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Phytophotodermatitis

Phytophotodermatitis, also known as margarita dermatitis when caused by lime juice, is a nonimmunologic phototoxic cutaneous eruption that occurs when the skin comes into contact with photosensitizing chemicals, primarily furocoumarins such as psoralens found in certain plants and fruits, followed by exposure to ultraviolet A (UVA) radiation from sunlight.^[1] This reaction damages skin cells without involving the immune system, leading to inflammation and potential long-term pigmentation changes.^[2] The condition is self-limited but can mimic burns, infections, or other dermatoses, often presenting as irregular, linear, or drip-like patterns on exposed skin areas.^[3] The mechanism involves furocoumarins penetrating the skin and binding to DNA or cell membranes upon UVA activation, causing oxygen-dependent or independent cell death that manifests clinically within 24 to 72 hours.^[1] Common culprits include citrus fruits like limes and lemons, vegetables such as celery, carrots, parsley, and dill, as well as plants like figs, wild parsnip, and hogweed, which release these compounds during handling, consumption, or environmental contact.^[2] It frequently affects individuals in occupational settings (e.g., gardeners, chefs, bartenders) or recreational activities (e.g., hiking, citrus squeezing), with children particularly vulnerable due to hand-to-skin transfer from adults.^[3] Incidence is underreported but documented in case series from dermatology and pediatrics literature since the 1980s.^[2] Symptoms typically begin with burning erythema and tenderness, progressing to vesicles, bullae, or erosions in severe cases, followed by postinflammatory hyperpigmentation that may persist for weeks to months; pruritus is uncommon.^[1] Diagnosis relies on clinical history of plant exposure and UVA light, often confirmed by the characteristic morphology, though patch testing or biopsy may rule out differentials like contact dermatitis or cellulitis.^[2] Treatment is supportive: mild cases resolve with cool compresses and emollients, while severe blistering may require topical corticosteroids, oral analgesics, or wound care to prevent secondary infection; systemic steroids are reserved for extensive involvement.^[1]^[3] Prevention emphasizes immediate skin washing after plant contact (ideally within 30-120 minutes) and using UVA-blocking sunscreens or protective clothing in high-risk environments.^[2]

Introduction and Pathophysiology

Definition

Phytophotodermatitis is a non-immunologic cutaneous phototoxic inflammatory eruption resulting from contact with light-sensitizing botanical substances, primarily furanocoumarins, followed by exposure to ultraviolet A (UVA) radiation.^[1] This condition manifests as an acute skin reaction in the areas of contact, typically presenting with erythema, edema, and sometimes blistering, due to the photochemical activation of the sensitizing agents.^[4] The term "phytophotodermatitis" was first introduced in the medical literature in 1942 by Robert Klaber to describe this plant- and light-induced dermatosis.^[5] Phytophotodermatitis affects individuals of all ages, sexes, and skin types, as it does not require prior sensitization or genetic predisposition.^[6] The acute phase is self-limited, generally resolving within days to weeks with supportive care and avoidance of further exposure, though it often leads to prolonged post-inflammatory hyperpigmentation that can persist for months due to stimulated melanocyte activity.^[2] In contrast to photoallergic reactions, which are immunologically mediated and occur only after prior sensitization in susceptible individuals, phytophotodermatitis represents a phototoxic response that is dose-dependent and can develop in anyone upon sufficient exposure to the sensitizer and UVA light.^[7]

Mechanism of Action

Phytophotodermatitis arises from a phototoxic reaction where furanocoumarins, commonly known as psoralens, penetrate the skin following contact with photosensitizing plants. These lipophilic compounds are readily absorbed into epidermal cells, where they intercalate between DNA base pairs without initial harm. Upon exposure to ultraviolet A (UVA) radiation in the 320-400 nm range, psoralens absorb photons and undergo a photochemical excitation, leading to the generation of reactive oxygen species (ROS) through oxygen-dependent Type II reactions and direct covalent bonding in oxygen-independent Type I reactions.^[8]^[4]^[9] The excited psoralens primarily form monofunctional adducts with pyrimidine bases, particularly thymine, in DNA, and upon further UVA exposure, these progress to interstrand cross-links that distort the DNA helix. This crosslinking inhibits DNA replication and transcription, triggering cell cycle arrest, epidermal cell apoptosis, and subsequent release of inflammatory mediators. The resulting cellular damage induces keratinocyte death and stimulates an acute inflammatory cascade, characterized by vasodilation and edema formation in the dermis.^[8]^[9]^[4] The photochemical initiation occurs rapidly, within minutes of combined psoralen and UVA exposure, but clinical manifestations emerge delayed due to the time required for DNA repair failure and inflammatory amplification. Symptoms typically onset around 24 hours post-exposure, peak at 48-72 hours, and involve cytokine release—such as interleukins and tumor necrosis factor—that promotes vasodilation, leukocyte recruitment, and prolonged hyperpigmentation.^[8]^[4]^[10] Environmental factors like heat and moisture enhance the severity by facilitating deeper penetration of psoralens into the stratum corneum, particularly through sweating or wet skin conditions that increase solubility and absorption. High humidity and elevated temperatures during exposure can thus intensify the phototoxic response and accelerate lesion development.^[4]^[10]

