View source for Phytophotodermatitis

{{Infobox disease
 | Name           = Phytophotodermatitis
 | Image          = Effet de la rue officinale.jpg

 | Caption        = Phytophotodermatitis caused by [[Common Rue]]
 | DiseasesDB     = 31395
 | ICD10          = {{ICD10|L|56|2|l|55}}
 | ICD9           = 
 | ICDO           = 
 | OMIM           = 
 | MedlinePlus    = 
 | eMedicineSubj  = 
 | eMedicineTopic = 
 | MeshID         = 
}}
__NOTOC__
{{CMG}}; {{AE}} {{KS}}
==Overview==

'''Phytophotodermatitis''', also known as "Lime Disease" (not to be confused with ''[[Lyme Disease]]''),<ref name="Weber et al 1999">{{cite journal |doi=10.1016/S0736-4679(98)00159-0 |title=Phytophotodermatitis: The other 'lime' disease |year=1999 |last1=Weber |first1=Ian C |last2=Davis |first2=Charles P |last3=Greeson |first3=David M |journal=The Journal of Emergency Medicine |volume=17 |issue=2 |pages=235–7 |pmid=10195477}}</ref> "Berloque dermatitis",<ref name="Andrews">{{cite book |editor1-first=William Daniel |editor1-last=James |editor2-first=Timothy G. |editor2-last=Berger |editor3-first=Dirk M. |editor3-last=Elston |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |page=32 |isbn=978-0-7216-2921-6}}</ref> or "Margarita photodermatitis"<ref>{{cite journal |url=http://www.the-dermatologist.com/content/what-caused-this-rash-on-this-man%E2%80%99s-wrist-and-hand |first1=Ryan R. |last1=Riahi |first2=Philip R. |last2=Cohen |first3=Floyd W. |last3=Robinson |first4=James M. |last4=Gray |title=What Caused The Rash On This Man's Wrist And Hand? |date=June 2009 |journal=The Dermatologist |volume=11 |issue=6}}</ref><ref>{{cite journal |doi=10.1056/NEJM199303253281220 |title=Margarita Photodermatitis |year=1993 |last1=Abramowitz |first1=Alan I. |last2=Resnik |first2=Kenneth S. |last3=Cohen |first3=Kenneth R. |journal=New England Journal of Medicine |volume=328 |issue=12 |pages=891 |pmid=8441448}}</ref> is a chemical reaction which makes skin hypersensitive to [[ultraviolet]] light. It is frequently  mistaken for hereditary conditions such as [[atopic dermatitis]] or chemical burns, but it is caused by contact with the photosensitizing compounds found naturally in some plants and vegetables like [[parsnips]], [[citrus fruits]], and more.<ref>{{cite journal |doi=10.1001/archfami.9.10.1195 |title=Phytophotodermatitis: A Sometimes Difficult Diagnosis |year=2000 |last1=Solis |first1=R. R. |journal=Archives of Family Medicine |volume=9 |issue=10 |pages=1195–6 |pmid=11115230 |last2=Dotson |first2=DA |last3=Trizna |first3=Z}}</ref>

==Symptoms==
The symptoms are equivalent to [[photodermatitis]], but vary in severity.
The skin condition is a [[cutaneous]] [[phototoxic]] inflammatory eruption resulting from contact with 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 reaction typically begins within 24 hours of exposure and peaks at 48–72 hours after the exposure.<ref name="emedicine.medscape.com">http://emedicine.medscape.com/article/1119566-overview{{full|date=August 2013}}</ref>

Phytophotodermatitis can affect people of any age, but because of the bruise-like appearance that is usually in the shape of handprints or fingerprints, it is often mistaken in children for [[child abuse]].<ref>{{cite journal |doi=10.1007/BF01956735 |title=Phytophotodermatitis mimicking child abuse |year=1993 |last1=Barradell |first1=R. |last2=Addo |first2=A. |last3=McDonagh |first3=A. J. G. |last4=Cork |first4=M. J. |last5=Wales |first5=J. K. H. |journal=European Journal of Pediatrics |volume=152 |issue=4 |pages=291–2 |pmid=8482273}}</ref>



