Ganesh Maniam, BA, MBA; Katelyn MacLeay Light, MD; Joanna Wilson, DO
Corresponding Author: Ganesh Maniam, BA, MBA; Texas Tech University Health Sciences Center. Email: Ganesh.Maniam@ttuhsc.edu
Section: Brief Report
Publication: 3/18/2021
Phytophotodermatitis is a cutaneous reaction caused by direct contact with phototoxic agents and subsequent sunlight exposure. Furocoumarins and psoralens are two such phototoxic agents that can cause this reaction, and these organic chemical compounds are found in many plant species consumed by humans Following contact exposure to such foods and ultraviolet radiation exposure via direct sunlight, phytophotodermatitis can occur. Due to the etiology of these rashes relating closely to the outdoor consumption of margaritas, the rash may be known by patients as “margarita burn”. The classically described clinical triad in these patients is a sequence of rash progression: first as erythematous macules or patches, which later become vesicles and appear similar to second degree burns, before finally becoming an asymptomatic hyperpigmentation. However, the wide variety of presentations may cause a difficult diagnosis due to confusion with other similar skin conditions. This case presents a 26-year-old female diagnosed with phytophotodermatitis following utilization of citrus fruits for margaritas while outdoors in direct sunlight. The diagnosis of phytophotodermatitis is often made clinically, but can be complicated due to its similarity in appearance to many other common cutaneous reactions. In this patient, the differential diagnosis included solar erythema, contact dermatitis (type IV hypersensitivity reaction), polymorphic light eruption, or drug-related photosensitivity. Careful history taking is essential in not only narrowing down the differential diagnosis, but also in avoiding unnecessary tests or ineffective treatments. A discussion of this case may assist physicians in the recognition and treatment of similar cases.