Clinical CommunicationsPhytophotodermatitis: the other “lime” disease1
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:...
- et al.
Endemic “lime” disease: phytophotodermatitis in San Diego County
Pediatrics
(1994) - et al.
Phytophotodermatitis: a visit to magaritaville
Cutis
(1993)
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