Phytophotodermatitis

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Phytophotodermatitis
Phytophotodermatitis from exposure to lime juice.jpg
Phytophotodermatitis caused by lime
Specialty Dermatology Edit this on Wikidata

Phytophotodermatitis, also known as Berloque dermatitis[1][2] or Margarita photodermatitis,[3][4] is a skin condition caused by a chemical reaction that leaves skin hypersensitive to ultraviolet light. It is frequently mistaken for hereditary conditions such as atopic dermatitis or chemical burns. In fact, phytophotodermatitis results from contact with certain photosensitizing compounds—such as furanocoumarins[5]—found naturally in some plants and vegetables such as parsnips. These same compounds are also found in citrus fruits, especially limes,[6] hence the alternative name "lime disease"[7] (not to be confused with Lyme disease). Symptoms include burning, itching and large blisters that slowly accumulate over time.[8]

Before the mid-twentieth century, reports of plant-based dermatitis failed to recognize the crucial role of ultraviolet radiation. In 1942, Klaber introduced the term "phytophotodermatitis" to emphasize that both plants and light were required to affect a reaction.[9][10] An early description of the disease was made by Darrell Wilkinson, a British dermatologist in the 1950s.[11]

Symptoms[edit]

The symptoms are equivalent to photodermatitis, but vary in severity. The skin condition is a cutaneous phototoxic inflammatory eruption resulting from contact with light-sensitizing botanical substances—particularly from the plant families Umbelliferae, Rutaceae, Moraceae, and Leguminosae—and ultraviolet light, typically from sun exposure. Phytophotodermatitis usually results in hyperpigmentation of the skin that often appears like a bruise. This may be accompanied by blisters or burning. The reaction typically begins within 24 hours of exposure and peaks at 48–72 hours after the exposure.[12]

Effect of the common rue on skin
A severe case of phytophotodermatitis

Phytophotodermatitis can affect people of any age. Because of the bruise-like appearance that is usually in the shape of handprints or fingerprints, it can be mistaken in children for child abuse.[13]

Common causes[edit]

Prevention[edit]

The first and best line of defense against phytophotodermatitis is to avoid contact with phototoxic substances in the first place:

  • Avoid contact with the Apiaceae family of plants and other biological agents known to have phototoxic effects. Do not incinerate phototoxic plants and agents since this will serve to disperse the phototoxic substances more widely.[29]
  • In situations where contact with phototoxic plants is likely, wear long pants and a long-sleeve shirt. Wear gloves and protective eyewear before handling such plants.
  • If protective clothing is not available, apply sunscreen to exposed areas. This will provide some measure of protection if contact is made.
  • After an outdoor activity, take a shower or a bath as soon as possible. Wash your clothing and then wash your hands after handling the dirty clothes.

A second line of defense is to avoid sunlight, so as not to activate a phototoxic substance:

  • If you come in contact with a phototoxic substance, immediately wash the affected area with soap and water, and avoid any further exposure to sunlight for at least 48 hours.
  • Stay indoors, if possible. Be careful to avoid light shining through windows.
  • In lieu of sun protective clothing, apply sunscreen[30] to the affected areas after washing.

Phytophotodermatitis is triggered by long wavelength ultraviolet light (called UVA) in the range of 320–380 nanometers,[31] so the best sun protective clothing and sunscreen products will block these wavelengths of UVA radiation.

In 2011, the U.S. Food and Drug Administration (FDA) established a "broad spectrum" test for determining a sunscreen product's UVA protection.[32] Sunscreen products that pass the test are allowed to be labeled as "Broad Spectrum" sunscreens, which protect against both UVA and UVB rays.

There is no equivalent test or FDA-approved labeling for sun protective clothing. Some clothing is labeled with an Ultraviolet Protection Factor (UPF) but test results from Consumer Reports[33] suggest that UPF is an unreliable indicator of UV protection.

If in doubt, consult a dermatologist for specific product recommendations.

Treatment[edit]

Many different topical and oral medications may be used to treat the inflammatory reaction of phytophotodermatitis. A dermatologist may also prescribe a bleaching cream to help treat the hyperpigmentation and return the skin pigmentation back to normal. If the patient does not receive treatment, the affected sites may develop permanent hyperpigmentation or hypopigmentation.[12]

See also[edit]

References[edit]

