title: Bullous phytophotodermatitis associated with high natural concentrations of furanocoumarins in limes.
abstract: BACKGROUND
  Phytophotodermatitis is a phototoxic reaction, occurring in skin exposed to sunlight after contact with plants containing furanocoumarins. Typical reactions are mild, showing erythema with post-inflammatory hyperpigmentation. A 6-year-old boy presented with marked, symmetric, painful erythema and edema of both hands that rapidly developed into dramatic bullae covering the entire dorsum of the hands. The history revealed that the hands had been bathed in lime juice for a prolonged period in the preparation of limeade.
  
  
  OBJECTIVE
  This report documents an unusual bullous presentation of phytophotodermatitis resulting from contact with furanocoumarins in local limes. This study was conducted to identify and measure the inciting substances from the rind and pulp of the limes.
  
  
  METHODS
  Psoralen, xanthotoxin, bergapten, and isopimpinellin content were measured by gas chromatography and high-pressure liquid chromatography
  
  
  RESULTS
  The rind contained 6- to 182-fold concentrations of all furanocoumarins measured when compared with pulp. Bergapten was the most abundant substance in the rind.
  
  
  CONCLUSIONS
  Hydration of the skin during the preparation of limeade combined with increased levels of bergapten in local limes to produce a dramatic bullous reaction. We encourage clinicians to consider the possibility of phytophotodermatitis in severe bullous skin reactions.
authors.affiliation: Department of Pediatrics, Northwestern University Medical School, Chicago, IL, USA. awagner@northwestern.edu
authors.forename: Annette M
authors.initials: AM
authors.lastname: Wagner
authors.forename: Jashin J
authors.initials: JJ
authors.lastname: Wu
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Hansen
authors.forename: Herbert N
authors.initials: HN
authors.lastname: Nigg
authors.forename: Ross C
authors.initials: RC
authors.lastname: Beiere
mesh_terms: D002648:Child; D002957:Citrus / Q000009:adverse effects; D003374:Coumarins / Q000009:adverse effects* / Q000032:analysis; D017484:Dermatitis, Phototoxic / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D003937:Diagnosis, Differential; D004638:Emergency Treatment; D006229:Hand Dermatoses / Q000139:chemically induced / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D010947:Plants, Toxic / Q000009:adverse effects
chemical_list: D003374:Coumarins