eMedicine Specialties > Emergency Medicine > Toxicology

Plant Poisoning, Phytophototoxins: Follow-up

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

Follow-up

Further Inpatient Care

  • In general, a phototoxic exposure is self-limited and subsides within a week if further insult is avoided.
  • If symptoms persist or worsen instead of improving, other illnesses, such as the primary light disorders, should be considered and further evaluation is warranted by a dermatologist.

Deterrence/Prevention

  • Limit or avoid contact with the specific plant.
  • Limit sun exposure.

Complications

  • Long-term exposure and severe reactions may result in hyperpigmentation requiring continued topical steroid treatment.

Prognosis

  • Significant long-term skin changes (hyperpigmentation, scarring) can occur with chronic exposure.

Patient Education

  • Patients should be educated regarding plants that produce phytophototoxicity in order to avoid skin exposure. Patients may be counseled to wear gloves and skin coverings when their work necessitates ongoing exposure to these plant oils and to the sun.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize systemic photosensitization caused by exposure to plant furocoumarins and the use of common drugs (eg, tetracycline, minocycline, doxycycline, chlorpromazine, chlorothiazide diuretics, sulfonamides, nalidixic acid, griseofulvin, sulfonylureas)
  • Once possibility of an exogenous light photosensitizer has been ruled out, failure to consider primary light disorders such as porphyria and collagen vascular disorders with polymorphous light eruption
 


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
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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].

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  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].

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  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.

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Further Reading

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Keywords

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

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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.

 
 
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