Letter to the Editor

Phytophotodermatitis Due to Puncture from Lime Tree Thorn

Authors: Lawrence M. Roth, MD, Elizabeth H. Levin, MD, Arthur H. Schwartz, MD, David J. Roth, BA

Abstract

To the Editor:


Phytophotodermatitis is a cutaneous phototoxic inflammatory eruption due to exposure to light-sensitizing botanical substances and long-wave ultraviolet radiation that usually begins approximately 24 hours after exposure and peaks at 48 to 72 hours.1 The primary skin lesions of phytophotodermatitis may range from delayed erythema (24–48 h) to a frankly nodular eruption. The photosensitizing compounds in the plants are furocoumarins. The phototoxic reaction is entirely independent of the immune system; thus, prior sensitization or an intact immune system is not required. The clinical history is essential in establishing the diagnosis of phytophotodermatitis.

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References

1. Baugh WP, Barnette D Jr. Phytophotodermatitis. emedicine [August 24, 2005;http://www.emedicine.com/derm/topic324.htm. Accessed March 1, 2006].
 
2. Goskowicz MO, Friedlander SF, Eichenfield LF. Endemic ‘lime’ disease: phytophotodermatitis in San Diego County. Pediatrics 1994;93:828–830.
 
3. Nigg HN, Nordby HE, Beier RC, et al. Phototoxic coumarins in limes. Food Chem Toxicol1993;31:331–335.
 
4. Wagner AM, Wu JJ, Hansen RC, et al. Bullous phytophotodermatitis associated with high natural concentrations of furanocoumarins in limes. Am J Contact Dermat 2002;13:10–14.
 
5. Solis RR, Dotson DA, Trizna Z. Phytophotodermatitis: a sometimes difficult diagnosis. Arch Fam Med 2000;9:1195–1196.