Etiology

Phototoxic Compounds

Phytophotodermatitis is primarily induced by phototoxic compounds known as linear furanocoumarins, a class of secondary metabolites that include psoralens such as 5-methoxypsoralen (bergapten) and 8-methoxypsoralen (xanthotoxin), as well as the angular furanocoumarin angelicin.^[8] These compounds feature a tricyclic structure consisting of a furan ring fused to a coumarin moiety, which confers their photoreactive properties.^[11] The chemical properties of these furanocoumarins enable their role in phototoxicity: they are highly lipophilic due to their non-polar aromatic rings, facilitating penetration through the skin barrier upon contact.^[8] Additionally, they absorb ultraviolet A (UVA) radiation in the 320–400 nm range, which excites their molecules and leads to the formation of reactive species or direct interactions with biological targets, such as generating cyclobutane pyrimidine dimers in DNA.^[8] Concentrations of these compounds in plants vary significantly depending on species, developmental stage, and environmental factors; for instance, levels can increase up to tenfold under stress conditions like UV exposure, drought, or pathogen attack, as furanocoumarins serve as defense metabolites.^[12] They are also present in higher amounts in processed plant materials, such as essential oils and perfumes; bergapten, for example, can constitute 0.1–1% of bergamot oil.^[8] Non-plant sources of these phototoxic compounds are rare but notable in pharmaceutical contexts, where synthetic or extracted forms like methoxsalen (a form of 8-methoxypsoralen) are used in psoralen-UVA (PUVA) therapy for dermatological treatments.^[8]

Involved Plant Families

Phytophotodermatitis is most frequently associated with plants from the Apiaceae (formerly Umbelliferae), Rutaceae, and Moraceae families, which contain high concentrations of furocoumarins such as psoralens that act as photosensitizers upon skin contact followed by ultraviolet A exposure.^[8] These families are widespread in temperate and subtropical regions, contributing to cases through everyday activities like gardening and food handling.^[4] The Apiaceae family includes numerous species implicated in phytophotodermatitis, particularly in occupational and recreational outdoor settings. Key examples are Apium graveolens (celery), Pastinaca sativa (wild parsnip), and Heracleum mantegazzianum (giant hogweed), which are common in Europe, North America, and along riverbanks in temperate zones.^[8] Exposure often occurs during farming, hiking, or weeding, where sap from bruised stems or leaves contacts the skin.^[4] Heracleum mantegazzianum, an invasive species, has been linked to severe reactions in forestry workers due to its high furocoumarin content.^[8] Rutaceae family plants are prevalent in culinary and cosmetic applications, leading to widespread cases globally, especially in tropical and subtropical areas. Prominent species include Citrus aurantifolia (lime), Citrus limon (lemon), and Citrus bergamia (bergamot), often encountered during food preparation like squeezing limes for drinks or applying bergamot oil in perfumes.^[13] These citrus fruits, cultivated worldwide, frequently cause linear blistering patterns from juice splashes on exposed skin during outdoor activities such as barbecues or beach outings.^[4] The Moraceae family is represented chiefly by Ficus carica (common fig), whose milky sap is rich in psoralens and poses risks in Mediterranean climates and global cultivation areas like the Himalayas.^[8] Contact typically happens in gardening or harvesting, with cases reported among hobbyists handling leaves or unripe fruit.^[4] Other families contribute less commonly but are notable in specific contexts. The Fabaceae family includes Psoralea corylifolia (babchi or scurf pea), used in traditional herbal remedies in Asia, leading to exposures via topical applications.^[4] Asteraceae (Compositae) species, such as Tagetes patula (French marigold) and Parthenium hysterophorus (parthenium weed), have emerged in recent reports, particularly post-2020 studies on herbal and wild plant interactions in Europe, North America, and India.^[8]^[14] Overall, over 40 plant families exhibit phototoxic potential, but exposures remain tied to gardening, food preparation (e.g., lime juice on skin during sunny activities), and herbal uses.^[8]

