1).

What is the treatment for kava dermopathy?

Kava dermopathy clears up when the consumption of kava is stopped [3,4].

General measures to manage the rash include:

• Soap-free cleanser
• Emollients and keratolytics, such as urea cream.

What is the outcome for kava dermopathy?

Ongoing kava consumption will result in persistence and likely progression of kava dermopathy.