Phytophotodermatitis

Table of Contents

1. A Reaction Between a Plant and the Sun
2. The Plants and Foods Linked to It
3. How It Changes Over Days and Weeks
4. The Form That Shows Only Brown Staining
5. Why Children Are Often Affected
6. Mistaken for Abuse or Burns
7. How It Is Told Apart From Sunburn and Contact Dermatitis
8. When It Becomes a Burn
9. What Case Series and Reviews Report About Treatment
10. Eating Furocoumarin Foods and Light Sensitivity
11. What Is Not Known
12. Key Research Papers
13. Connections
14. Featured Videos

A Reaction Between a Plant and the Sun

The name explains itself in three parts: "phyto" for plant, "photo" for light, and "dermatitis" for inflamed skin. A 2021 review in the journal Dermatitis describes it as a skin reaction that occurs after exposure to plant-derived furocoumarins and ultraviolet A light, and names psoralen as the most common of these light-activated plant compounds. A 2024 review in the journal Life calls it a non-immunologic reaction, meaning the immune system does not drive it. That is the main difference from poison-ivy-type allergic rashes, which only appear in people whose immune systems have already been primed against a plant.

On its own, a furocoumarin sitting on the skin does little. The damage starts when ultraviolet A light arrives. A 2018 case report on wild parsnip explains the chain in plain terms: once activated by ultraviolet light, the furocoumarins interact with oxygen, and the reactive oxygen species that result damage the tissue, showing first as blistering and later as darkened skin. The same light-plus-psoralen chemistry is used on purpose in medicine, in the psoralen-and-ultraviolet-A treatment used for some skin diseases (see the lovage furanocoumarins page for the drug side of that story).

Because the reaction needs both steps, the injury shows up only where the plant chemical and the light met. Skin that had the juice but stayed covered, or skin that was in the sun but never touched the plant, is spared. A 2021 dermatology review in the journal Cutis notes that the light can be solar or artificial, and that the reaction affects skin at the points of contact and ultraviolet exposure. The same review notes that it is not only a recreational problem but can also be a serious occupational skin disease.

The Plants and Foods Linked to It

The 2024 review in Life names three plant families as the most common sources: the carrot family (Apiaceae), the citrus family (Rutaceae) and the fig and mulberry family (Moraceae). Among individual species it names giant hogweed (Heracleum mantegazzianum), common rue (Ruta graveolens), the fig tree (Ficus carica) and the parsnip (Pastinaca sativa), and it singles out furocoumarin-containing limes as a cause of lime-induced photodermatitis. A 1999 report in the British Journal of Dermatology adds the pea family (Leguminosae) to the list of plant families that carry psoralens.

• Limes and other citrus. A 2026 case report and literature review in Cureus describes "margarita dermatitis" from lime peel or lime juice on the skin followed by sun, and lists related variants named for the drinks involved: mojito dermatitis and Mexican beer dermatitis. Lemons cause the same reaction: a 2017 report from a burn center in Arizona describes a 7-year-old girl who squeezed lemon juice onto her skin while playing outside in the sun.
• Makrut lime. The 1999 British Journal of Dermatology report describes extensive phytophotodermatitis in a hiker who had applied the juice of Citrus hystrix (makrut lime, often sold as kaffir lime) as a folk remedy to keep biting insects away. The site's makrut lime essential oil page covers the oils themselves.
• Bergamot in perfume. A 2002 report describes "berloque dermatitis," a form caused by perfumed products containing bergamot (or another psoralen) on the skin followed by sunlight. It leaves striking straight lines of darkened skin where the scented product was applied, sometimes after a first phase of redness and blistering.
• Celery. A 2025 review in Cutis states that celery (Apium graveolens) contains furocoumarins and psoralens that can cause the reaction, with blisters on sun-exposed skin. It identifies people who handle celery regularly, people who eat produce infected with fungus, and tanning-bed users as being at increased risk.
• Parsnip and wild parsnip. The 2018 wild parsnip report describes a plant brought to North America as a root vegetable that now grows wild on prairies and roadsides, with furocoumarins in its stems and leaves. The woman described developed the reaction after walking through wild parsnip on a midwestern prairie. The site's parsnip page covers the vegetable itself.
• Fig leaves, sap and fig-leaf preparations. A 2019 report from Iran states that the leaf and root sap of the fig tree are the most potent parts. Several reports describe reactions after fig leaves were used in home preparations: foot soaks, baths, and a fig-leaf tea used as a tanning lotion (details in the burn section below).
• Giant hogweed. This tall carrot-family weed accounts for some of the most severe reports, including injuries managed in burn centers. A 2017 burn-unit case series from Manchester notes that phytophotodermatitis from the plant can progress to a chemical burn.

Two more traditions turn up in the reports as sources of exposure. A 2023 case report and review in Photodiagnosis and Photodynamic Therapy describes fig tree latex being used as a traditional wart treatment in some rural areas, especially in Iran, and notes that its effect on warts has never been scientifically evaluated. The fig-leaf foot-soak patients in a 2017 Korean series had used the decoction to treat their own existing skin conditions.

How It Changes Over Days and Weeks

The reaction usually follows a recognisable course, though not every person goes through every stage.

