Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications.
Corticosteroids
Class Summary
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli. Low-to-high potency topical steroids may be applied to affected areas to reduce local inflammation induced by the photoactivated psoralens. They may help to relieve the burning sensation associated with phytophotodermatitis as well as to reduce the associated postinflammatory hyperpigmentation.
Hydrocortisone valerate 0.2% cream (Westcort)
Hydrocortisone valerate 0.2% cream treats inflammatory dermatoses responsive to steroids. It dDecreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Clobetasol (Temovate)
Clobetasol is a class I superpotent topical steroid; it suppresses mitosis and increases the synthesis of proteins that decrease inflammation and cause vasoconstriction.
Betamethasone topical (Diprolene, Betatrex)
Betamethasone topical is for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Nonsteroidal anti-inflammatory drugs
Class Summary
These agents are most commonly used for relief of mild to moderate pain. Indomethacin is an analgesic and NSAID medication that may offer some protection against acute UV-A–induced epidermal apoptosis as well as provide some relief of skin discomfort.
Indomethacin (Indocin)
Indomethacin has anti-inflammatory properties resulting from the inhibition of prostaglandin synthesis and/or leukocyte migration into inflamed areas. It is rapidly absorbed; metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation.
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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.
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Closer clinical view of bizarre angulated vesicular streaks, which occurred after contact with a plant and ultraviolet light exposure.
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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.
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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.
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Close-up view of vesicular linear streaks with morphology suggestive of scattered foci of epidermal necrosis.
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Queen Anne's lace, a member of the Umbelliferae family of plants, is well known to produce a furocoumarin-induced phototoxic eruption.
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Ficus. The common fig contains furocoumarins and should be considered amidst the list of potential offending agents that cause phytophotodermatitis.
Tables
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 |
Psoralens, 5-MOP |
|
Leguminosae |
Psoralea |
corylifolia |
Bavchi, Scurf pea |
Psoralens |
