This page was printed on

21/9/2021

Phytophotodermatitis
Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. September 2014.

Phytophotodermatitis — codes and concepts close

Categories: Reaction to external agent, Eczema or dermatitis

Subcategories: Phototoxic reaction, Furocoumarins in plants, Role of UVA,

Post-inflammatory hyperpigmentation, Berloque dermatitis, Perfumes,
Bergapten, PUVA

ICD-10: L57.8

ICD-11: EK2Y

SNOMED CT: 238521005, 95349002, 402172000, 58419006, 58306008

What is phytophotodermatitis?
Phytophotodermatitis is a phototoxic reaction to contact with certain plants.

Phytophotodermatitis generally occurs during in spring or summer following some outdoor activity on a sunny day
during which there has been contact with one of the responsible plants.

Its name has 3 components: phyto (plant), photo (light) and dermatitis (in!ammatory rash).

What are the clinical features of phytophotodermatitis?

During the acute in!ammatory stage, itchy blisters and reddened patches appear on exposed skin, usually the forearms
or lower legs. These are often irregularly distributed and odd in shape. Linear lesions are characteristic. In some cases,
the in!ammatory phase is not observed.

Acute phytophotodermatitis

Acute Acute phytophotodermatitis Acute phytophotodermatitis Acute phytophotodermatitis

phytophotodermatitis,
which was followed by
hyperpigmentation
After a few days the redness and blistering settles down, but is replaced by unsightly and bizarre pigmentation at the
same sites. The pigmentation is more pronounced in dark skin compared to fair skin. This postin!ammatory
pigmentation may persist for weeks to months.

Pigmentary phytophotodermatitis

Pigmentary Pigmentary Pigmentary Pigmentary

phytophotodermatitis phytophotodermatitis phytophotodermatitis phytophotodermatitis

What causes phytophotodermatitis?

Phytophotodermatitis is induced by the action of long wavelength ultraviolet radiation (UVA) on a plant chemical called
furocoumarins (psoralens) on the skin surface. Contact with the plant, fruit or vegetable may have been brief and
unnoticed. The reaction depends on:

The amount of juice or sap on the skin

The amount of furocoumarins in the plant, which is thought to be produced in response to fungal attack
Amount of UVA exposure. UVA levels are greater when during the middle part of the day, in midsummer and at high
altitude

The reaction causes in!ammation in the epidermis (contact dermatitis) and activation of melanocytes (pigment cells) to
produce melanin pigment.

Pigmentation due to phytophotodermatitis is partly epidermal melanosis (ie pigment is within the skin cells) and partly
dermal melanosis (ie the pigment is deeper in the skin).

Which plants cause phytophotodermatitis?

Responsible plants include:

Parsley
Parsnips
Celery
Carrot
Fig
Lime
Lemon
Bergamot oranges
Common rue
Several species of wild !owers (umbelliferae), such as hogweed.

Plants that cause phytophotodermatitis

Parsley Parsnip Lime Wild carrot

What is berloque dermatitis?

Berloque dermatitis (or trinket dermatitis) is a special form of phytophotodermatitis caused by exposure to perfumes.
These perfumes contain a high concentration of bergapten (5-methoxypsoralens).

Berloque dermatitis is rare nowadays, but may arise if an older fragrance is applied to the skin. Current regulations
restrict the concentration of bergapten so that it is below the threshold required to cause contact dermatitis or
pigmentation.

The acute in!ammatory dermatitis due to berloque dermatitis is sometimes unnoticed and the patient may present with
streaky pigmentation on the neck or wrist.

Photoxicity due to PUVA

Photochemotherapy (PUVA) is a treatment for in!ammatory skin diseases such as psoriasis and eczema. The treatment
involves taking psoralens by mouth or applying psoralens solution to the skin, followed by exposure to UVA, in
controlled circumstances.

PUVA has bene"cial e#ects on the skin diseases, but as it involves the same process as occurs in phytophotodermatitis,
it can result in excessive pigmentation. This can be quite noticeable after topical or bathwater PUVA.

Phototoxic pigmentation due to topical PUVA

Topical PUVA followed by

sun exposure has caused
phototoxic pigmentation on
uncovered skin

What is the treatment for phytophotodermatiits?

By the time pigmentation has occurred, the in!ammatory phase of phytophotodermatitis is over. This means that anti-
in!ammatory treatments like topical steroids are only useful in the early phase of redness and blistering.
The postin!ammatory pigmentation that follows phytophotodermatitis responds poorly to treatment with bleaching
creams. It fades gradually over weeks to months. Using covering clothing and broad spectrum sunscreens, a#ected skin
should be protected from further sun exposure, which might cause the pigmentation to darken. It can be disguised
using cosmetic camou!age make-up.

Dermographism

Related information

On DermNet NZ
Pigmentation
Dermatitis
Contact dermatitis
Fragrances and perfumes
Plant dermatitis

Other websites
Phytophotodermatitis – Medscape Reference
The many faces of phytophotodermatitis – Dermatology Online Journal

Books about skin diseases

Books about the skin
Dermatology Made Easy book
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