Clinical Features

Symptoms and Signs

Phytophotodermatitis manifests in an acute phase typically 24 to 72 hours following exposure to phototoxic plant compounds and subsequent ultraviolet A radiation, presenting as an exaggerated sunburn-like erythema accompanied by edema, tenderness, and a burning sensation.^[2]^[13] In severe cases, this evolves into the formation of vesicles and bullae, reflecting intense phototoxic damage to keratinocytes and epidermal cells.^[15]^[16] The reaction progresses over the following days, with resolution of the acute inflammation leading to desquamation within 1 to 2 weeks, often without the development of systemic symptoms such as fever, unless secondary bacterial infection occurs.^[13]^[2] This self-limited course underscores the localized nature of the phototoxic insult. Manifestations vary by skin type, with individuals of fair skin experiencing more pronounced blistering due to lower melanin protection, whereas those with darker skin tones may exhibit less visible erythema but similar underlying epidermal injury.^[13] The delayed onset is attributed to an incubation period required for psoralen absorption and UVA-induced DNA cross-linking, and symptoms can be exacerbated by factors such as occlusion or sweating, which enhance penetration of the phototoxic agents.^[15]^[17]

Patterns and Complications

Lesions in phytophotodermatitis characteristically follow the pattern of contact with photosensitizing plant sap or juice prior to ultraviolet A (UVA) exposure, resulting in sharply demarcated, irregular distributions on sun-exposed skin. Linear streaks commonly arise from brushing against plants containing furocoumarins, such as wild parsnip or fig, creating elongated erythematous or hyperpigmented bands along the path of contact. Drip marks manifest as splash-like or elongated lesions when juice from citrus fruits like limes contacts the skin, often appearing on the hands, forearms, or neck; a notable example is the "lime necklace" pattern, where juice dripping from squeezed limes forms pendant-like streaks around the neck during beverage preparation. These configurations can produce bizarre, non-uniform shapes, including handprint-like impressions from direct handling or intersecting lines from multiple exposures, sometimes simulating patterns of external trauma. The primary complication is postinflammatory hyperpigmentation, which emerges after resolution of acute inflammation and typically persists for weeks to months, with resolution often taking 2-6 months in many cases. In individuals with darker skin phototypes, this hyperpigmentation may become permanent in a subset of patients, lasting beyond a year or indefinitely without intervention. Scarring is rare but can occur in severe cases involving extensive blistering or full-thickness epidermal damage, potentially necessitating surgical management. Secondary bacterial infection may develop if blisters rupture, leading to cellulitis in susceptible areas, though this is uncommon with prompt recognition. Ocular involvement is possible if photosensitizing sap contacts the eyes followed by UVA exposure, potentially causing photokeratitis with symptoms of pain, tearing, and temporary vision impairment; however, evidence linking phytophotodermatitis to permanent blindness is limited and primarily based on outdated reports from high-dose psoralen exposures. In pediatric patients, the linear or splash-like lesion patterns frequently lead to misdiagnosis as non-accidental injury, prompting unwarranted child protection investigations, as seen in cases where juice from wild parsnip or lime contact mimics inflicted burns or bruises on the arms, legs, or torso.

