Five Cases of Phytophotodermatitis Caused by Fig Leaves and Relevant Literature Review

Abstract

Phytophotodermatitis is a condition caused by sequential exposure to photosensitizing substances present in plants followed by ultraviolet light. Several plants (e.g., limes, celery, fig, and wild parsnip) contain furocoumarin compounds (psoralens). It is important for dermatologists to be aware of phytophotodermatitis because it may be misdiagnosed as cellulitis, tinea, or allergic contact dermatitis. We present five patients with a sharply defined erythematous swollen patch with bullae on both feet. They described soaking their feet in a fig leaves decoction to treat their underlying dermatologic diseases. Within 24 hours, all patients had a burning sensation in their feet, and erythema and edema had developed on the feet dorsa with exception of the portion of the skin covered by the sandals. Histopathologic examinations revealed sub-epithelial blisters with intensive epidermal necrosis. Phytophotodermatitis was ultimately diagnosed and, after several days, the patients' skin lesions began to recover upon treatment with systemic and topical corticosteroids. Unfortunately, since there are no studies providing sufficient evidence on the benefits of fig leaves, they should be used with caution.

Perioral phytophotodermatitis induced by parsnip mash

“…Prevention is important. However, most people are not aware of the potential adverse effect of these plants, as illustrated by the reported case of second degree burns in four children who played with fig leaves during a picnic 3 . Parsnip is increasingly being used, notably in processed baby food; another case of phytophotodermatitis in a 6‐month‐old baby due to parsnip has been recently reported 2 .…”

“…Phytophotodermatitis is a chemical reaction that occurs after exposure of phototoxic compounds to ultraviolet rays (UVA 320 to 380 nm) 1 . Many plants, including parsnip, fennel, parsley, lemon, bergamot, aniseed, coriander, celery, and figs, may cause phytophotodermatitis, 2 because they contain natural photosensitizing compounds called furocoumarins (eg, 5‐methoxypsoralen) 3 . When activated by UVA, furocoumarins release free radicals, which bind to the pyrimidine bases of DNA, damaging it and leading to cell death 1 .…”

57-jährige Patientin mit Blasen und striatiformen Erythemen an den Extremitäten

“…Die Dermatitis bullosa pratensis wird durch den Kontakt mit Pflanzen, die Photosensibilisatoren enthalten, und hinzukommende UV-Strahlung [3] ausgelöst. Photosensibilisatoren kommen in einer Vielzahl von Pflanzen vor [4].…”

Phytophotodermatitis related to carrot extract-containing sunscreen

“…There are numerous plants implicated in phytophotodermatitis including wild parsnip, parsley, celery, carrots, lime, and fig. These plants contain natural photosensitizing compounds called furocoumarins, which are thought to provide anti-fungal protection to the plant [2]. However, when furocoumarins are ingested or applied to human skin, they are activated by ultraviolet light, which leads to production of reactive oxygen species, cellular damage, phototoxicity, and skin eruptions [3].…”