The Sunny Side of Lime

Abstract

A 26-year-old woman was affected with a maculopapular rash because of a jellyfish sting on her right leg while surfing in Indonesia. A locally-prepared liniment was applied on the affected skin. She presented with hyperpigmented linear tracks that she noted a few days later.

Lime-induced phytophotodermatitis

“…The above history and clinical findings are characteristic of lime phytophotodermatitis. Phytophotodermatitis is a nonimmunologic skin eruption which develops after the skin comes in contact with phototoxic agents in certain plants and then is exposed to ultraviolet A (UVA) radiation ( 1 ). Several common plant families, including Rutaceae family (lime, lemon) and Umbelliferae family (celery, wild parsnip, parsley, hogweed), contain phototoxic compounds called furocoumarins which are psoralen isomers ( 1 ).…”

“…Phytophotodermatitis is a nonimmunologic skin eruption which develops after the skin comes in contact with phototoxic agents in certain plants and then is exposed to ultraviolet A (UVA) radiation ( 1 ). Several common plant families, including Rutaceae family (lime, lemon) and Umbelliferae family (celery, wild parsnip, parsley, hogweed), contain phototoxic compounds called furocoumarins which are psoralen isomers ( 1 ). When exposed to UVA radiation, psoralens cause photochemical reactions in the skin which damage cell membranes, resulting in cell death, edema, blistering, and injury to the epidermis ( 2 ).…”

“…Clinically phytophotodermatitis can initially present as lesions ranging from painful erythema and edema to blisters. There can be corresponding vesicles, plaques, or areas of hyperpigmentation ( 1 , 3 , 4 ). This eruption can begin within hours to days after initial sunlight exposure, and commonly transforms into patches of post-inflammatory hyperpigmentation which can last up to several months ( 1 ).…”

“…There can be corresponding vesicles, plaques, or areas of hyperpigmentation ( 1 , 3 , 4 ). This eruption can begin within hours to days after initial sunlight exposure, and commonly transforms into patches of post-inflammatory hyperpigmentation which can last up to several months ( 1 ). It often presents in irregularly shaped, well demarcated patterns representing the exposure to the lime juice or other phototoxic agent.…”

“…Treatment is principally symptomatic with topical steroids and application of cold compresses to alleviate pain and reduce duration of symptoms. Prevention is key, with avoidance of sunlight after exposure to photosensitizing agents ( 1 ).…”