Diagnosis

Clinical Diagnosis

The clinical diagnosis of phytophotodermatitis relies primarily on a detailed patient history and physical examination, as the condition presents with characteristic features following exposure to photosensitizing plants or fruits and subsequent ultraviolet A (UVA) radiation.^[18]^[19] During history-taking, clinicians should elicit reports of contact with psoralen-containing substances, such as citrus fruits (e.g., limes or lemons), figs, or celery, combined with sunlight exposure within the preceding 24 to 48 hours.^[18]^[19] Relevant contexts often include occupational exposures, such as agricultural work or bartending, or recreational activities like handling lime juice in cocktails during outdoor events.^[18] Patients may describe an initial burning or stinging sensation rather than itching, with symptoms developing delayed after exposure.^[18] On physical examination, the diagnosis is supported by identifying a phototoxic pattern, such as linear streaks, drips, or bizarre shapes corresponding to the site of plant contact and sun exposure, often sparing covered or photo-protected areas like the eyelids or clothing-covered skin.^[18]^[19] Typical lesions appear as erythematous patches that may progress to blisters in the acute phase, followed by postinflammatory hyperpigmentation in a streaky or splash-like distribution.^[18] No routine laboratory tests or imaging are required, as the diagnosis is clinical; phototesting or patch testing is rarely indicated and reserved for atypical presentations where the history is unclear.^[19]^[20] Phytophotodermatitis has been reported in recreational contexts, such as "margarita dermatitis" from lime juice in cocktails during sun-exposed vacations, including beach trips to Mexico.^[15]

Differential Diagnosis

Phytophotodermatitis must be differentiated from other photodermatoses, contact dermatitides, and mimic conditions that present with similar erythematous, vesicular, or hyperpigmented patterns on sun-exposed skin. Accurate identification relies on a detailed history of plant or photosensitizer exposure combined with UVA light, typically followed by a characteristic 24- to 72-hour delay in onset, which distinguishes it from more immediate reactions.^[4]^[2] Among photodermatoses, polymorphous light eruption (PMLE) is a common mimic, featuring pruritic papules, vesicles, or plaques on sun-exposed areas such as the arms and legs, often with symmetrical distribution and sparing of the face; it typically erupts within hours to days of initial summer sun exposure and recurs seasonally without requiring exogenous photosensitizers. In contrast, phytophotodermatitis exhibits asymmetrical, linear or drip-like patterns corresponding to plant contact sites, lacks intense pruritus, and depends on prior contact with psoralen-containing plants. Solar urticaria presents with immediate (within minutes) formation of itchy wheals and hives upon light exposure, resolving within hours, unlike the delayed, non-urticarial blistering and burning in phytophotodermatitis.^[2]^[21]^[22] Contact dermatitis, both allergic and irritant types, can resemble phytophotodermatitis through localized erythema and vesicles but lacks photodependence. Allergic contact dermatitis requires prior sensitization to an allergen (e.g., poison ivy), produces pruritic lesions independent of light exposure, and can be confirmed via patch testing, whereas phytophotodermatitis is a nonimmunologic phototoxic reaction without sensitization. Irritant contact dermatitis or chemical burns cause immediate onset of pain and inflammation upon direct contact, without the characteristic delay or need for UVA activation seen in phytophotodermatitis.^[23]^[2]^[22] Other differentials include berloque dermatitis, a phototoxic reaction from bergamot oil or psoralens in perfumes applied to areas like the neck or hands, producing streak-like hyperpigmentation similar to phytophotodermatitis but linked to cosmetic use rather than plant handling. Drug-induced photosensitivity, often from systemic agents such as tetracyclines (e.g., doxycycline), NSAIDs, or diuretics, results in widespread or symmetrical eruptions on photoexposed skin and is identified by recent medication history, differing from the localized, exposure-patterned lesions of phytophotodermatitis. Non-accidental injury or child abuse may mimic the linear streaks of phytophotodermatitis, particularly in pediatric cases, but is excluded by corroborating history of accidental plant contact and absence of other abuse indicators.^[24]^[25]^[2] Key differentiators include the patient's history of exposure to psoralen-rich plants (e.g., citrus, celery) followed by sun exposure and the delayed onset, which are unique to phytophotodermatitis. Skin biopsy, if performed, reveals non-specific findings such as necrotic keratinocytes, sunburn cells, mild spongiosis, and minimal lymphocytic infiltrate without vasculitis, helping to rule out allergic contact dermatitis (prominent spongiosis and eosinophils) or infectious causes (e.g., herpes simplex with multinucleated giant cells). These phototoxic patterns, such as linear vesiculation, further support differentiation when aligned with exposure history.^[20]^[2]

