Phytophotodermatitis from lime juice

A 36-year-old pregnant woman presented to the emergency department with a 3-day history of uncomfortable, blistering eruption involving both hands (Figure).

She described making guacamole at an outdoor picnic before developing this linear bullous eruption. The dermatologist diagnosed phytophotodermatitis. She responded to a short course of potent topical steroid application.

Phytophotodermatitis is an exaggerated blistering sunburn-like reaction caused by the interaction of ultraviolet A light and psoralens in plants. These plants include limes (in this case), lemons, parsley, parsnips, celery, carrot, fig and wild flowers of the Umbelliferae spp.1

A thorough history allows prompt diagnosis and avoids unnecessary investigations.

Figure