Emergency Department Care
If the patient presents shortly after exposure, the affected area should be washed with soap and water to remove plant sap. Protect the affected area from sunlight by covering and/or applying sunblock until at least 48 hours post exposure.
Treat inflammatory condition based on severity of symptoms, as follows:
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Treat mild reactions with cool wet dressings, topical steroids, and nonsteroidal anti-inflammatory drugs (NSAIDs)
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Severe reactions may require systemic steroids
Patient reassurance that the problem will resolve once the offending agent has been removed is very helpful. Consultation with a dermatologist may be helpful.
Prevention
Limit or avoid contact with the specific plant. Limit sun exposure. Regular use of a UV-A-blocking sunscreen may help to prevent phytophotodermatitis.
Long-Term Monitoring
While phytophototoxicity cases may spontaneously resolve within 3 to 5 days, wound care may be necessary for up to 3 weeks for adequate treatment before clinical wound resolution. [1]
Long-term exposure and severe reactions may result in hyperpigmentation requiring continued topical steroid treatment. 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.
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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 photo of the patient above 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.