Management

Prevention

Preventing phytophotodermatitis involves minimizing contact with phototoxic plant compounds, particularly furanocoumarins, and subsequent exposure to ultraviolet A (UVA) radiation. Individuals handling plants such as those in the Apiaceae or Rutaceae families during gardening, cooking, or foraging should wear protective gloves, long-sleeved clothing, and long pants to create a physical barrier against sap or juice. ^[3] ^[8] Immediately after potential exposure, thoroughly washing the affected skin with soap and water as soon as possible, ideally within 30 minutes to 2 hours, can remove residual photosensitizing agents and reduce the risk of reaction. ^[26] ^[27] ^[2] To further mitigate risk, avoiding direct sunlight for at least 48 hours following contact with suspect plants is recommended, as the phototoxic reaction typically develops within this window upon UVA exposure. ^[28] Applying broad-spectrum sunscreen with an SPF of 30 or higher and high UVA protection before outdoor activities provides an additional layer of defense, especially for those in high-risk professions like agriculture. ^[29] ^[30] Awareness of psoralen-containing products is essential; consumers should avoid cosmetics, fragrances, or essential oils derived from plants like bergamot or citrus that may contain these compounds, opting instead for phototoxicity-tested formulations. ^[31] ^[26] High-risk activities, such as preparing lime-based drinks like margaritas outdoors, can lead to "margarita burns," so washing hands promptly after handling citrus fruits and applying sunscreen is advised to prevent inadvertent exposure. ^[32] ^[33] In environmental settings, removing invasive species like giant hogweed from gardens and public spaces through manual cutting of the taproot or targeted herbicide application helps eliminate local hazards. ^[34] ^[35] Public health campaigns targeting agricultural workers emphasize education on recognition of phototoxic plants, use of protective gear, and prompt decontamination to reduce incidence in farming communities. ^[8] ^[36]

Treatment

Treatment of phytophotodermatitis primarily involves symptomatic relief and supportive measures, as the condition is self-limiting and resolves without specific antidotes. Initial management focuses on avoiding further exposure to ultraviolet A (UVA) light to prevent exacerbation, alongside gentle cleansing of the affected area with soap and water to remove residual photosensitizing compounds. Cool wet compresses are recommended to soothe acute inflammation and edema, while emollients such as petrolatum or ceramide-based moisturizers help maintain skin barrier function and reduce discomfort. Oral analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, or acetaminophen, are used for pain control, with more potent options like opioids reserved for severe cases.^[29]^[37]^[1] For mild to moderate erythema, edema, or pruritus, topical therapies form the cornerstone of intervention. Moderate-potency corticosteroids, such as hydrocortisone 1% or triamcinolone 0.1% cream, applied twice daily for up to two weeks, effectively reduce inflammation and itching. Calamine lotion provides additional symptomatic relief for pruritus, and topical antihistamines may be employed if histamine-mediated irritation is prominent. In cases of persistent irritation, topical calcineurin inhibitors like tacrolimus offer an alternative to steroids, particularly for facial involvement. Indomethacin, administered orally at 50-75 mg daily for adults, has been noted to mitigate phototoxic responses in some protocols.^[29]^[37]^[38] Severe phytophotodermatitis, characterized by extensive involvement exceeding 30% of body surface area, bullae formation, or necrosis, requires escalation to systemic therapies and potential hospitalization. Oral corticosteroids, such as prednisone at 0.5-1 mg/kg/day for 5-10 days with a taper, are indicated to control widespread inflammation. Admission to a burn unit may be necessary for wound care, including debridement of necrotic tissue and monitoring for secondary bacterial infections, though prophylactic antibiotics are not routinely recommended unless clinical signs of infection (e.g., purulence, fever) are present. In such instances, topical agents like silver sulfadiazine or oral antibiotics (e.g., cephalexin) are used judiciously.^[29]^[37]^[1] Post-inflammatory hyperpigmentation, a common sequela appearing 1-2 weeks after the acute phase, typically resolves spontaneously within 2-6 months but can persist longer in darker skin types. Management after resolution of active inflammation includes topical depigmenting agents like hydroquinone 4% cream applied twice daily, or retinoids such as tretinoin 0.05%, to accelerate fading. Adjunctive therapies, including azelaic acid 20% or chemical peels, may be considered for refractory cases, always under dermatologic supervision to avoid irritation. Strict photoprotection with broad-spectrum sunscreens (SPF 30+ with UVA blockers) is essential during this phase.^[37]^[1]^[29] Recent updates in dermatologic practice as of 2025 emphasize non-pharmacologic interventions, such as cooling compresses and emollients, as first-line for most cases, with antibiotics reserved strictly for confirmed infections to minimize resistance risks. This approach aligns with broader guidelines prioritizing conservative, symptom-directed care over aggressive pharmacotherapy.^[29]^[37]

