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Phytophotodermatitis (also known as "Berloque dermatitis"[1]: 32 ) is a chemical reaction which makes skin hypersensitive to ultraviolet light. It is frequently mistaken for a chemical burn, or for hereditary conditions such as atopic dermatitis, but it is caused by contact with the photosensitizing compounds found naturally in some plants and vegetables like parsnips, citrus fruits, and others.[2]
Symptoms edit
The symptoms are equivalent to photodermatitis, but vary in severity. The skin condition is a cutaneous phototoxic inflammatory eruption resulting from contact with both light-sensitizing botanical substances—particularly from the plant families Umbelliferae, Rutaceae, Moraceae, and Leguminosae—and ultraviolet light, typically from sun exposure. Phytophotodermatitis usually results in hyperpigmentation of the skin that often appears like a bruise. This may be accompanied by blisters or burning. The blisters may form in spots and streaks with unaffected skin between; this is a consequence of the way lines of sap are "drawn" onto the skin by brushing against the plants.[3]
The reaction typically begins within 24 hours of exposure and peaks at 48–72 hours after the exposure.[4]
Phytophotodermatitis can affect people of any age, but because of the bruise-like appearance and streaks that can have the shape of handprints or fingerprints, it is often mistaken in children for child abuse.
Cause edit
Sap or juices from many common plants contains varying quantities of psoralen, angelicin, and other related furanocoumarins. On a molecular level, these compounds intercalate with the DNA of skin cells, and subsequent exposure to UV-A light causes covalent cross-linking of purine bases, thus damaging the DNA beyond repair and inducing the affected cells to undergo apoptosis. This is the main difference between phototoxic dermatitis and the allergic dermatitis caused by poison ivy and its relatives. Phytophotodermatatis is similar to a physical burn, whereas poison ivy rashes are less painful and more itchy.
The following species have been known to cause phytophotodermatitis:
- Umbelliferae (Carrot family)
- Rutaceae (Citrus family)
- Sclerotinia sclerotiorum, which can infect celery[12]
- Fig[13]
Treatment edit
Phytophotodermatitis can be prevented by avoiding direct exposure of skin, for example, by wearing a long-sleeved shirt and long pants while in close proximity to possible plant sources. It can also be avoided by preventing exposure to ultraviolet light after contact, for example, by staying indoors where windows will filter out UV and prevent symptoms from arising. Furanocoumarins are also water-soluble, and thorough washing of the affected skin can remove most of the causative agents.
If blisters or discoloration appear, the damage has already been done. Treatment is symptomatic and similar to that of a normal sunburn.
Many different topical and oral medications can be used to treat the inflammatory reaction of phytophotodermatits. A dermatologist may also prescribe a bleaching cream to help treat the hyperpigmentation and return the skin pigmentation back to normal. If they do not receive treatment, the affected sites may develop permanent hyperpigmentation or hypopigmentation.[4]
See also edit
References edit
- ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
{{cite book}}: Explicit use of et al. in:|author=(help); Unknown parameter|isbn status=ignored (help)CS1 maint: multiple names: authors list (link) - ^ Solis RR, Dotson DA, Trizna Z (2000). "Phytophotodermatitis: a sometimes difficult diagnosis". Arch Fam Med. 9 (10): 1195–6. doi:10.1001/archfami.9.10.1195. PMID 11115230.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ http://northernwoodlands.org/articles/article/avoiding_rash_decisions_a_guide_to_plants_you_shouldnt_touch
- ^ a b http://emedicine.medscape.com/article/1119566-overview
- ^ Photocontact dermatitis. DermNet NZ
- ^ Lutchman L, Inyang V, Hodgkinson D (November 1999). "Phytophotodermatitis associated with parsnip picking". J Accid Emerg Med. 16 (6): 453–4. doi:10.1136/emj.16.6.453. PMC 1343418. PMID 10572825.
{{cite journal}}: CS1 maint: date and year (link) CS1 maint: multiple names: authors list (link) - ^ Giant Hogweed phytophotodermatitis GPnotebook login required
- ^ Phytophotodermatitis at eMedicine
- ^ Weber IC, Davis CP, Greeson DM (1999). "Phytophotodermatitis: the other "lime" disease". J Emerg Med. 17 (2): 235–7. doi:10.1016/S0736-4679(98)00159-0. PMID 10195477.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Phytophotodermatitis - Consultant Live
- ^ Photocontact dermatitis. DermNet NZ
- ^ CDC MMWR Phytophotodermatitis among Grocery Workers - Ohio
- ^ Photocontact dermatitis. DermNet NZ