Phytophotodermatitis: still a poorly recognised diagnosis

Description 

A 30-year-old man, forestry worker, with no medical history, presented acutely with pruritic erythematous streaks and bullae (figure 1) in linear configuration on his arms. On the previous day he had pruned branches from a fig tree and carried them with his forearms wearing a sleeveless shirt. Symptoms gradually resolved over 4 weeks of topical treatment with clobetasol propionate 0.05% cream (figure 2).

Figure 1

Bullae and irregular pigmented lesions on both arms.

Figure 2

Recovered skin 2 months later.

Furocoumarins are botanical phytoalexins found in a wide variety of plants, including the fig tree (Ficus carita; Moraceae family), which may induce a skin photosensitivity reaction following ultraviolet A radiation exposure.1 2 The acute lesions often present with irregular erythematous streaks or bullae with sharp demarcation between lesional and...

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