Elsevier

The Journal of Emergency Medicine

Volume 17, Issue 2, March–April 1999, Pages 235-237
The Journal of Emergency Medicine

Clinical Communications
Phytophotodermatitis: the other “lime” disease1

https://doi.org/10.1016/S0736-4679(98)00159-0Get rights and content

Abstract

Phytophotodermatitis is a skin eruption that occurs after contact with photosensitizing compounds in plants and exposure to UV light. There are two common presentations of phytophotodermatitis. Acutely, erythema and vesiculation similar to a severe sunburn are noted. After resolution of the inflammation, the involved skin has marked hyperpigmentation. Many plants have been identified that contain furocoumarins (psoralens), including limes, lemons, and celery. We present a patient with an acute phototoxic eruption and hyperpigmentation after contact with limes during a beach vacation.

Introduction

Phytophotodermatitis is reported in patients with occupational exposure to plants (e.g., chef, grocer, field worker; References 1, 2, 3). It is also seen in patients exposed to lime products while partaking in festivities in the sunlight. We present a case in which a 27-year-old female presented to the emergency department (ED) with erythematous, blistering eruptions on both upper and lower extremities. The patient, during the dermatology interview, related that she had come in contact with limes while partaking in festivities during her recent vacation trip to Mexico.

The purpose of this paper is two-fold. One is to bring attention to this type of dermatitis, especially in patients who have had a recent trip to a tropical destination. The second goal is to bring attention to the possibility of the misdiagnosis of child abuse in children 3, 4 who may have accompanied parents to these vacation spots or been around their parents during festivities at home.

Section snippets

Case report

A 27-year-old female presented to the ED in a frantic state complaining of blistering eruptions on her lower extremities and small blisters on both of her upper extremities. At the time she provided no history of any similar “rash” and provided no clues as to why she might have these blistering eruptions.

Physical examination revealed erythematous eruptions, some with blisters, on both upper and lower extremities (Figure 1, A–C) . Parallel linear streaking with a few blisters was prominent on

Discussion

Phytophotodermatitis has been identified as a reaction that takes place on an area of skin that has come in contact with both photosensitizing agents and sunlight. The active chemical compounds identified in causing phytophotodermatitis are psoralens. They belong to a family of compounds called furocoumarins. Common plants that have been associated with phytophotodermatitis are listed in Table 1. Psoralens have been used in the treatment of skin depigmentation and are thought to have been used

Summary

Phytophotodermatitis is not an uncommon disease. It is a photosensitive reaction that does not need previous exposure to furocoumarins. The disease can be properly diagnosed if a complete history is obtained. Sometimes, however, patients cannot give a complete history. Our patient did not think her trip and the use of limes were related to the rash. She didn’t originally mention this trip and only mentioned it to the dermatologist upon direct questioning regarding limes and alcoholic beverages.

References (6)

  • Harber LC, Blickers DR. Photosensitivity disease: principles of diagnosis and treatment. 2nd ed. Philadelphia:...
  • M.O Goskowicz et al.

    Endemic “lime” disease: phytophotodermatitis in San Diego County

    Pediatrics

    (1994)
  • C.L Egan et al.

    Phytophotodermatitis: a visit to magaritaville

    Cutis

    (1993)
There are more references available in the full text version of this article.

Cited by (0)

1

Clinical Communications (Adults) is coordinated by Ron M. Walls, md, of Brigham and Women’s Hospital and Harvard University Medical School, Boston, Massachusettts

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