Phytophotodermatitis related to Peucedanum paniculatum Loisel, a case report

Abstract

Phytophotodermatitis is a skin reaction caused by ultraviolet light exposure after previous contact with a photosensitizing plant compound such as a furocoumarin. There are frequent reports of phytophotodermatitis caused by lime, 1 fig leaves, 2 or celery. 3 We report the case of a 60-year-old man who developed phytophotodermatitis after encountering Peucedanum paniculatum Loisel during a walk in Corsica, France. CASE REPORTThe patient consulted the Paris Poison Control Centre with a rash on his forearms ( Figure 1A,B). He did not have other associated systemic symptoms or a relevant previous medical history. He explained how he went on a walk the day before, in the mountains near Corte in Corsica, and saw signs mentioning the presence of a "toxic" plant along the path. The presence of P. paniculatum Loisel in this area is known to locals and documented. 4 The patient recognized the plants from pictures, and remembered walking among them. He did not wear appropriate clothing such as long sleeves, and was out in the sun during the walk and for several hours afterwards. Seven hours after exposure, he had non-pruritic erythematous rashes on both of his forearms. The next morning, the rashes were erythematous, with vesicles and large blisters (Figures 1 and 2). We diagnosed phytophotodermatitis, given the appearance and localization of his rashes and their non-pruritic nature, and a history of exposure to P. paniculatum Loisel and sunlight. Treatment was symptomatic, with rinsing baths of the forearms, disinfection of the blisters, and application of a moisturizing cream. After 5 days, the blistering had resolved but hyperpigmented lesions on his forearms persisted. DISCUSSIONPhytophotodermatitis may present with erythema, plaques, vesicles, and bullae, and evolve as hyperpigmented patches that may take several months to resolve. 5 Lesions are well demarcated with bizarre shapes. Clinicians should rule out other cutaneous photosensitivity diseases such as idiopathic photosensitivity diseases (polymorphous light eruption; solar urticaria), photosensitivity associated with endogenous phorosensitizers (porphyrias and pellagra), or photoallergy. 6 Treatment involves early removal of the agent; disinfection and topical corticosteroids may be used for severe eruptions. 7 The later use of tretinoin cream has also been reported to help reduce residual hyperpigmentation. 7 Furocoumarins are found in the sap of plants, mostly in the Apiaceae (or Umbelliferae) family, but also in the Rutaceae, DUFAYET AND LANGRAND 249

Phytophotodermatitis

“…An and Ozturk conducted a prospective study from Turkey identifying phytophotodermatitis implicating Heracleum persicum, Ferula orientalis, and Chaerophyllum macropodum Boiss, with the latter two being the first time described in the literature [16]. A report from France in 2018 claimed to be the first phytophotodermatitis case implicating native plant Peucedanum paniculatum Loisel [17]. Two carrot phytophotodermatitis cases have been reported-one from carrot extract containing sunscreen in 2018 and the other from a carrot decoction for wet compresses in 2011 [18,19].…”

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

“…Andere Differenzialdiagnosen, z. B. Pellegra, Dermatitis solaris oder Porphyrien, sollten dennoch ausgeschlossen werden [6].…”