Phytophotodermatitis is a cutaneous phototoxic inflammatory eruption that occurs when a photosensitizer, such as psoralen, contained in many plants, comes in contact with the skin and is followed by exposure to UVA radiation from the sun. The eruption could be considered a very localized sunburn that usually begins 12-24 hours after exposure and peaks at 48-72 hours. Phytophotodermatitis most commonly occurs in the spring and the summer when psoralens are most concentrated in plants and when UV exposure is greatest for children.
After plant contact and subsequent exposure to sunlight, a burning erythema develops that may lead to vesicle and bullae formation. This is commonly followed by postinflammatory hyperpigmentation. Four main plant families implicated as the causative agent are Umbelliferae (hogweed, cow parsley, wild parsnip, celery, wild carrots, meadow grass), Rutaceae (rue bergamot, citrus fruits, especially lime juice and lemon skin), Moraceae (figs), and Leguminoseae (scurf pea). The term "berloque dermatitis" refers to phytophotodermatitis from natural oil of bergamot – extracted from the peel of ornamental oranges – in perfumes and colognes. Since the introduction of artificial oil of bergamot, it has become rare.
Exposure to the plant sap of wild parsnip (Pastinaca sativa; "poison parsnip") can cause severe phytophotodermatitis. It is frequently found in road ditches and fields, and exposure has occurred while hiking or biking along trails and gardening (pulling weeds). When in bloom it looks similar to Queen Anne's lace or dill plant and grows to around 4 feet tall. It is common throughout the United States.
There is no age, sex, or racial predilection, although phytophotodermatitis may be more noticeable on lighter skin phototypes. The condition is benign and self-limited, and treatment is supportive. In some cases, the preceding inflammatory skin reaction may be mild, and the patient may just present with postinflammatory hyperpigmentation.
Phytophotodermatitis is a common mimicker of child abuse, with lesions similar to bruises, burns, or imprinted finger marks. Classic examples include a linear drip pattern and streaks on a child's hands, arms, and around the mouth after eating citrus ice pops or drinking juice, and a hand imprint from adults handling the sensitizing material. The eruption typically appears hours to days after the exposure, making the lesion more difficult to attribute to the contact. Thus, history of exposure is the crucial factor differentiating these lesions from abuse.
Phytophotodermatitis is a skin reaction due to sun exposure (ultraviolet radiation) following contact with certain plants containing furocoumarins. These include fennel, figs, carrots, celery, parsley, wild parsnip, oil of bergamot, limes, Persian limes, lemons, oranges, other citrus plants, and certain weeds, such as hogweed and Queen Anne's lace (also called wild carrot). Contact can be made during agricultural work, outdoor gardening, hiking, and outdoor dining.
A burning, red, sometimes blistering skin reaction can occur about 24 hours after exposure to plants and sunlight.
Although unpleasant, phytophotodermatitis commonly goes away on its own. Dark patches may last months to years.
Who’s At Risk
Phytophotodermatitis can occur in adults or children, male or female, and of any race or ethnicity. Persons handling citrus fruits and beverages, citrus grove and celery workers, and others exposed to sunlight and furocoumarin-containing plants are more likely to develop this skin reaction.
Tropical and subtropical regions have a greater occurrence of cases of phytophotodermatitis.
Signs & Symptoms
Phytophotodermatitis looks like burning, red, and sometimes blistering skin where it came in contact with limes, citrus, figs, or other furocoumarins followed by exposure to sunlight. Skin may be painful, itchy, swollen, and darkened. The skin reaction may appear in lines, streaks, angular patches, or strange configurations.
This reaction can occur within 24-48 hours of exposure.
Self-Care Guidelines
Avoid plant and citrus contact with skin. Use adequate sunscreen and protective clothing to prevent the reaction.
Symptoms may be relieved with cool compresses or soaking in cool water.
When to Seek Medical Care
For severe reactions that persist or to rule out other causes, contact your doctor.
Patient Information for Phytophotodermatitis in Child