Medical Care
Patient reassurance is essential once the diagnosis is made. Phytophotodermatitis (PPD) is a self-limited problem that resolves with removal of the offending agent. Patients should avoid the offending agent (furocoumarin).
Cool wet compresses may be used for acute lesions. Topical steroids may be used if the eruption is severe and edematous. Indomethacin (50-75 mg PO qd) may be used for adults.
If a severe case evolves or greater than 30% of the body is affected, then it is recommended for the patient to be admitted to a burn unit for local wound care.
Consultations
Referral to a dermatologist may be useful.
Activity
Use of UV-A sunscreens may help prevent further phototoxic reactions from occurring when exposed to sunlight.
Diet
A study on diet-related phototoxic reactions in patients with psoriasis examined whether vegans and vegetarians (who often consume foods containing photosensitizers) are at higher risk of experiencing phytophotodermatitis during phototherapy. [32] The results determined that vegans experience more frequent severe erythema after phototherapy, prompting the suggestion that adjustments to phototherapy protocols may be needed in vegan patients.
Prevention
Regular use of UV-A–blocking sunscreens may help to diminish the cutaneous effects of phytophotodermatitis if contact with plant psoralens occurs.
Patients should avoid the offending agent.
-
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.
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 |
