Phytophotodermatitis

Background

• The result of chemicals in certain foods reacting with sunlight to cause an aggrevated "sun-burn" like rash

Common Causative Agents

• Celery
• Parsnip
• Fennel
• Lime
• Carrot
• Mustard
• Parley
• Dill
• Grapefruit
• Lemon
• Fig
• St. John's wort

Clinical Features

Phytophotodermatitis caused by lime

Classic phytophotodermatitis

Severe phytophotodermatitis

• Bizzarre, linear streaking rash that can be painful or burning
• Bullae and vesicles
• Often in a "dripping" pattern or with hand-prints
• Acute phase 3-5 days, may then progress to hyperpigmentation for months

Differential Diagnosis

Vesiculobullous rashes

Febrile

• Diffuse distribution
  • Varicella
  • Smallpox
  • Disseminated gonococcal disease
  • DIC
  • Purpural fulminans
• Localized distribution
  • Necrotizing fasciitis
  • Hand-foot-and-mouth disease

Afebrile

• Diffuse distribution
  • Bullous pemphigoid
  • Drug-Induced bullous disorders
  • Pemphigus vulgaris
  • Phytophotodermatitis
  • Erythema multiforme major
• Localized distribution
  • Contact dermatitis
  • Herpes zoster
  • Dyshidrotic eczema
  • Burn
  • Dermatitis herpetiformis
  • Erythema multiforme minor
  • Poison Oak, Ivy, Sumac dermatitis
  • Bullosis diabeticorum

Evaluation

• Clinical diagnosis

Management

• Topical steroids (e.g. topical triamcinolone)

Disposition

• Outpatient

See Also

• Rashes

References

Authors

Ross Donaldson, Neil Young