eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Phytophototoxins: Differential Diagnoses & Workup

Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Coauthor(s): Thomas Joseph Lydon, MD, PhD, Consulting Staff, Section of Emergency Medicine, Dartmouth-Hitchcock Medical Center; William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
Contributor Information and Disclosures

Updated: Sep 23, 2008

Differential Diagnoses

Dermatitis, Atopic
Dermatitis, Contact
Sunburn

Other Problems to Be Considered

Actinic prurigo
Allergic contact dermatitis to airborne substances
Hydroa aestivalis and vacciniforme
Chronic actinic dermatitis
Porphyria cutanea tarda
Protoporphyria
Polymorphous light eruption
Solar urticaria

Workup

Laboratory Studies

  • PPD is a clinical diagnosis. No serum level for psoralens is available or appropriate. Clinical presentation is delayed and systemic clearance of psoralens is complete.

Other Tests

  • With yeast inhibition technique, plant extract is used to evaluate for presence of psoralens.
  • In individuals in whom the diagnosis is in question, referral to a dermatologist for photo-patch testing may be warranted. Testing should include sunscreens, pesticides, and plant allergens.

Procedures

  • In individuals in whom the diagnosis is in question, referral to a dermatologist for a skin biopsy may be warranted. A skin biopsy may demonstrate epidermal hyperkeratosis, "sunburn cells," and an inflammatory cell infiltrate. An increase in melanocytes is seen.

More on Plant Poisoning, Phytophototoxins

Overview: Plant Poisoning, Phytophototoxins
Differential Diagnoses & Workup: Plant Poisoning, Phytophototoxins
Treatment & Medication: Plant Poisoning, Phytophototoxins
Follow-up: Plant Poisoning, Phytophototoxins
References
[ CLOSE WINDOW ]

References

  1. Bansal I, Kerr H, Janiga JJ, Qureshi HS, Chaffins M, Lim HW. Pinpoint papular variant of polymorphous light eruption: clinical and pathological correlation. J Eur Acad Dermatol Venereol. Apr 2006;20(4):406-10. [Medline].

  2. Berkley SF, Hightower AW, Beier RC, et al. Dermatitis in grocery workers associated with high natural concentrations of furanocoumarins in celery. Ann Intern Med. Sep 1986;105(3):351-5. [Medline].

  3. Epstein WL, Epstein JH. Plant induced dermatitis. In: Wilderness Medicine. 3rd ed. 1995:843-61.

  4. Gross TP, Ratner L, de Rodriguez O, et al. An outbreak of phototoxic dermatitis due to limes. Am J Epidemiol. Mar 1987;125(3):509-14. [Medline].

  5. Ivie GW, Holt DL, Ivey MC, et al. Natural toxicants in human foods: psoralens in raw and cooked parsnip root. Science. Aug 21 1981;213(4510):909-10. [Medline].

  6. Juckett G. Plant dermatitis. Possible culprits go far beyond poison ivy. Postgrad Med. Sep 1996;100(3):159-63, 167-71. [Medline].

  7. Klaber R. Phyto-photo-dermatitis. Br J Dermatol. 1943;54:193-211.

  8. Lecha M. Idiopathic photodermatoses: clinical, diagnostic and therapeutic aspects. J Eur Acad Dermatol Venereol. Nov 2001;15(6):499-504; quiz 504-5. [Medline].

  9. Ljunggren B. Severe phototoxic burn following celery ingestion. Arch Dermatol. Oct 1990;126(10):1334-6. [Medline].

  10. Lovell CR. Phytodermatitis. Clin Dermatol. Jul-Aug 1997;15(4):607-13. [Medline].

  11. Mark KA, Brancaccio RR, Soter NA, Cohen DE. Allergic contact and photoallergic contact dermatitis to plant and pesticide allergens. Arch Dermatol. Jan 1999;135(1):67-70. [Medline].

  12. Maso MJ, Ruszkowski AM, Bauerle J, et al. Celery phytophotodermatitis in a chef. Arch Dermatol. Jun 1991;127(6):912-3. [Medline].

  13. Massmanian A. Contact dermatitis due to Euphorbia pulcherrima Willd, simulating a phototoxic reaction. Contact Dermatitis. Feb 1998;38(2):113-4. [Medline].

  14. Moller H. Contact and photocontact allergy to psoralens. Photodermatol Photoimmunol Photomed. Feb 1990;7(1):43-4. [Medline].

  15. Pathak MA. Phytophotodermatitis. Clin Dermatol. Apr-Jun 1986;4(2):102-21. [Medline].

  16. Pathak MA, Kramer DM. Photosensitization of skin in vivo by furocoumarins (psoralens). Biochim Biophys Acta. Nov 19 1969;195(1):197-206. [Medline].

  17. Rhodes LE. Topical and systemic approaches for protection against solar radiation-induced skin damage. Clin Dermatol. Jan-Feb 1998;16(1):75-82. [Medline].

  18. Sasseville D. Phytodermatitis. J Cutan Med Surg. Jul 1999;3(5):263-79. [Medline].

  19. Sharma A, Goel HC. Some naturally occurring phytophototoxins for mosquito control. Indian J Exp Biol. Oct 1994;32(10):745-51. [Medline].

  20. Tunget CL, Turchen SG, Manoguerra AS, et al. Sunlight and the plant: a toxic combination: severe phytophotodermatitis from Cneoridium dumosum. Cutis. Dec 1994;54(6):400-2. [Medline].

  21. White W. Club Med dermatitis. N Engl J Med. Jan 30 1986;314(5):319-20. [Medline].

  22. Wolf R, Oumeish OY. Photodermatoses. Clin Dermatol. Jan-Feb 1998;16(1):41-57. [Medline].

  23. Zeller MP. Beauty with a Bite: Apiaceae (Umbelliferae) the carrot family. Regul Horticult. 1999;25:10-13.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

phytophotodermatitis, PPD, photosensitization, phytophotosensitivity, photosensitive reaction, furocoumarins, psoralens, Umbelliferae, Rutaceae, Moraceae, Compositae, Ranunculaceae, perfume-induced berloque dermatitis, ultraviolet light, UV, UVA , UV-A

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Thomas Joseph Lydon, MD, PhD, Consulting Staff, Section of Emergency Medicine, Dartmouth-Hitchcock Medical Center
Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Glaxo Smith Kline Consulting fee Consulting; Glaxo Smith Kline Honoraria Speaking and teaching

Medical Editor

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, Associate Clinical Professor; Medical and Managing Director, South Texas Poison Center, Department of Surgery/Emergency Medicine and Toxicology, University of Texas Health Science Center at San Antonio
Miguel C Fernandez, MD, FAAEM, FACEP, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

Michael Hodgman, MD, Assistant Clinical Professor of Medicine, Department of Emergency Medicine, Bassett Healthcare
Michael Hodgman, MD is a member of the following medical societies: American College of Medical Toxicology, American College of Physicians, Medical Society of the State of New York, and Wilderness Medical Society
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.