Lime Juice + Sun Can Cause Skin Rashes All About Phytophotodermatitis
The Bottom Line
When human skin is exposed to ultraviolet light and certain natural plant-derived substances, a skin condition called “phytophotodermatitis” can occur. This condition is frequently reported after skin exposure to the combination of sunlight and lime juice, and can include skin rashes, blistering, and dark pigmentation. Although it may be painful, phytophotodermatitis generally resolves on its own over time.
The Full Story
Furocoumarins are natural chemicals found in the seeds, stems, and flowers of various plant species including parsley, grapefruit, limes, lemons, celery, and carrots. Different varieties of the same plant species may contain differing levels of furocoumarins. This may be related to variations in plant species breeding (usually to increase disease resistance and hardiness). When exposed to ultraviolet light, furocoumarins cause skin cell damage that can result in swelling, rashes, and blistering. The activity of furocoumarins may serve as a defense system for plants against potential predators. In humans, exposure to sunlight as well as furocoumarins can result in skin changes (called “phytophotodermatitis”).
Phytophotodermatitis is most commonly noted in bartenders, agricultural workers, and grocery store employees. The condition may also affect individuals who live or vacation in tropical climates and drink beverages made with lime, lemon, or other citrus juices. Limes are the most common cause of phytophotodermatitis, and the condition may occur after the consumption or handling of lime-containing margaritas, beers, or other beverages. The presence of wet skin, sweating, heat, and humidity can make an exposure more severe. The classic presentation of phytophotodermatitis involves an initial area of redness on sun-exposed skin, that progresses over several days to blistering and dark pigmentation. The affected skin is usually not severely itchy, which can help differentiate phytophotodermatitis from other skin conditions such as poison ivy reactions. The skin changes caused by phytophotodermatitis may affect the arms or hands (from accidental spilling of a drink) or even the skin around the mouth (from drinking). The initial skin redness often occurs within a day of exposure to the sun and furocoumarin-containing plants. Blisters develop within 3 days; increased pigmentation changes occur over the next 1-2 weeks, and may last for months or even years in some cases. The pigmentation changes may appear as odd patterns, depending on where the furocoumarins were in contact with sun-exposed skin.
Prevention of phytophotodermatitis is important; avoidance of the sun as well as affected plant species can reduce exposure to furocoumarins. Washing affected areas with water within 1-2 hours of an exposure to furocoumarins can reduce the absorption of these agents through the skin. Sunscreen is not always protective against phytophotodermatitis, but may reduce the risk of long-term skin pigmentation changes. The treatment of phytophotodermatitis involves avoidance of additional sunlight in exposed areas. Cool compresses can be used for pain relief. Topical corticosteroids (such as hydrocortisone cream) or hospitalization may be needed for severe cases. Fortunately, most cases of phytophotodermatitis resolve on their own, and do not require medical attention or specialized treatment.
If you have a question about skin changes that may be due to phytophotodermatitis, use the webPOISONCONTROL® online tool or call 1-800-222-1222. Both options are free for the public, and available 24 hours a day.
Kelly Johnson-Arbor, MD
Medical Toxicology Physician
Poisoned?
Call 1-800-222-1222 or
Prevention Tips
- When enjoying time in the sun, try to avoid spilling citrus juices on the sun-exposed parts of your skin. If a spill occurs, wash the affected skin as soon as possible with soap and water.
- If skin changes such as blistering or rash occur after exposure to sunlight and citrus fruits, stay out of the sunlight as much as possible to reduce the risk of dark pigmentation changes.
- Wear sunscreen at all times while exposed to sunlight, and reapply it every 2 hours or more frequently if you are being active.
This Really Happened
A 6-year-old boy prepared limeade, bathing his hands in lime juice for at least 15 minutes. He then went swimming in an outdoor pool for an hour. Several hours later, he developed painful redness on both hands, which progressed to large blisters over the next 8 hours. He was unable to move his fingers or wrists due to the severity of the pain and swelling. He was admitted to a hospital and treated with burn dressings, oral steroids, splinting of his affected extremities, and range-of-motion exercises. Seventeen days later, the hands were well healed and had no evidence of scarring.References
Poisoned?
Call 1-800-222-1222 or
Prevention Tips
- When enjoying time in the sun, try to avoid spilling citrus juices on the sun-exposed parts of your skin. If a spill occurs, wash the affected skin as soon as possible with soap and water.
- If skin changes such as blistering or rash occur after exposure to sunlight and citrus fruits, stay out of the sunlight as much as possible to reduce the risk of dark pigmentation changes.
- Wear sunscreen at all times while exposed to sunlight, and reapply it every 2 hours or more frequently if you are being active.