Diagnostic Considerations

Also consider the following:

Child abuse^{[23, 24, 25]}
Cutaneous larva migrans
Factitious dermatitis
Folk medicine^[26]
Herpes simplex^[25]
Marine envenomations^[27]
Phototoxic eruption
Phototoxic drug reaction
Straw mite or grocer's mite dermatitis
Superficial lymphangitis^[28]
Sunburn
Thermal burn^[29]

Differential Diagnoses

Workup

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Avallone G, Mastorino L, Agostini A, Merli M, Siliquini N, Rubatto M, et al. Ruta graveolens phytophotodermatitis. Dermatol Online J. 2021 Jul 15. 27 (7):[QxMD MEDLINE Link].
Downs JW, Cumpston KL, Feldman MJ. Giant Hogweed phytophotodermatitis. Clin Toxicol (Phila). 2019 Sep. 57 (9):822-823. [QxMD MEDLINE Link].
Izumi AK, Dawson KL. Zabon phytophotodermatitis: first case reports due to Citrus maxima. J Am Acad Dermatol. 2002 May. 46(5 Suppl):S146-7. [QxMD MEDLINE Link].
Imen MS, Ahmadabadi A, Tavousi SH, Sedaghat A. The Curious Cases of Burn by Fig Tree Leaves. Indian J Dermatol. 2019 Jan-Feb. 64 (1):71-73. [QxMD MEDLINE Link].
Papazoglou A, Mantadakis E. Fig Tree Leaves Phytophotodermatitis. J Pediatr. 2021 Aug 21. 27 (7):[QxMD MEDLINE Link].
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Raam R, DeClerck B, Jhun P, Herbert M. Phytophotodermatitis: The Other "Lime" Disease. Ann Emerg Med. 2016 Apr. 67 (4):554-6. [QxMD MEDLINE Link]. [Full Text].
Berkley SF, Hightower AW, Beier RC, et al. Dermatitis in grocery workers associated with high natural concentrations of furanocoumarins in celery. Ann Intern Med. 1986 Sep. 105(3):351-5. [QxMD MEDLINE Link].
Maso MJ, Ruszkowski AM, Bauerle J, DeLeo VA, Gasparro FP. Celery phytophotodermatitis in a chef. Arch Dermatol. 1991 Jun. 127(6):912-3. [QxMD MEDLINE Link].
Bassioukas K, Stergiopoulou C, Hatzis J. Erythrodermic phytophotodermatitis after application of aqueous fig-leaf extract as an artificial suntan promoter and sunbathing. Contact Dermatitis. 2004 Aug. 51(2):94-5. [QxMD MEDLINE Link].
Bollero D, Stella M, Rivolin A, Cassano P, Risso D, Vanzetti M. Fig leaf tanning lotion and sun-related burns: case reports. Burns. 2001 Nov. 27(7):777-9. [QxMD MEDLINE Link].
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Beattie PE, Wilkie MJ, Smith G, Ferguson J, Ibbotson SH. Can dietary furanocoumarin ingestion enhance the erythemal response during high-dose UVA1 therapy?. J Am Acad Dermatol. 2007 Jan. 56(1):84-7. [QxMD MEDLINE Link].
Coffman K, Boyce WT, Hansen RC. Phytophotodermatitis simulating child abuse. Am J Dis Child. 1985 Mar. 139(3):239-40. [QxMD MEDLINE Link].
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Koh D, Ong CN. Phytophotodermatitis due to the application of citrus hystrix as a folk remedy. Br J Dermatol. 1999 Apr. 140(4):737-8. [QxMD MEDLINE Link].
Burnett JW, Nguyen TV. Phytophotodermatitis: differentiation from jellyfish stings. Australas J Dermatol. 1989. 30(2):101-2. [QxMD MEDLINE Link].
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Tunget CL, Turchen SG, Manoguerra AS, Clark RF, Pudoff DE. Sunlight and the plant: a toxic combination: severe phytophotodermatitis from Cneoridium dumosum. Cutis. 1994 Dec. 54(6):400-2. [QxMD MEDLINE Link].
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Media Gallery

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 picture of a patient with a drip-pattern blister formation on the dorsal forearm 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.

of 7

Author

William P Baugh, MD Assistant Clinical Professor of Dermatology, Western University of Health Sciences; Medical Director, Full Spectrum Dermatology; Consulting Staff, Department of Dermatology, St Jude Medical Center

William P Baugh, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Coauthor(s)

Cynthia C Lazzaro, DO Physician

Cynthia C Lazzaro, DO is a member of the following medical societies: American Academy of Dermatology, American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

David Barnette, Jr, MD Voluntary Associate Clinical Professor, University of California San Diego School of Medicine

David Barnette, Jr, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.

Natalie Ana Baugh California State University, Long Beach

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories<br/>Received research grant from: NIH, Veterans Administration, California Grape Assn<br/>Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.

Walter D Kucaba, DO Medical Group of the Carolinas--Family Medicine--Duncan

Walter D Kucaba, DO is a member of the following medical societies: Aerospace Medical Association, American Medical Association, American Osteopathic Association, Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Sections Phytophotodermatitis
Overview
Presentation
DDx
Workup
Treatment
- Medical Care
- Consultations
- Activity
- Diet
- Prevention
- Show All
Medication
Questions & Answers
Media Gallery
Tables
References

Family	Genus	Species	Common Names	Main Compounds
Umbelliferae	Amni	majus	Queen Anne's lace, Bishop's weed	8-methoxypsoralen (8-MOP), 5-methoxypsoralen (5-MOP), imperatorin
	Heracleum	sphondylium	Cow parsnip	8-MOP, 5-MOP, imperatorin, phellopterin
	Heracleum	mantegazzianum	Giant hogweed,^[11]Cartwheel flower	8-MOP, 5-MOP, imperatorin, phellopterin
	Pastinaca	sativa	Parsnip	8-MOP, 5-MOP, imperatorin, isopimpinellin
	Apium	graveolens	Celery	Psoralens, 8-MOP, 5-MOP
Rutaceae	Citrus	bergamia	Bergamot lime	5-MOP
	Citrus	maxima	Zabon^[12]	5-MOP
	Dictamnus	albus	Gas plant, “Burning bush of Moses”	8-MOP, 5-MOP
Moracea	Ficus	carica	Fig^{[13, 14]}	Psoralens, 5-MOP
Leguminosae	Psoralea	corylifolia	Bavchi, Scurf pea	Psoralens

Phytophotodermatitis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

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