Epidemiology and History

Occurrence and Risk Factors

The incidence of phytophotodermatitis is unknown and likely underreported due to frequent misdiagnosis as other dermatoses such as burns or abuse, particularly in children.^[4] Cases peak during summer months when ultraviolet radiation levels are higher and outdoor activities increase, with additional surges during tropical vacations involving plant exposure.^[39] The condition occurs globally but shows higher reporting rates in Mediterranean and tropical regions, where phototoxic plants like figs and citrus are abundant and environmental conditions favor their growth.^[8] Key risk factors include occupational exposure among individuals handling phototoxic plants, such as farmers, gardeners, landscapers, chefs, food processors, and bartenders who frequently contact celery, citrus, or figs.^[8]^[26] Recreational activities also contribute, including preparing lime-based beach drinks or hiking near wild plants like hogweed, which can lead to inadvertent skin contact followed by sun exposure.^[19] Children face elevated risk through play and exploration involving plants, often resulting in linear or handprint-like patterns from juice handling.^[8] Demographically, phytophotodermatitis exhibits no sex predilection and affects all ages, from infants to adults.^[4] It manifests across skin types, though postinflammatory hyperpigmentation is more persistent and cosmetically distressing in individuals with darker skin tones.^[40] Cases have been linked to international travel and tourism, where vacationers encounter unfamiliar phototoxic plants during outdoor pursuits in sunny destinations.^[2] As of 2025, regional increases have been reported, such as in India due to exposure to Parthenium hysterophorus, prompting calls for greater public awareness.^[41]

Historical Background

Phytophotodermatitis has roots tracing back over 3,000 years, with ancient civilizations recognizing the phototoxic effects of certain plants, though often in the context of therapeutic applications rather than adverse reactions. In ancient Egypt around 1550 BCE, texts like the Ebers Papyrus describe the use of plant extracts, including from figs (Ficus carica), combined with sunlight to treat skin conditions such as vitiligo, inadvertently highlighting risks of sap-induced blisters and inflammation. Similar practices appear in ancient Indian records from 1500–1000 BCE, where psoralen-containing plants were applied topically followed by sun exposure for depigmentation disorders, sometimes resulting in unintended phototoxic eruptions; Chinese records date from the Tang Dynasty (618–907 CE) onward. These early observations laid the groundwork for understanding the interaction between plant-derived furocoumarins and ultraviolet light, though the mechanisms were not yet elucidated.^[37]^[13] By the 19th and early 20th centuries, more systematic reports emerged, shifting focus to accidental exposures. In 1834, bergapten (5-methoxypsoralen), a key furocoumarin, was isolated from bergamot (Citrus bergamia), marking an early chemical identification of phototoxic agents. The condition gained attention through cases like "meadow dermatitis" or dermatitis bullosa striata pratensis, first described by Oppenheim in 1934 (with earlier allusions possibly to 1926 reports), linked to parsnip (Pastinaca sativa) and other Apiaceae family plants during agricultural work, causing linear blisters after sun exposure. In 1916, Freund documented berloque dermatitis from bergamot oil in perfumes, emphasizing citrus-related risks. The term "phytophotodermatitis" was formally coined in 1942 by Robert Klaber to describe phototoxic reactions from plants like celery (Apium graveolens), distinguishing it from other dermatitides. These reports underscored occupational hazards in farming and handling, with wavelengths of 320–400 nm identified as triggers by Jensen and Hansen in 1930.^[13]^[42]^[8] Key milestones in the mid-to-late 20th century advanced both clinical understanding and therapeutic applications. The 1970s saw the development of PUVA (psoralen plus UVA) therapy, pioneered by researchers like Parrish and Wolff in 1974, which harnessed oral or topical psoralens with controlled UVA irradiation to treat psoriasis and vitiligo, building directly on phytophotodermatitis mechanisms but minimizing risks through dosing. The 1990s brought increased recognition of citrus-induced cases, dubbed "bartender's dermatitis" or "margarita burn," from lime (Citrus aurantifolia) juice in beverages, with reports surging among hospitality workers due to global cocktail culture. In the 2020s, invasive species like giant hogweed (Heracleum mantegazzianum) have drawn renewed attention, with poison control centers noting severe burns from its high furanocoumarin content, prompting public health campaigns on invasive plant management.^[43]^[44] Culturally, phytophotodermatitis reflects a dual legacy of benefit and peril in traditional medicine. Plants like rue (Ruta graveolens) have been used for centuries in European folk remedies for digestive issues and as insect repellents, despite known risks of severe blistering upon sun exposure, as documented in historical herbals. Similarly, fig sap's application in ancient Egyptian and Indian healing persisted, even as adverse reactions were anecdotally noted, influencing modern awareness through poison control data that tracks recreational and occupational exposures. These practices highlight how empirical knowledge evolved into scientific caution, with high-impact contributions like PUVA transforming potential harms into targeted therapies.^[42]^[37]^[45]

