What are the other Names for this Condition? (Also known as/Synonyms)

• Berloque Dermatitis
• Lime Disease
• PPD (Phytophotodermatitis)

What is Phytophotodermatitis? (Definition/Background Information)

• Phytophotodermatitis (PPD) is a common condition that is caused when there is an accidental or intentional contact with certain plants or plant products followed by sun exposure, which results in skin inflammation and burning sensation
• Phytophotodermatitis is a common skin condition. It is named after the terms “phyto” indicating plant, “photo” indicating light, and “dermatitis” indicating skin inflammation
• Some common plants and plant products that can trigger the condition include citrus fruits, vegetables such as carrots and celery, and some plant oils and fragrances
• Some of the common signs and symptoms include red rashes and bumps on the skin, lesions or patches that resemble burns, and the presence of blisters that drain fluid. A superimposed bacterial or fungal infection can be a complication of Phytophotodermatitis
• The treatment of Phytophotodermatitis involves a complete avoidance of the causative agent and the use of medications that may include corticosteroids and antihistamines. The condition typically resolves in a short period of time, usually without any complications
• Identification of plants and plant-based products that are skin allergens and irritants is the first and foremost preventive measure

Who gets Phytophotodermatitis? (Age and Sex Distribution)

• Phytophotodermatitis can affect individuals of any age, who are exposed to the offending plants or plant products and subsequently exposed to sunlight. However, not all individuals may be affected by the condition
• There is no gender, race, or ethnic predilection observed

What are the Risk Factors for Phytophotodermatitis? (Predisposing Factors)

The following are the risk factors for Phytophotodermatitis:

• Exposure to certain plants and plant products, either through physical contact or after consuming the plant-based product
• Use of plant-based products such as perfumes, oils, etc.
• Rinsing hair with lemon juice (such as for dandruff removal)
• Contact with meadow grass on the beach
• Exposure to lime peel and alcohol drinks in sunny locations
• Summer and spring season when people generally venture out in the sun

Individuals with the following occupation may have an increased risk for Phytophotodermatitis:

• Farmers and vegetable growers, including those tending to kitchen and rooftop gardens
• Forest rangers, explorers, campers, etc.
• Cooks and chefs
• Bartenders, especially those who prepare and serve lime juice (or other fruit juice)

Grocery workers who handle produce. Spoiled vegetables and fruits are more likely to deliver the offending chemicals to skin

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Phytophotodermatitis? (Etiology)

• Phytophotodermatitis is a type of allergic skin reaction that occurs due to the combined effect of contact with a plant or plant-based product and subsequent sun exposure
• The ultraviolet radiation from the sun causes a hypersensitive reaction on the skin resulting in inflammation, rashes, and burning sensation; the sunlight activates certain substances (photosensitive chemicals) on exposure
• The contact with the plant or plant-based product may be a direct, physical contact (accidental or intentional), or it could be even consumed as a food item (vegetable, fruit, or juice, etc.)

Contact with the following common plants or plant products are known to cause Phytophotodermatitis in some individuals:

• Citrus fruits, such as lime, lemon, etc.
• Greens, such as celery, parsley, parsnip, etc.
• Figs
• Carrots (including wild carrots)
• South African blister bush plant
• Meadow grass
• Oil of bergamot found in certain perfumes
• Common rue
• Queen Anne’s lace

What are the Signs and Symptoms of Phytophotodermatitis?

The signs and symptoms may be mild or severe depending on the extent of sun exposure and contact with the plant. Usually the reaction begins 24 hours after exposure. All individuals may not present the symptomatic features of Phytophotodermatitis.

The common signs and symptoms observed with Phytophotodermatitis include:

• Inflammation of skin with burning sensation
• The skin can become red (erythematous) with the formation of vesicles and bullae (fluid-filled bubbles)
  • The bullae may burst over time leaving crusted skin
  • The skin may peel and shed, as new skin forms over the damaged skin
• Pain, pain on touch, tenderness of skin
• Itching, which may be intense at times
• In case of contact: The signs and symptoms occur on skin areas with plant contact and which has been exposed to ultraviolet light
• In case of consumption: The signs and symptoms may be systemic and the skin rashes can appear anywhere on the body part exposed to the sun
• Sometimes, the area of contact may show skin hyperpigmentation in the form of unusual streaks (like after applying a fragrant spray or perfume). This condition is called ‘Berloque Dermatitis’
• Typical body regions affected may include sun-exposed areas such as the face and lips, scalp, neck, arms (hand, forearm), and chest

How is Phytophotodermatitis Diagnosed?

