A Sometimes Difficult Diagnosis
Renee R. Solis, BA;
Dearl A. Dotson, MD;
Zoltan Trizna, MD, PhD
Arch Fam Med. 2000;9:1195-1196.
Phytophotodermatitis may not be diagnosed when a patient is seen with erythema and vesicles on the skin. However, with the appropriate medical history, the diagnosis of phytophotodermatitis is easily made.
Phytophotodermatitis is the eruption that occurs after contact with photosensitizing compounds in plants and exposure to sunlight. It may be mistaken for atopic dermatitis, type IV hypersensitivity reaction, or a chemical burn.
REPORT OF A CASE
A young Hispanic patient took part in a beach party at which he was preparing margaritas by squeezing limes with both of his hands. Subsequently, he had extensive sun exposure throughout the day. One day thereafter he developed erythema affecting both the radial and the ulnar aspects of his fingers. Two days after the sun exposure, vesicles developed over the erythematous areas (Figure 1).
Vesicles distributed in erythematous areas of the fingers.
Plants may cause allergic contact, irritant contact, and phototoxic dermatitis. The eruption that occurs after contact with photosensitizing compounds in plants and exposure to sunlight (especially UV-A, 320-400 nm range of the spectrum) is called phytophotodermatitis.1 It is frequently found in people who spend a lot of time participating in outdoor activities, beach-goers, and children playing outdoors, and it is commonly diagnosed in agricultural workers, florists, and gardeners.2 Furocoumarins (eg, 5-methoxypsoralen), found in limes, lemons, oranges, celery, fig, parsnip, parsley, carrots, dill, and perfumes, are commonly implicated.1, 3
The diagnosis of phytophotodermatitis may not be first entertained when a patient presents with erythema and vesicles.4 It is often mistaken for atopic dermatitis, type IV hypersensitivity reaction (eg, poison ivy), or a chemical burn. However, with the appropriate history, the diagnosis of phytophotodermatitis is easily made. Making the correct diagnosis allows for patient education (to avoid future exposure) and early treatment with a topical steroid; this decreases the amount of inflammation that leads to the hyperpigmentation seen as the long-term sequelae of phytophotodermatitis.
After a short treatment with topical steroids (triamcinolone 0.1% cream twice daily), the lesions in our patient healed. Four weeks after the initial clinical presentation, very slight hyperpigmentation over the affected areas remained.
Accepted for publication August 29, 2000.
Corresponding author: Zoltan Trizna, MD, PhD, Department of Dermatology, Texas Tech University Health Sciences Center, 3601 Fourth St, Lubbock, TX 79430.
From the Department of Dermatology, University of Texas Medical Branch, Galveston. Dr Trizna is now with the Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock.
1. Egan CL, Sterling G. Phytophotodermatitis: a visit to Margaritaville. Cutis. 1993;51:41-42.
2. Koh D, Ong CN. Phytophotodermatitis due to the application of citrus hystrix as a folk remedy. Br J Dermatol. 1999;140:737-738.
3. Weber IC, Davis CP, Greeson DM. Phytophotodermatitis: the other "lime" disease. J Emerg Med. 1999;17:235-237.
4. Lutchman L, Inyang V, Hodgkinson D. Phytophotodermatitis associated with parsnip picking. J Accid Emerg Med. 1999;16:453-454.
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