Assessing Phytophotodermatitis
Assessing Phytophotodermatitis
Phytophotodermatitis (PPD) is a phototoxic reaction which occurs when the skin comes in contact with a photosensitizer and is subsequently exposed to radiation. PPD is often seen in people handling furocoumarin-containing products, such as agricultural workers, bartenders, florists, and gardeners. It may also be seen in beachgoers, athletes, and children. The pattern of the lesions usually resembles streaks; the hands and mouth are most commonly affected due to eating and handling of the offending furocoumarin-containing agents.
This 13-year-old boy was referred by his pediatrician for an "emergency" dermatology evaluation of an eruption of blisters with sensation of burning for 48 hours; the lesions involved the dorsa of the hands and wrists.
Upon questioning the patient revealed he was lawn mowing and came in contact with "some bad weeds" 3 days prior to his presentation. He also spent some time at an outdoor swimming pool. He denies any pruritus or any history to contact with poison ivy or related plants, or the use of any perfumes. He did not have any co- morbid conditions and was not taking any medications. Close contacts did not exhibit a similar condition. On physical examination, there was a significant erythema with multiple vesicles and bullae, some of which had a linear pattern on the dorsa of both hands and wrists (see Figures 1 & 2).
(Enlarge Image)
Erythema and vesicles and bullae on the dorsum of the hand
(Enlarge Image)
Linear arrangement of bullae
Phytophotodermatitis (PPD), also known as dermatitis bullosa striata, plant dermatitis, meadow dermatitis, strimmer dermatitis, and weed wacker dermatitis, is a phototoxic reaction which occurs when the skin comes in contact with a photosensitizer and is subsequently exposed to radiation. In this case, the photosensitizer was the pigment furocoumarin, a lipid-soluble 8-methoxypsoralen. This pigment is found in various plants and vegetables, including celery, limes and lemons, figs, citrus fruits, parsley, sagebrush, goldenrod, chrysanthemum, ragweed, and cocklebur (Bergeson, & Weiss, 2000; Koh, & Ong, 1999; Weber, Davis, & Greeson, 1999).
In order for PPD to develop, the pigment must be present in sufficient quantities, and the wavelength of the subsequent radiation must be within the photosensitizing compound's action spectrum, typically in the UVA 320-400 nanometer range.
PPD is often seen in people handling furocoumarin-containing products, such as agricultural workers, bartenders, florists, and gardeners. It may also be seen in beachgoers, athletes, and children. In its acute phase, PPD presents with burning, erythema, edema, blistering, and/or vesiculation within 24 hours of the contact, depending on the extent of exposure. Post-inflammatory hyperpigmentation may follow, especially with repeated exposures, but usually fades after 2 to 3 months. The pattern of the lesions usually resembles streaks; the hands and mouth are most commonly affected due to eating and handling of the offending furocoumarin-containing agents. Systemic manifestations are rare. However, one case of PPD was associated with hemolytic anemia and retinal hemorrhage (Bollero et al., 2001).
Phytophotodermatitis is a clinical diagnosis based on history and physical examination. Characteristic presentation in its acute phase; bizarre and linear residual hyperpigmentation should raise suspicion of PPD in the context of exposure to photosensitizing plants or furocoumarin-containing products.
Toxicodendron dermatitis is an allergic contact dermatitis (allergic phytodermatitis) that occurs from exposure to members of the plant genus Toxicodendron. In North America, this includes poison ivy, poison oak, and much less frequently, poison sumac.
Berloque dermatitis often presents around the neck area. It occurs when fragrance products containing bergamot oil are applied to the skin followed by exposure to sunlight. Bergapten is the photoactive component of bergamot oil, and exposure to sunlight after contact results in erythema and hyperpigmentation. Bergamot oil use is restricted in the United States.
Fixed drug eruption tends to be annular, less bizarre in shape, and reappears chronically in the same location with repeated exposure to the offending agent. Other conditions that mimic the clinical picture of PPD are summarized in Table 1 .
The first step in managing PPD should focus on the removal of the offending agent. In the acute phase, cool compresses and oral salicylates or other NSAIDs for pain relief, and keeping blistered areas clean with use of topical antiseptics to avoid secondary infection, are very helpful and sufficient. Topical corticosteroids, such as 0.1% triamcinolone cream, often result in a rapid improvement with clearing of erythema.
In severe cases with intense pruritus, antihistamines may be used for treatment and relief of pruritus. Corticosteroids are not very helpful for hyperpigmentation, which usually clears within several weeks to months. Patients should be told about the residual type of linear hyperpigmentation.
Preventative measures include educating grocery store employees, bartenders, gardeners, and agricultural workers about this condition and stressing the need to wear protective gloves. Bartenders and grocery store workers should be advised to wash their hands before going outdoors. The young patient in this case study was reassured and educated about PPD and sun protection. In view of the mild nature of the eruption, the absence of any signs of infection, he was treated with topical antiseptics. He cleared completely in 2 weeks.