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Phytophotodermatitis symptoms and treatment
Sep 17, 2021 · So-called "margarita burn" can cause lasting skin discoloration after the damaged skin peels away. Phytophotodermatitis can cause painful ...
[30]
Phototoxicity: essential oils, sun and safety - Tisserand Institute
When caused by plants or essential oils, it is known as phytophotodermatitis (phyto: plant, photo: light, dermatitis: skin inflammation.) When caused by ...
[31]
Margarita Burn: The Danger of Mixing Lime Juice and Sun - Healthline
May 11, 2018 · You can avoid margarita burn by wearing sun-protective clothing, washing your hands thoroughly, and drinking responsibly.
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Margarita Burn: Why Lime Juice and Sun Don't Mix
May 18, 2023 · Margarita burns can be difficult to identify because of their similarity in appearance to other skin rashes brought on by phototoxic exposure.
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Giant Hogweed Management - Coastal Invasive Species Committee
The recommended control methods for landowners on private property is manual cutting of the taproot in spring or early summer or careful use of glyphosate.
[34]
Giant Hogweed - NYIS - New York Invasive Species
May 31, 2019 · One of New York's most striking and dangerous invasive plants, the giant hogweed (Heracleum mantegazzianum) can make a case of poison ivy seem like a mild rash.
[35]
Publication : USDA ARS
Technical Abstract: Phytophotodermatitis is a phototoxic reaction. It occurs in skin exposed to sunlight after contact with plants containing furanocoumarins.
[36]
New Insights Concerning Phytophotodermatitis Induced by ... - MDPI
The clinical presentation of phytophotodermatitis can vary, with acute phototoxic reactions characterized by erythema, edema, and hyperpigmentation [4,12].
[37]
Erythema, bullae, and vesicles on the hands of a dental student - PMC
The treatment of phytophotodermatitis is conservative and may consist of topical steroids (0.1% triamcinolone cream) and, if hyperpigmentation persists, ...
[38]
Phytophotodermatitis and the effects of parthenium plants in india
Aug 16, 2025 · Apiaceae or Umbelliferae family dermatitis ... Five cases of phytophotodermatitis caused by fig leaves and relevant literature review.
[39]
Unique Acute Phytophotodermatitis Reaction and a Visual ...
Apr 28, 2024 · Most cases of phytophotodermatitis occur in the summer months when there are higher levels of ultraviolet radiation or during tropical vacations ...Missing: prevalence | Show results with:prevalence
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What You Should Know About Phytophotodermatitis - WebMD
Apr 24, 2024 · You can get phytophotodermatitis if your skin absorbs psoralen from certain plants, fruits, or vegetables and is then exposed to UVA light.Missing: heat penetration
[41]
Plants as an Etiological Factor in Phytophotodermatitis
Phytophotodermatitis has a long history; even in ancient India,. China, Arabia and Egypt plants were employed in the treatment of vitiligo (Fitzpatrick and ...
[42]
The Patient's Guide to Psoriasis Treatment. Part 2: PUVA Phototherapy
Jul 29, 2016 · They then demonstrated the effectiveness of topical psoralens followed by UVA light in clearing psoriatic plaques in 1974, though research was ...
[43]
The Science of Margarita Burn - The Atlantic
Jul 20, 2016 · Another bartender he worked with also suffered phytophotodermatitis, but not as severely, because she was assigned a bar in the shade.Missing: 1990s | Show results with:1990s
[44]
Tanning Beds, Rue, and Major Burns: An Alarming Association - NIH
Feb 9, 2022 · Skin contact with phytotoxic chemicals present in Ruta graveolens L. and UV light exposure might cause a nonallergic contact dermatitis ...Missing: folk | Show results with:folk