Clinical analysis of 11 patients with phytophotodermatitis caused by ingesting Chenopodium album / 中华皮肤科杂志

Objective To investigate clinical characteristics and treatment of phytophotodermatitis due to ingesting Chenopodium album.Methods This study included 11 patients with phytophotodermatitis caused by ingesting Chenopodium album collected from Department of Dermatology,Affiliated Hospital of Jining Medical University from 2013 to 2017.The patients' general information,clinical manifestations,laboratory test results,treatment and prognosis were retrospectively analyzed.Results All the 11 patients were female,and their age ranged from 45 to 62 years.They all had a history of ingesting Chenopodium album and exposing to sunlight within 1-2 days prior to the disease onset.Clinical manifestations included symmetrically distributed,painful and pruritic,nonpitting,swelling erythema on the face and back of both hands and at sunexposed sites of forearms,with a tense and bright surface.Increased white blood cell counts were observed in 6 patients,and increased eosinophil counts in 1.All of the 11 patients were treated with systemic methylprednisolone,loratadine,ebastine,spironolactone,furosemide and omeprazole as well as topical agents,2 also received human immunoglobulin treatment,and 3 were also treated with oral ibuprofen and codeine for painful lesions.Ten patients received obvious improvement and were discharged after 7-10 days of treatment,and no pigmentation or scars were observed after 1-year follow-up.Skin necrosis occurred on the back of both hands in 1 patient after 7-day treatment,and scars remained in the patient after follow-up of half a year.Conclusions Chenopodium album-induced phytophotodermatitis commonly manifests as swelling erythema on the exposed body sites.After confirmed diagnosis,Chenopodium album ingestation and sunlight exposure should be avoided,and timely antianaphylactic treatment should be considered to effectively control the disease.

Clinical analysis of 11 patients with phytophotodermatitis caused by ingesting Chenopodium album / 中华皮肤科杂志

Objective@#To investigate clinical characteristics and treatment of phytophotodermatitis due to ingesting Chenopodium album.@*Methods@#This study included 11 patients with phytophotodermatitis caused by ingesting Chenopodium album collected from Department of Dermatology, Affiliated Hospital of Jining Medical University from 2013 to 2017. The patients′ general information, clinical manifestations, laboratory test results, treatment and prognosis were retrospectively analyzed.@*Results@#All the 11 patients were female, and their age ranged from 45 to 62 years. They all had a history of ingesting Chenopodium album and exposing to sunlight within 1 - 2 days prior to the disease onset. Clinical manifestations included symmetrically distributed, painful and pruritic, nonpitting, swelling erythema on the face and back of both hands and at sunexposed sites of forearms, with a tense and bright surface. Increased white blood cell counts were observed in 6 patients, and increased eosinophil counts in 1. All of the 11 patients were treated with systemic methylprednisolone, loratadine, ebastine, spironolactone, furosemide and omeprazole as well as topical agents, 2 also received human immunoglobulin treatment, and 3 were also treated with oral ibuprofen and codeine for painful lesions. Ten patients received obvious improvement and were discharged after 7 - 10 days of treatment, and no pigmentation or scars were observed after 1-year follow-up. Skin necrosis occurred on the back of both hands in 1 patient after 7-day treatment, and scars remained in the patient after follow-up of half a year.@*Conclusions@#Chenopodium album-induced phytophotodermatitis commonly manifests as swelling erythema on the exposed body sites. After confirmed diagnosis, Chenopodium album ingestation and sunlight exposure should be avoided, and timely antianaphylactic treatment should be considered to effectively control the disease.

Plantas relacionadas con fitofotodermatitis en Isla de Pascua, Chile / Plants related with phytophotodermatitis in Easter Island, Chile

La fitofotodermatitis es una enfermedad fototóxica caracterizada por la exposición de la piel a agentes fotosensibles (furocumarinas) que cambian su configuración en presencia de luz UV-A, resultando en daño cutáneo de magnitud variable según condiciones ambientales del huésped. Se identificó las plantas que contienen furocumarinas y se buscó su presencia en Isla de Pascua. Se encontraron cuatro especies en la vegetación de Isla de Pascua que están relacionadas con la fitofotodermatitis: Apium graveolens (apio), Daucus carota (zanahoria), Ficus carica (higuera y Citrus limon (limonero). El apio y la zanahoria se distribuyen principalmente en plantaciones rurales, mientras la higuera se encuentra distribuida en numerosos lugares urbanos y rurales de la isla, y el limonero está presente en sitios que reciben baja afluencia de turistas. La exposición cutánea a bebidas alcohólicas preparadas con cítricos y luz UV-A también pueden causar la patología.

Phytophotodermatitis is a phototoxic disease characterized by skin exposure to photosensitizing agents (furocoumarins), which change their configuration when exposed to UV-A ligth, resulting in variable skin damage according to environmental and host conditions. Plants containing forocoumarins were searched in Easter Island. Four species were identified in Easter Island s vegetation related with phytophotodermatitis: Apium graveolens (celery), Daucus carota (carrot), Ficus carica (fig tree) and Citrus limon (lemon tree). The celery and the carrot are distributed in numerous urban and rural plantations, the fig tree is distributed in numerous urban and rural places of the island, while the lemon tree is present in sites that receive few tourists. The skin exposition to alcoholic drinks prepared with citrus fruits plus UV-A light can also cause the disease.

Transmission electron microscopy of the preclinical phase of experimental phytophotodermatitis

OBJECTIVE: To examine the epidermis in induced phytophotodermatitis using transmission electron microscopy in order to detect histologic changes even before lesions are visible by light microscopy. INTRODUCTION: In the first six hours after the experimental induction of phytophotodermatitis, no changes are detectable by light microscopy. Only after 24 hours can keratinocyte necrosis and epidermal vacuolization be detected histologically, and blisters form by 48 hours. METHODS: The dorsum of four adult rats (Rattus norvegicus) was manually epilated. After painting the right half of the rat with the peel juice of Tahiti lemon, they were exposed to sunlight for eight minutes under general anesthesia. The left side was used as the control and exposed to sunlight only. Biopsies were performed immediately after photoinduction and one and two hours later, and the tissue was analyzed by transmission electron microscopy. RESULTS: No histological changes were seen on the control side. Immediately after induction, vacuolization in keratinocytes was observed. After one hour, desmosomal changes were also observed in addition to vacuolization. Keratin filaments were not attached to the desmosomal plaque. Free desmosomes and membrane ruptures were also seen. At two hours after induction, similar changes were found, and granular degeneration of keratin was also observed. DISCUSSION: The interaction of sunlight and psoralens generates a photoproduct that damages keratinocyte proteins, leading to keratinocyte necrosis and blister formation. CONCLUSIONS: Transmission electron microscopy can detect vacuolization, lesions of the membrane, and desmosomes in the first two hours after experimental induction of phytophotodermatitis.

Phytophotodermatitis / 대한피부과학회지

We describe herein a 3 family members with phytophotodermatitis. After fig (juice) was applied to skin for the purpose of treating psoriasis in a 30 year-old woman and applied incidentally in her mother and 3 year-old daughter, vesicobullous eruptions developed immediately after sun-exposure, predominantly in the sun-exposed area. ln histopathology, the epidermis shows intraepidermal separation with necrosis and reepithelization on basal layer and marked spongiosis. We treated with systemic steroid, wet dressing with burow solution etc, so she healed without sequela after 2 weeks.