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Fig tree sap exposure resulting in phytophotodermatitis with multiple bullae
Visual Journal of Emergency Medicine 8 (2017) 10–11
Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Fig tree sap exposure resulting in phytophotodermatitis with multiple bullae
MARK
James M. Burgert DNAP Midwestern University, College of Health Sciences, Glendale, AZ, USA
A R T I C L E I N F O Keywords: Phytophotodermatitis Fig sap Bullae Phototoxic dermatitis Furocoumarins
A 42-year-old healthy male presented to urgent care 24 h after cutting down a fig tree complaining of itching and a vesicular, erythematous rash over the bilateral tibial regions with a circumscribed margin at the ankles (Fig. 1). He was given IM hydrocortisone and discharged. After air travel, a day later, he developed multiple bullae over the affected areas (Fig. 2). Several bullae ruptured because of vigorous activity during travel (Fig. 3). Dermatology was consulted on his return and a diagnosis of phytophotodermatitis (PPD) made. He was treated with an oral antihistamine, topical steroid cream, and advised to avoid sun exposure.
Fig. 1. Erythematous rash and vesicle formation 24 h after fig tree sap exposure.
http://dx.doi.org/10.1016/j.visj.2017.02.003 Received 23 January 2017; Accepted 27 February 2017 2405-4690/ © 2017 Elsevier Inc. All rights reserved.
Fig. 2. Bullae formation 48 h after fig tree sap exposure and air travel.
Visual Journal of Emergency Medicine 8 (2017) 10–11
J.M. Burgert
DNA. Exposure of FC bound DNA to sunlight blocks DNA synthesis and repair resulting in epidermal necrosis, vesicles, and bullae.3 The condition is self-limiting and usually managed with skin decontamination and supportive care as above. Diagnostic caution should be observed as this condition may appear similar to signs of abuse.2 References 1 Raam R, DeClerck B, Jhun P, et al. Phytophotodermatitis: the other lime disease. Ann Emerg Med. 2016;67(4):554–556. http://dx.doi.org/10.1016/j.annemergemed.2016.02.023. 2 Abali AE, Aka M, Aydogan C, Haberal M. Burns or phytophotodermatitis, abuse or neglect: confusing aspects of skin lesions caused by the superstitious use of fig leaves. J Burn Care Res. 2012;33(6):e309–e312. http://dx.doi.org/10.1097/ BCR.0b013e318257d877. 3 Mandalia MR, Chalmers R, Schreuder FB. Contact with fig tree sap: an unusual cause of burn injury. Burns. 2008;34(5):719–721. http://dx.doi.org/10.1016/ j.burns.2007.03.026.
Fig. 3. Resolving ruptured bullae 1 week after fig tree sap exposure.
Skin contamination with furocoumarins (FC) found in lime, lemon, fig, celery, and other plants causes PPD.1,2 The FC bind with epidermal
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Contents lists available at ScienceDirect
Visual Journal of Emergency Medicine journal homepage: www.elsevier.com/locate/visj
Visual Case Discussion
Fig tree sap exposure resulting in phytophotodermatitis with multiple bullae
MARK
James M. Burgert DNAP Midwestern University, College of Health Sciences, Glendale, AZ, USA
A R T I C L E I N F O Keywords: Phytophotodermatitis Fig sap Bullae Phototoxic dermatitis Furocoumarins
A 42-year-old healthy male presented to urgent care 24 h after cutting down a fig tree complaining of itching and a vesicular, erythematous rash over the bilateral tibial regions with a circumscribed margin at the ankles (Fig. 1). He was given IM hydrocortisone and discharged. After air travel, a day later, he developed multiple bullae over the affected areas (Fig. 2). Several bullae ruptured because of vigorous activity during travel (Fig. 3). Dermatology was consulted on his return and a diagnosis of phytophotodermatitis (PPD) made. He was treated with an oral antihistamine, topical steroid cream, and advised to avoid sun exposure.
Fig. 1. Erythematous rash and vesicle formation 24 h after fig tree sap exposure.
http://dx.doi.org/10.1016/j.visj.2017.02.003 Received 23 January 2017; Accepted 27 February 2017 2405-4690/ © 2017 Elsevier Inc. All rights reserved.
Fig. 2. Bullae formation 48 h after fig tree sap exposure and air travel.
Visual Journal of Emergency Medicine 8 (2017) 10–11
J.M. Burgert
DNA. Exposure of FC bound DNA to sunlight blocks DNA synthesis and repair resulting in epidermal necrosis, vesicles, and bullae.3 The condition is self-limiting and usually managed with skin decontamination and supportive care as above. Diagnostic caution should be observed as this condition may appear similar to signs of abuse.2 References 1 Raam R, DeClerck B, Jhun P, et al. Phytophotodermatitis: the other lime disease. Ann Emerg Med. 2016;67(4):554–556. http://dx.doi.org/10.1016/j.annemergemed.2016.02.023. 2 Abali AE, Aka M, Aydogan C, Haberal M. Burns or phytophotodermatitis, abuse or neglect: confusing aspects of skin lesions caused by the superstitious use of fig leaves. J Burn Care Res. 2012;33(6):e309–e312. http://dx.doi.org/10.1097/ BCR.0b013e318257d877. 3 Mandalia MR, Chalmers R, Schreuder FB. Contact with fig tree sap: an unusual cause of burn injury. Burns. 2008;34(5):719–721. http://dx.doi.org/10.1016/ j.burns.2007.03.026.
Fig. 3. Resolving ruptured bullae 1 week after fig tree sap exposure.
Skin contamination with furocoumarins (FC) found in lime, lemon, fig, celery, and other plants causes PPD.1,2 The FC bind with epidermal
11