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 Table of Contents  
CME IN IMAGES
Year : 2019  |  Volume : 17  |  Issue : 3  |  Page : 92-93

A more common reaction than thought


1 Family Health Unit Grão Vasco, Viseu Heath Center III, Viseu, Portugal
2 Department of Dermatology and Venereology, Tondela Viseu Hospital Centre, Viseu, Portugal

Date of Submission30-Aug-2018
Date of Acceptance12-Aug-2019
Date of Web Publication26-Sep-2019

Correspondence Address:
Dr. Marisa Benigno Bizarro
Immaculate Heart of Mary Street, Lote 50, 1°P, 3500-236 Viseu
Portugal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_33_18

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How to cite this article:
Bizarro MB, Duarte L, Beirão M. A more common reaction than thought. Curr Med Issues 2019;17:92-3

How to cite this URL:
Bizarro MB, Duarte L, Beirão M. A more common reaction than thought. Curr Med Issues [serial online] 2019 [cited 2019 Oct 14];17:92-3. Available from: http://www.cmijournal.org/text.asp?2019/17/3/92/267910


  Case Scenario Top


A 34-year-old man presented to the emergency with burning sensation, rash, and irregular blister formation localized in the left thigh that appeared in the morning. Previous day, he had exposure to plants while cutting eucalyptus and also he referred sunlight exposure too. His physical examination revealed irregular and well-demarcated blister [Figure 1].
Figure 1: Irregular and well-demarcated blister.

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  Questions Top


Question 1

These clinical findings are associated with what underlying condition?

  1. Allergic contact dermatitis
  2. Phytophotodermatitis
  3. Bullous impetigo
  4. Cellulitis.


Question 2

A physician must be aware that this entity exists as it is often misdiagnosed as other skin conditions. The diagnosis is clinical, so the patient history and the physical examination are essential. Which of these clinical findings is less common in this entity?

  1. Recent contact with plants or fruits (citrus fruits and figs) and sun exposure
  2. Painful or burning sensation
  3. Itching
  4. Irregularly shaped lesions with well-demarcated patterns representing the exposure to the phototoxic agent.


Question 3

About treatment and prognosis, which of these statements is not correct?

  1. Treatment depends on its extent of involvement
  2. Systemic treatment with corticosteroid is contraindicated
  3. Treatment is principally symptomatic with topical steroids, and application of cold compresses to alleviate pain and reduce duration of symptoms
  4. This is a self-limited problem that resolves with the removal of photosensitizing substance.



  Answers to the Questions Top


Question 1

The answer is phytophotodermatitis. This entity is a cutaneous phototoxic inflammatory eruption, resulting from contact with photosensitizing compounds in plants and then exposed to sunlight.[1],[2],[3]

Question 2

The answer is itching. The clinic situation usually has a history of recent contact with plants or fruits (citrus fruits and fi gs), sun exposure, and complaints of painful or burning sensation, rather than itching, which is more common in allergic contact dermatitis [2]. On physical examination, irregularly shaped lesions with well-demarcated patterns representing the exposure to the phototoxic agent are often observed [1],[2].

Question 3

The answer is systemic treatment with corticosteroid is contraindicated. This is a self-limited problem that resolves with the removal of photosensitizing substance. Treatment depends on its extent of involvement. It is principally symptomatic with topical steroids, and application of cold compresses to alleviate pain and reduce duration of symptoms [1],[2],[3]. Systemic treatment with corticosteroid is recommended in severe cases [3].

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Hankinson A, Lloyd B, Alweis R. Lime-induced phytophotodermatitis. J Community Hosp Intern Med Perspect 2014;4:25090.  Back to cited text no. 1
    
2.
Baugh WP, Chen CL, Kucaba WD, Barnette D, Baugh NA. Phytophotodermatitis clinical presentation. Medscape 2018. Available from: https://emedicine.medscape.com/article/1119566-overview. [Last accessed on 2018 Aug 30].  Back to cited text no. 2
    
3.
Sarhane KA, Ibrahim A, Fagan SP, Goverman J. Phytophotodermatitis. Eplasty 2013;13:ic57.  Back to cited text no. 3
    


    Figures

  [Figure 1]



 

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