Plant Poisoning, Phytophototoxins Medication

  • Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Jan 7, 2010
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Depigmenting agents

Class Summary

These agents have been shown to be useful in the treatment of phytophototoxin plant poisoning.

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Hydroquinone (Claripel, Eldoquin-Forte, Solaquin-Forte)

 

Suppresses melanocyte metabolic processes, especially enzymatic oxidation of tyrosine to 3,4-dihydroxyphenylamine. Exposure to sun reverses effects and causes repigmentation.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

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Hydrocortisone topical (Cortaid, Cortizone)

 

Applied to skin and mucus membranes provides general anti-inflammatory activity via intracellular mechanisms. Absorption from skin and potency depend on modifications to drug structure, vehicle of application, and condition of exposed skin.

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Prednisone (Deltasone, Meticorten, Orasone)

 

Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and also suppresses lymphocyte and antibody production.

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Nonsteroidal anti-inflammatory agents

Class Summary

Although most NSAIDs are used primarily for their anti-inflammatory effects, they are effective analgesics and are useful for the relief of mild to moderate pain.

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Indomethacin (Indocin)

 

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.

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Contributor Information and Disclosures
Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM  Associate Professor, Education Officer, 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 None None; Glaxo Smith Kline Honoraria Speaking and teaching

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  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, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

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.

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, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

  1. Bassioukas K, Stergiopoulou C, Hatzis J. Erythrodermic phytophotodermatitis after application of aqueous fig-leaf extract as an artificial suntan promoter and sunbathing. Contact Dermatitis. Aug 2004;51(2):94-5. [Medline].

  2. Bensasson RV, Land EJ, Salet C. Triplet excited state of furocoumarins: reaction with nucleic acid bases and amino acids. Photochem Photobiol. Mar 1978;27(3):273-80. [Medline].

  3. 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].

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

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

  6. Moloney FJ, Parnell J, Buckley CC. Iatrogenic phytophotodermatitis resulting from herbal treatment of an allergic contact dermatitis. Clin Exp Dermatol. Jan 2006;31(1):39-41. [Medline].

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

  8. 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].

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

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

  11. Solis RR, Dotson DA, Trizna Z. Phytophotodermatitis: a sometimes difficult diagnosis. Arch Fam Med. Nov-Dec 2000;9(10):1195-6. [Medline].

  12. Bollero D, Stella M, Rivolin A, Cassano P, Risso D, Vanzetti M. Fig leaf tanning lotion and sun-related burns: case reports. Burns. Nov 2001;27(7):777-9. [Medline].

  13. Burnett JW, Nguyen TV. Phytophotodermatitis: differentiation from jellyfish stings. Australas J Dermatol. 1989;30(2):101-2. [Medline].

  14. Centers for Disease Control and Prevention. Phytophotodermatitis among grocery workers--Ohio. MMWR Morb Mortal Wkly Rep. Jan 11 1985;34(1):11-3. [Medline].

  15. Chiarugi A, Nardini P, Borgognoni L, Brandani P, Crocetti E, Carli P. Clinico-pathological characteristics of familial melanoma in a Mediterranean population. Melanoma Res. Oct 2008;18(5):367-9. [Medline].

  16. Goskowicz MO, Friedlander SF, Eichenfield LF. Endemic "lime" disease: phytophotodermatitis in San Diego County. Pediatrics. May 1994;93(5):828-30. [Medline].

  17. Kerr AC, Muller F, Ferguson J, Dawe RS. Occupational carprofen photoallergic contact dermatitis. Br J Dermatol. Dec 2008;159(6):1303-8. [Medline].

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

  19. 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].

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

  21. Carlsen K, Weismann K. Phytophotodermatitis in 19 children admitted to hospital and their differential diagnoses: Child abuse and herpes simplex virus infection. J Am Acad Dermatol. Nov 2007;57(5 Suppl):S88-91. [Medline].

  22. Coffman K, Boyce WT, Hansen RC. Phytophotodermatitis simulating child abuse. Am J Dis Child. Mar 1985;139(3):239-40. [Medline].

  23. Mehta AJ, Statham BN. Phytophotodermatitis mimicking non-accidental injury or self-harm. Eur J Pediatr. Jul 2007;166(7):751-2. [Medline].

  24. Mill J, Wallis B, Cuttle L, Mott J, Oakley A, Kimble R. Phytophotodermatitis: case reports of children presenting with blistering after preparing lime juice. Burns. Aug 2008;34(5):731-3. [Medline].

  25. De Almeida Jr HL, Magalhaes Jorge V. The many faces of phytophotodermatitis. Dermatol Online J. 2008;12.

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

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

  28. 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].

  29. 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].

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

  31. Furukawa F, Muto M. Ethnic differences in immunogenetic features and photosensitivity of cutaneous lupus erythematosus. Arch Dermatol Res. Jan 2009;301(1):111-5. [Medline].

  32. 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].

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

  34. Klaber RE. Phytophotodermatitis. Arch Dis Child. May 2006;91(5):385. [Medline].

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

  36. Lembo S, Fallon J, O'Kelly P, Murphy GM. Polymorphic light eruption and skin cancer prevalence: is one protective against the other?. Br J Dermatol. Dec 2008;159(6):1342-7. [Medline].

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

  38. Lugovic Mihic L, Bulat V, Situm M, Cavka V, Krolo I. Allergic hypersensitivity skin reactions following sun exposure. Coll Antropol. Oct 2008;32 Suppl 2:153-7. [Medline].

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

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

  41. Pipili C, Cholongitas E, Ionnidou D. The diagnostic importance of photosensitivity dermatoses in chronic alcoholism: Report of two cases. Dermatol Online J. November 2008;14:15.

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

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

 
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A 37-year-old white woman presented to the clinic complaining of a rash on the medial part of her right thigh and left arm that was acquired after clearing some weeds in her yard. A phototoxic combination of sunlight and a psoralen-containing plant produced this bizarre linear vesicular eruption.
Closer clinical view of bizarre angulated vesicular streaks, which occurred after contact with a plant and ultraviolet light exposure.
A 26-year-old female airline flight attendant exposed to lime while serving drinks en route to the Caribbean. During the Caribbean layover, she had significant sun exposure. The combination of lime juice and sun exposure led to a drip-pattern blister formation on the dorsal forearm consistent with phytophotodermatitis. This picture clearly delineates the potential severity of phytophotodermatitis with extensive blister formation.
The 2-month follow-up photo of the patient above demonstrates the potential postinflammatory pigmentation changes and scarring that may occur with severe blistering of phytophotodermatitis.
Close-up view of vesicular linear streaks with morphology suggestive of scattered foci of epidermal necrosis.
Queen Anne's lace, a member of the Umbelliferae family of plants, is well known to produce a furocoumarin-induced phototoxic eruption.
Ficus. The common fig contains furocoumarins and should be considered amidst the list of potential offending agents that cause phytophotodermatitis.
 
 
 
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