==Common causes==
* [[Umbelliferae]]
** Wild [[parsnip]], [[parsley]], [[celery]], [[common hogweed]], [[Heracleum mantegazzianum|giant hogweed]]<ref name="dermnetnz">[http://dermnetnz.org/reactions/photocontact-dermatitis.html Photocontact dermatitis. DermNet NZ<!-- Bot generated title -->]{{MEDRS|date=August 2013}}</ref><ref>{{cite journal |doi=10.1136/emj.16.6.453 |title=Phytophotodermatitis associated with parsnip picking |year=1999 |last1=Lutchman |first1=L |last2=Inyang |first2=V |last3=Hodgkinson |first3=D |journal=Emergency Medicine Journal |volume=16 |issue=6 |pages=453–4 |pmid=10572825 |pmc=1343418}}</ref><ref>[http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20060802142545511440 Giant Hogweed phytophotodermatitis] GPnotebook login required{{MEDRS|date=August 2013}}</ref>
** [[Carrot]]<ref>{{cite journal |doi=10.1001/archderm.1956.01550080035006 |title=Sensitization Dermatitis to Carrots: Report of Cross-Sensitization Phenomenon and Remarks on Phytophotodermatitis |year=1956 |last1=Klauder |first1=Joseph V. |journal=Archives of Dermatology |volume=74 |issue=2 |pages=149–58 |pmid=13353987 |last2=Klauder |first2=JV}}</ref> and [[wild carrot]]<ref>{{EMedicine|DERM|324|Phytophotodermatitis}}</ref>
** ''[[Notobubon galbanum]]'', a South African plant also known as Blister Bush
* Rutaceae 
** [[Lemon (fruit)|Lemon]], [[Lime (fruit)|Lime]], [[Bergamot orange]]<ref name="dermnetnz" /><ref name="Weber et al 1999" /><ref>{{cite web |url=http://www.consultantlive.com/display/article/10162/43009 |title=Alexander K. C |last1=Leung |first2=Justine H. S. |last2=Fong |date=April 1, 2003}}</ref>
** [[Common Rue]] (''Ruta graveolens'') and other plants in the genus ''[[Ruta]]''<ref>{{cite journal |doi=10.1093/rheumatology/kep234 |title=Phytophotodermatitis due to Ruta graveolens prescribed for fibromyalgia |year=2009 |last1=Arias-Santiago |first1=S. A. |last2=Fernández-Pugnaire |first2=M. A. |last3=Almazán-Fernández |first3=F. M. |last4=Serrano-Falcón |first4=C. |last5=Serrano-Ortega |first5=S. |journal=Rheumatology |volume=48 |issue=11 |pages=1401 |pmid=19671699}}</ref><ref>{{cite journal |doi=10.1097/BCR.0B013E318148CB82 |title=Herb of Grace: An Unusual Cause of Phytophotodermatitis Mimicking Burn Injury |year=2007 |last1=Furniss |first1=Dominic |last2=Adams |first2=Titus |journal=Journal of Burn Care & Research |volume=28 |issue=5 |pages=767–9 |pmid=17667834}}</ref><ref>{{cite journal |doi=10.2310/6620.2007.06033 |title=Rue the Herb: Ruta graveolens–Associated Phytophototoxicity |year=2007 |last1=Eickhorst |first1=Kimberly |last2=Deleo |first2=Vincent |last3=Csaposs |first3=Joan |journal=Dermatitis |volume=18 |pages=52–5 |pmid=17303046 |issue=1}}</ref><ref>{{cite journal |doi=10.1111/j.1600-0536.1999.tb06145.x |title=Phytophotodermatitis due to Ruta graveolens applied as protection against evil spells |year=1999 |last1=Wessner |first1=D. |last2=Hofmann |first2=H. |last3=Ring |first3=J. |journal=Contact Dermatitis |volume=41 |issue=4 |pages=232 |pmid=10515113}}</ref>
* ''[[Sclerotinia sclerotiorum]]'', which can infect celery<ref>{{cite journal |journal=Morbidity and Mortality Weekly Report |url=http://www.cdc.gov/MMWR/preview/mmwrhtml/00000464.htm |title=Phytophotodermatitis among Grocery Workers - Ohio |date=January 11, 1985 |volume=34 |issue=1 |pages=11–3 |pmid=3155560 |author1=Centers for Disease Control (CDC)}}</ref>
* [[Ficus carica|Fig]], its latex contains various [[furocoumarin]] isomers such as 8-methoxypsoralen, which induce allergic photodermatitis <ref>{{cite journal |author=Bonamonte D, Foti C, Lionetti N, Rigano L, Angelini G |title=Photoallergic contact dermatitis to 8-methoxypsoralen in Ficus carica |journal=Contact Dermatitis |volume=62 |issue=6 |pages=343–8 |date=June 2010  |pmid=20557340 |doi=10.1111/j.1600-0536.2010.01713.x}}</ref><ref name="dermnetnz" /><ref> allergy to latex, including fig latex http://www.medic8.com/healthguide/allergies/latex-allergies/symptoms-latex-allergy.html </ref>

==Diagnosis==
===Physical Examination===
====Skin====
====Extremity====
<gallery>
Image:Phytophotodermatitis01.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
Image:Phytophotodermatitis04.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



Image:Phytophotodermatitis05.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



Image:Phytophotodermatitis06.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Phytophotodermatitis07.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Phytophotodermatitis08.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



Image:Phytophotodermatitis09.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>





Image:Phytophotodermatitis10.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



</gallery>

=====Trunk=====
<gallery>Image:Phytophotodermatitis02.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Phytophotodermatitis03.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Phytophotodermatitis11.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



Image:Phytophotodermatitis12.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



Image:Phytophotodermatitis13.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Phytophotodermatitis14.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Phytophotodermatitis15.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



Image:Phytophotodermatitis16.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>


Image:Phytophotodermatitis17.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Phytophotodermatitis18.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>




Image:Phytophotodermatitis19.jpg|Phytophotodermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>



</gallery>

== Treatment ==
Phytophotodermatitis can be prevented by staying indoors after handling the above substances. Windows will filter out ultraviolet light and prevent symptoms from arising.

Many different topical and oral medications can be used to treat the [[Inflammation|inflammatory]] reaction of phytophotodermatitis. 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]].<ref name="emedicine.medscape.com"/>

Sunblock can greatly mitigate symptoms, at least when caused by rue (Ruta Graveolens).

== See also ==
* [[List of cutaneous conditions]]
* [[Psoralen]]
* [[Photosensitivity in humans]]

== References ==
{{commons category}}
{{reflist|2}}

{{Radiation-related disorders}}

[[Category:Skin conditions resulting from physical factors]]