Severe phytophotodermatitis from fig sap: a little known phenomenon

Abstract

A 46-year-old arborist with no medical history presented to the emergency department with a confluent blistering, erythematous, non-pruritic, painful rash covering both arms circumferentially and the back of his neck. He sought medical advice as his arms were becoming more painful and swollen with blister formation, despite aloe vera cream and wet towel wraps. He recalled that 2 days previously he had been pruning a fig tree on a hot sunny day. He was wearing a t-shirt and his forearms had been exposed to a large quantity of fig sap, while he was working under direct sunlight. On examination, there were several blisters with no superimposed infection. He was diagnosed with phytophotodermatitis and referred to a regional burns unit. He recovered well with simple dressings and a course of antibiotics. At present, he has made a good recovery with no long-term sequelae such as skin hyperpigmentation or hypopigmentation.

Keywords: dermatology; emergency medicine; exposures; plastic and reconstructive surgery.

Figure 1

Images of the patient’s arms at presentation to the emergency department.