Welcome to our latest slideshow! Click through the slides to learn about presentations of phytophotodermatitis. Each slide links to the full case report for more details.
Phytophotodermatitis is a cutaneous photochemical reaction that can affect any skin type. The cutaneous reaction is provoked by exposure to phototoxic plant substances called furocoumarins (psoralen isomers) and the activation of long-wave UV-A radiation that damages the epidermal cells. The skin reaction can vary from asymptomatic erythema and a painful maculopapular rash to the formation of severe bullae. Presentations also can include pain from sunburn and linear rash (nonserpiginous), with or without hyperpigmented tracks, in which the hyperpigmentation (caused by an increase in melanin deposition) may persist for weeks to months.
In the case above, lime juice permeated the skin and became the photosensitizer, creating the exaggerated burns after subsequent UV-A exposure in the tanning bed.
Robert Klaber in 1942 coined the term phytophotodermatitis to describe the phenomenon. Some people have since referred to it as “Club Med” dermatitis.
Phytophotodermatitis is most commonly seen in the summer when furocoumarins are at the highest concentrations in plants, when people are outdoor more often with less protective clothing, and when ultraviolet exposure is greatest. Perspiration, high humidity, and heat increase the absorption of furocoumarins, thereby increasing the intensity of phototoxic reactions.
This case involved a child who often ate lemons and limes, carrying the dripping fruit around outdoors while she sucked on it.
In most cases, as with this patient, there is hyperpigmentation in an annular, guttate pattern formed by the liquid as it drips onto skin, followed immediately by sun exposure. Patients may also report mild irritation.
The darker the patient’s skin, the darker the hyperpigmentation, and the longer it takes for the condition to clear. No treatment is necessary.
In this case, a 25-year-old man had spent several hours on a pool float drinking several bottled beverages. He had placed lime wedges in the bottles, and he felt that the lime juice likely had leaked down the side of the bottles and onto his chest.
The most common plant families associated with the development of phytophotodermatitis include the Rutaceae, Umbelliferae, and Moraceae families. The Rutaceae family contains many citrus fruits, including limes, lemons, and grapefruits, as well as garden rue, a type of shrub. As in our patient’s case, many people have incidental exposure to the fruit or fruit juice, such as lime juice consumed with beverages. The Umbelliferae family contains carrot, celery, parsnip, and parsley plants. One common scenario is that of grocery store workers who develop this reaction following contact with celery. In the Moraceae family, the fig tree is a common trigger that may result in reactions in farmers who are exposed to its stems and leaves.
Dermatology Disorders
Slideshow: Phytophotodermatitis
05/07/2021