  1. ^ James, William Daniel; Berger, Timothy G.; Elston, Dirk M., eds. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 32. ISBN 978-0-7216-2921-6. 
  2. ^ Alikhan, Ali (March 4, 2016). "Berloque Dermatitis". Medscape. Retrieved August 9, 2018. 
  3. ^ Riahi, Ryan R.; Cohen, Philip R.; Robinson, Floyd W.; Gray, James M. (June 2009). "What Caused The Rash On This Man's Wrist And Hand?". The Dermatologist. 11 (6). 
  4. ^ Abramowitz, Alan I.; Resnik, Kenneth S.; Cohen, Kenneth R. (1993). "Margarita Photodermatitis". New England Journal of Medicine. 328 (12): 891. doi:10.1056/NEJM199303253281220. PMID 8441448. 
  5. ^ Lime Disease SciShow YouTube video
  6. ^ Hankinson, Andrew; Lloyd, Benjamin; Alweis, Richard (2014). "Lime-induced phytophotodermatitis". J Community Hosp Intern Med Perspect. 4 (4). doi:10.3402/jchimp.v4.25090. PMID 25317269. 
  7. ^ a b Weber, Ian C; Davis, Charles P; Greeson, David M (1999). "Phytophotodermatitis: The other 'lime' disease". The Journal of Emergency Medicine. 17 (2): 235–7. doi:10.1016/S0736-4679(98)00159-0. PMID 10195477. 
  8. ^ Solis, R. R.; Dotson, DA; Trizna, Z (2000). "Phytophotodermatitis: A Sometimes Difficult Diagnosis". Archives of Family Medicine. 9 (10): 1195–6. doi:10.1001/archfami.9.10.1195. PMID 11115230. 
  9. ^ McGovern, Thomas W; Barkley, Theodore M. "Phytophotodermatitis". The Electronic Textbook of Dermatology--Botanical Dermatology. Retrieved August 11, 2018. 
  10. ^ a b de Almeida Junior, Hiram Larangeira; Sartori, Débora Sarzi; Jorge, Valéria Magalhães; Rocha, Nara Moreira; de Castro, Luis Antonio Suita (2016). "Phytophotodermatitis: A Review of Its Clinical and Pathogenic Aspects". Journal of Dermatological Research. 1 (3): 51–56. Retrieved August 13, 2018. 
  11. ^ "Munks Roll Details for Peter Edward Darrell Sheldon Wilkinson". munksroll.rcplondon.ac.uk. Retrieved 2017-11-10. 
  12. ^ a b c Phytophotodermatitis at eMedicine
  13. ^ Barradell, R.; Addo, A.; McDonagh, A. J. G.; Cork, M. J.; Wales, J. K. H. (1993). "Phytophotodermatitis mimicking child abuse". European Journal of Pediatrics. 152 (4): 291–2. doi:10.1007/BF01956735. PMID 8482273. 
  14. ^ a b c Photocontact dermatitis. DermNet NZ[unreliable medical source?]
  15. ^ Lutchman, L; Inyang, V; Hodgkinson, D (1999). "Phytophotodermatitis associated with parsnip picking". Emergency Medicine Journal. 16 (6): 453–4. doi:10.1136/emj.16.6.453. PMC 1343418Freely accessible. PMID 10572825. 
  16. ^ Giant Hogweed phytophotodermatitis GPnotebook login required[unreliable medical source?]
  17. ^ Klauder, Joseph V.; Klauder, JV (1956). "Sensitization Dermatitis to Carrots: Report of Cross-Sensitization Phenomenon and Remarks on Phytophotodermatitis". Archives of Dermatology. 74 (2): 149–58. doi:10.1001/archderm.1956.01550080035006. PMID 13353987. 
  18. ^ The Plant List (2013). Version 1.1. Published on the Internet; http://www.theplantlist.org/ (accessed 19th December 2015)
  19. ^ Manning, John (2008). Field Guide to Fynbos. Cape Town: Struik Publishers. ISBN 9781770072657. 
  20. ^ Leung; Fong, Justine H. S. (April 1, 2003). "Alexander K. C". 
  21. ^ Arias-Santiago, S. A.; Fernández-Pugnaire, M. A.; Almazán-Fernández, F. M.; Serrano-Falcón, C.; Serrano-Ortega, S. (2009). "Phytophotodermatitis due to Ruta graveolens prescribed for fibromyalgia". Rheumatology. 48 (11): 1401. doi:10.1093/rheumatology/kep234. PMID 19671699. 
  22. ^ Furniss, Dominic; Adams, Titus (2007). "Herb of Grace: An Unusual Cause of Phytophotodermatitis Mimicking Burn Injury". Journal of Burn Care & Research. 28 (5): 767–9. doi:10.1097/BCR.0B013E318148CB82. PMID 17667834. 
  23. ^ Eickhorst, Kimberly; Deleo, Vincent; Csaposs, Joan (2007). "Rue the Herb: Ruta graveolens–Associated Phytophototoxicity". Dermatitis. 18 (1): 52–5. doi:10.2310/6620.2007.06033. PMID 17303046. 
  24. ^ Wessner, D.; Hofmann, H.; Ring, J. (1999). "Phytophotodermatitis due to Ruta graveolens applied as protection against evil spells". Contact Dermatitis. 41 (4): 232. doi:10.1111/j.1600-0536.1999.tb06145.x. PMID 10515113. 
  25. ^ Centers for Disease Control (CDC) (January 11, 1985). "Phytophotodermatitis among Grocery Workers - Ohio". Morbidity and Mortality Weekly Report. 34 (1): 11–3. PMID 3155560. 
  26. ^ Bonamonte D, Foti C, Lionetti N, Rigano L, Angelini G (June 2010). "Photoallergic contact dermatitis to 8-methoxypsoralen in Ficus carica". Contact Dermatitis. 62 (6): 343–8. doi:10.1111/j.1600-0536.2010.01713.x. PMID 20557340. 
  27. ^ allergy to latex, including fig latex http://www.medic8.com/healthguide/allergies/latex-allergies/symptoms-latex-allergy.html
  28. ^ "Wellness Library:Ambrette (Abelmoschus moschatus)". 
  29. ^ Davis, Dawn (August 12, 2011). "Sun-related Skin Condition Triggered by Chemicals in Certain Plants, Fruits". Dermatology, Mayo Clinic. Retrieved August 8, 2018. 
  30. ^ Leonard, Jayne (August 19, 2017). "Phytophotodermatitis: When plants and light affect the skin". Medical News Today. Retrieved August 8, 2018. 
  31. ^ Baugh, William P (September 8, 2016). "Phytophotodermatitis". Medscape. Retrieved August 9, 2018. 
  32. ^ "FDA announces new requirements for over-the-counter (OTC) sunscreen products marketed in the U.S." U.S. Food and Drug Administration. June 11, 2011. Retrieved August 9, 2018. 
  33. ^ "Testing sun protective clothing". Consumer Reports. August 11, 2015. Retrieved August 9, 2018. 

External links[edit]

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