Phytophotodermatitis (PPD) is a phototoxic reaction which occurs when the skin comes in contact with a photosensitizer and is subsequently exposed to radiation. PPD is often seen in people handling furocoumarin-containing products, such as agricultural workers, bartenders, florists, and gardeners. It may also be seen in beachgoers, athletes, and children. The pattern of the lesions usually resembles streaks; the hands and mouth are most commonly affected due to eating and handling of the offending furocoumarin-containing agents.
This 13-year-old boy was referred by his pediatrician for an "emergency" dermatology evaluation of an eruption of blisters with sensation of burning for 48 hours; the lesions involved the dorsa of the hands and wrists.
Upon questioning the patient revealed he was lawn mowing and came in contact with "some bad weeds" 3 days prior to his presentation. He also spent some time at an outdoor swimming pool. He denies any pruritus or any history to contact with poison ivy or related plants, or the use of any perfumes. He did not have any co- morbid conditions and was not taking any medications. Close contacts did not exhibit a similar condition. On physical examination, there was a significant erythema with multiple vesicles and bullae, some of which had a linear pattern on the dorsa of both hands and wrists (see Figures 1 & 2).
(Enlarge Image)
Erythema and vesicles and bullae on the dorsum of the hand
(Enlarge Image)
Linear arrangement of bullae
Phytophotodermatitis (PPD), also known as dermatitis bullosa striata, plant dermatitis, meadow dermatitis, strimmer dermatitis, and weed wacker dermatitis, is a phototoxic reaction which occurs when the skin comes in contact with a photosensitizer and is subsequently exposed to radiation. In this case, the photosensitizer was the pigment furocoumarin, a lipid-soluble 8-methoxypsoralen. This pigment is found in various plants and vegetables, including celery, limes and lemons, figs, citrus fruits, parsley, sagebrush, goldenrod, chrysanthemum, ragweed, and cocklebur (Bergeson, & Weiss, 2000; Koh, & Ong, 1999; Weber, Davis, & Greeson, 1999).
In order for PPD to develop, the pigment must be present in sufficient quantities, and the wavelength of the subsequent radiation must be within the photosensitizing compound's action spectrum, typically in the UVA 320-400 nanometer range.
PPD is often seen in people handling furocoumarin-containing products, such as agricultural workers, bartenders, florists, and gardeners. It may also be seen in beachgoers, athletes, and children. In its acute phase, PPD presents with burning, erythema, edema, blistering, and/or vesiculation within 24 hours of the contact, depending on the extent of exposure. Post-inflammatory hyperpigmentation may follow, especially with repeated exposures, but usually fades after 2 to 3 months. The pattern of the lesions usually resembles streaks; the hands and mouth are most commonly affected due to eating and handling of the offending furocoumarin-containing agents. Systemic manifestations are rare. However, one case of PPD was associated with hemolytic anemia and retinal hemorrhage (Bollero et al., 2001).
Phytophotodermatitis is a clinical diagnosis based on history and physical examination. Characteristic presentation in its acute phase; bizarre and linear residual hyperpigmentation should raise suspicion of PPD in the context of exposure to photosensitizing plants or furocoumarin-containing products.
Toxicodendron dermatitis is an allergic contact dermatitis (allergic phytodermatitis) that occurs from exposure to members of the plant genus Toxicodendron. In North America, this includes poison ivy, poison oak, and much less frequently, poison sumac.
Berloque dermatitis often presents around the neck area. It occurs when fragrance products containing bergamot oil are applied to the skin followed by exposure to sunlight. Bergapten is the photoactive component of bergamot oil, and exposure to sunlight after contact results in erythema and hyperpigmentation. Bergamot oil use is restricted in the United States.
Fixed drug eruption tends to be annular, less bizarre in shape, and reappears chronically in the same location with repeated exposure to the offending agent. Other conditions that mimic the clinical picture of PPD are summarized in Table 1 .
The first step in managing PPD should focus on the removal of the offending agent. In the acute phase, cool compresses and oral salicylates or other NSAIDs for pain relief, and keeping blistered areas clean with use of topical antiseptics to avoid secondary infection, are very helpful and sufficient. Topical corticosteroids, such as 0.1% triamcinolone cream, often result in a rapid improvement with clearing of erythema.
In severe cases with intense pruritus, antihistamines may be used for treatment and relief of pruritus. Corticosteroids are not very helpful for hyperpigmentation, which usually clears within several weeks to months. Patients should be told about the residual type of linear hyperpigmentation.
Preventative measures include educating grocery store employees, bartenders, gardeners, and agricultural workers about this condition and stressing the need to wear protective gloves. Bartenders and grocery store workers should be advised to wash their hands before going outdoors. The young patient in this case study was reassured and educated about PPD and sun protection. In view of the mild nature of the eruption, the absence of any signs of infection, he was treated with topical antiseptics. He cleared completely in 2 weeks.
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