The fig trees revenge, two rare cases of severe phytophotodermatitis

Dr Peter Meier1, Sharon  Rowe1, Professor  Fiona  Wood1, Dr  Helen  Douglas1

1Western Australia State Burns Unit, Murdoch, Australia


Robert Klaber first introduced the term phyotphotodermatitis in 1942, a reaction cause by the combination of phototoxic agents in plants and ultraviolet light (UV). The fig tree (ficus carica) contain two of note, psoralen and bergaptol (Bowers, 1999). The cascade which causes phytophotodermatits is initiated after furocoumarins come into contact with skin and exposure to UV light causing cellular death via DNA linkage inhibiting cellular repair, synthesis and replication. We present two cases of phyophotodermatitis requiring specialist burns care

Case one, a 38 male was referred to the state burn outpatient clinic with patchy superficial partial thickness skin loss to bilateral forearms totaling TBSA 2%. The patients had been removing fig trees from a rural property and had sap dripped onto both forearms. He awoke the following day with itch pruritus, oedema and vesicles on both forearms. The injuries were managed conservatively with dressings (figure 1).

Case two, a 28-year-old male was referred from a rural hospital with patchy superficial partial thickness skin loss to bilateral lower legs with a TBSA 3.5%. The gentleman had the previous day been cutting down a fig tree and sap came in contact with his lower legs. The following day he awoke with both anterior lower legs inflamed, painful and oedematous, with some areas of skin loss. Fortunately his injuries were managed conservatively with dressings (figure 2).

Phytophotodermatitis is a rare dermatological condition that occurs with a unique set of circumstances prevail, the right plant, bright sunny conditions and a susceptible host. Usually this type of dermatitis is with much smaller areas of skin loss and managed under the care of dermatologists, only when large areas of skin loss are involved is specialist burns care sort (Bonamonte, 2010).

We present two unusual cases on phytophotodermatitis requiring specialist burn service management.


SET 3 Trainee in Plastic Surgery in Western Australia

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