A diagnosis of Phytophotodermatitis would include:

• A complete evaluation of one’s medical history to learn about the causative agent, which is the source of the condition
• A thorough physical examination of the patient to check for signs and symptoms with respect to Phytophotodermatitis
• Patch test:
  • In this test, small quantities of substances (believed to be allergens) are applied on the skin in small patches
  • The application is left for a couple of days, after which the responses are observed
  • If the individual develops bumps or rashes in the patchy area where the substances/allergens were applied, it may be confirmed that the patient is allergic to that particular substance
• Skin biopsy: A skin biopsy is performed and sent to the laboratory for pathological examination. The pathologist examines the biopsy under a microscope for a definitive diagnosis

Note: In most cases, based on the signs and symptoms, a diagnosis can be made by the dermatologist through a physical examination and medical history study, without resorting to a biopsy.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Phytophotodermatitis?

Phytophotodermatitis could lead to the following complications namely:

• Bacterial and fungal infection: Continuous itching and scaling of the skin leads to skin moistness, which provides a suitable environment for bacteria and fungi to grow and thrive
• The skin condition may give rise to cosmetic concerns in some individuals
• Severe allergic reaction may occur in some cases
• Stress and anxiety issues in some individuals
• Recurrence of the condition on further exposure or contact with the offending agent

How is Phytophotodermatitis Treated?

Treatment strategies that may be adopted in the management of Phytophotodermatitis include:

• Avoiding exposure or contact with plants or plant products that are known irritants and allergens
• Topical treatment includes cooling the skin using moist towels and moisturizing creams to soothe the condition
  • Use of topical ointments, lotions, and creams - these may be antiseptic and anti-inflammatory applications
  • Topical steroidal creams can help reduce inflammation
• Systemic treatment may be required in some cases
  • It may include medications, such as aspirin and other non-steroidal anti-inflammatory over-the-counter painkillers
  • In severe cases, oral steroids and IV fluids may be necessary
• Oral medications: The physician may prescribe oral corticosteroids to reduce inflammation or antihistamines to provide relief from severe itching sensation

Note: In many individuals, the signs and symptoms may get better and disappear without any treatment, purely on removal of the offending agent (plant or plant product)

A few self-care tips and home remedies for Phytophotodermatitis may include:

• Scratching the affected areas must be completely avoided
• Apply cool wet compress to the affected skin
• A comfortable, cool bath may help soothe the skin
• Wearing smooth cotton clothes
• Use of mild perfumes, soaps, and detergents

How can Phytophotodermatitis be Prevented?

The following measures may be adopted to prevent or reduce the risk of acquiring Phytophotodermatitis:

• Identification of plants and plant-based products that are skin allergens and irritants is the first and foremost preventive step
• Avoiding these identified substances (allergens/irritants) will help protect from Phytophotodermatitis. Avoid contact with (or the consumption of) certain plants and their products that may induce an inflammatory reaction on the skin following sunlight exposure
• In case of contact with the allergic substance, wash the affected area immediately with water
• Wearing protective gloves (or clothing) while doing jobs or hobbies that would involve coming into contact with the offending plants or plant-based products
• A protective cream may be applied over the skin for protection. The use of a moisturizer can help protect the topmost layer of the skin
• Use suitable sunscreens, sun protective clothing (such as wide-brimmed hats) etc.

What is the Prognosis of Phytophotodermatitis? (Outcomes/Resolutions)

• Phytophotodermatitis usually resolves in a short duration of time, generally without any complications. Sometimes, on removing the offending substance, the condition may get better
• If the condition is recurrent, it may be because the exact cause is not yet identified
• If Phytophotodermatitis is due to an occupational exposure, then the occupation or job-related tasks or habits may have to be changed/modified suitably, or appropriate protective gear used

Additional and Relevant Useful Information for Phytophotodermatitis:

Phytophotodermatitis can be confused with atopic dermatitis and chemical dermatitis.