Ann Dermatol.  2017 Feb;29(1):86-90. 10.5021/ad.2017.29.1.86.

Five Cases of Phytophotodermatitis Caused by Fig Leaves and Relevant Literature Review

Affiliations
  • 1Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea. dockbs@pusan.ac.kr
  • 2Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Abstract

Phytophotodermatitis is a condition caused by sequential exposure to photosensitizing substances present in plants followed by ultraviolet light. Several plants (e.g., limes, celery, fig, and wild parsnip) contain furocoumarin compounds (psoralens). It is important for dermatologists to be aware of phytophotodermatitis because it may be misdiagnosed as cellulitis, tinea, or allergic contact dermatitis. We present five patients with a sharply defined erythematous swollen patch with bullae on both feet. They described soaking their feet in a fig leaves decoction to treat their underlying dermatologic diseases. Within 24 hours, all patients had a burning sensation in their feet, and erythema and edema had developed on the feet dorsa with exception of the portion of the skin covered by the sandals. Histopathologic examinations revealed sub-epithelial blisters with intensive epidermal necrosis. Phytophotodermatitis was ultimately diagnosed and, after several days, the patients' skin lesions began to recover upon treatment with systemic and topical corticosteroids. Unfortunately, since there are no studies providing sufficient evidence on the benefits of fig leaves, they should be used with caution.

Keyword

Ficus; Photodermatitis; Remedy

MeSH Terms

Adrenal Cortex Hormones
Apium graveolens
Blister
Burns
Cellulitis
Citrus aurantiifolia
Dermatitis, Allergic Contact
Edema
Erythema
Ficus
Foot
Humans
Necrosis
Photosensitivity Disorders
Sensation
Skin
Tinea
Ultraviolet Rays
Adrenal Cortex Hormones

Figure

  • Fig. 1 Sharply defined erythematous swollen patch with bullae on both feet in five patients. (A) Case 1, (B) Case 2, (C) Case 3, (D) Case 4, (E) Case 5.

  • Fig. 2 Erythema, edema, and bullae developed on feet dorsa, except the portion of the skin hidden under the sandal straps, after sequential exposure to fig leaves and ultraviolet A within 24 hours. The phototoxic reaction was considered to be a positive result for the photopatch test. (A) Case 1, (B) Case 2.

  • Fig. 3 H&E images of a sub-epithelial blister with intensive epidermal necrosis. (A, B) Case 1 (A: ×40, B: ×200). (C, D) Case 2 (C: ×40, D: ×200).


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