Phytophotodermatitis

A 3-year-old girl was with her family on vacation in Cancun, Mexico, when blisters developed on the fingers of both her hands. The family returned home early and sought immediate medical attention.

The skin changes had developed about 48 hours before presentation. After careful questioning, it was learned that the child had been squeezing limes with her hands. Only the skin that had been in contact with the lime juice was affected.

This child had phytophotodermatitis, which results when skin comes in contact with photosensitizing chemicals, commonly psoralens, and then is exposed to UVA light. These chemicals are found in various plants, such as limes, lemons, parsley, and celery. The reaction is benign and temporary, although it may be quite severe, with erythema and bullae that resemble the features of a bad sunburn (as in this child). Phytophotodermatitis occurs quite frequently in children and adults vacationing in Mexico because of the frequent use of limes in Mexican cuisine combined with the intensity of the sunlight in that country.^1,2

The lesions had almost healed within a week after presentation. The family was given a topical antibiotic to prevent secondary bacterial infection. Phytophotodermatitis typically heals without long-term sequelae, although post-inflammatory hyperpigmentation can appear and persist for several months to years.

References:

REFERENCES:
1. Goskowicz MO, Friedlander SF, Eichenfield LF. Endemic “lime” disease: phytophotodermatitis in San Diego County. Pediatrics. 1994;93:828-830.
2. Weber IC, Davis CP, Greeson DM. Phytophotodermatitis: the other “lime” disease. J Emerg Med. 1999;17:235-237.