1. The quiet hours. Right after the exposure, the skin often looks and feels normal. The 2021 Cutis review states that people typically develop symptoms within 24 hours. A 2026 series of five patients treated in a French plastic surgery department reported a mean time to symptom onset of 28.8 hours.
2. Redness, burning and swelling. The first visible sign is usually a red, burning or painful patch. In the Korean fig-leaf series, all five patients felt burning in their feet within 24 hours, followed by redness and swelling. The 2026 Cureus review describes lime reactions as painful and occasionally itchy.
3. Blisters. Fluid blisters can follow, from small vesicles to large bullae. Among the five French patients, all had redness, two had small blisters and three had large blisters. The Arizona burn-center report calls the progression from redness to blisters to darkened skin a well-described clinical triad.
4. Brown staining. As the inflammation settles, the skin in the same shape turns brown. This is called post-inflammatory hyperpigmentation. The Cureus review states that this pigmentation often eventually improves or completely resolves. The French series states that it can persist for several years, and in one of their five patients it remained as a lasting result of the injury.

The 2021 Cutis review adds that the acute reaction may be mild or severe, and that in some people the brown staining is more noticeable than the original redness ever was. The shape is the most telling sign throughout: the same review describes bizarre patterns and straight streaks where the plant juice splashed onto the skin.

The Form That Shows Only Brown Staining

Some people never notice a burn at all. A 2018 report in the Annals of Dermatology describes two patients who developed sudden, painless brown patches on their hands after handling citrus fruit and then being in strong sunlight, with no redness or blistering beforehand. The authors note that this pigment-only form appears especially in people with darker skin, and that it can make the diagnosis difficult, because a person who never felt a burn has no reason to connect the marks to a lime or a lemon.

The 2026 Cureus review gathered the reported cases of this painless, delayed form linked to lime. Including the review's own patient, a 28-year-old man whose hands developed pigment three days after contact with lime and sun, the authors counted 14 people. In 11 of them the staining was on the backs of the hands, and in the remaining three it was on the back. The most common exposure was preparing a drink or a meal that included lime. The pigment appeared anywhere from two days to three to seven weeks after the exposure, with a median of seven days.

That long and variable gap matters for anyone trying to work out the cause. By the time a brown mark appears, the person may have forgotten a lime squeezed into a drink a week earlier. The Cureus review notes that many patients are unaware that the lime contact and the later sun exposure were related to their new skin change, and that a person with either the acute or the long-lasting pigment form is often first given an incorrect diagnosis.

Why Children Are Often Affected

The 2021 Cutis review states that children and adolescents seem particularly prone to phytophotodermatitis, and it gives the reasons in ordinary terms: children spend time in the sun, and they come into contact with plants such as wild parsley in lawn grass and with drinks flavoured with lime. The 1999 British Journal of Dermatology report makes a similar point about temperate countries, where cases are often seen among children playing outdoors in summer, the season when psoralens are most abundant in wild and garden plants.

The reports describe how ordinary the exposures are. The Arizona girl was playing with lemons in her own backyard. In the 2019 Iranian report, four children were playing with fig tree leaves during a family picnic and were referred to a burn center with second-degree burns covering about 10% of their total body surface area. In a 2014 report from Austria, a 10-year-old girl developed extensive reactions after contact with giant hogweed and long sun exposure, involving 10% of her body surface area, mainly on the legs. A 2011 report from Dublin describes a 10-year-old boy with a giant hogweed injury on his shin.

Children are also exposed through home remedies chosen by adults. In a 2012 report from a burn center in Ankara, a 13-year-old boy was bathed in a fig leaf decoction that his parents hoped would help his developmental disability. All three family members developed the reaction, the boy most severely.

Mistaken for Abuse or Burns

Straight streaks, drip marks and sharp-edged patches on a child's skin can look like an injury someone caused. That resemblance has led to real investigations. A 2002 report describes a 9-year-old girl with berloque dermatitis from a perfumed product who was first reported as a case of child abuse; the authors described it as the first report of berloque dermatitis mimicking abuse. The 2017 Arizona report and the 2017 Manchester giant hogweed series both name a mistaken diagnosis of non-accidental injury as one of the reasons accurate recognition matters.

The clearest numbers come from a 2024 systematic review in Pediatric Dermatology that collected published cases of children (under 18) investigated for both a skin rash and nonaccidental trauma. It included 21 case reports or series covering 29 patients. Among the 26 children first investigated as possible abuse, 26.9% involved Child Protective Services. Their final diagnoses were irritant contact dermatitis in 53.8%, phytophotodermatitis in 30.8%, allergic contact dermatitis in 7.7%, perianal infectious dermatitis in 3.8% and atopic dermatitis in 3.8%.

The same review also found the opposite error. Three children who were first diagnosed with an ordinary rash were later found to be victims of abuse: two of physical abuse and one of sexual abuse. The review's authors list the history points that helped separate the two, including contact with furocoumarin-containing plants or fruit, similar marks in family members or friends, and the pattern of the lesions. They also note that their review is limited by possible underreporting and by the low quality of the case-based evidence it drew on.

How It Is Told Apart From Sunburn and Contact Dermatitis

Compared with sunburn. A sunburn follows the outline of whatever skin was uncovered. Phytophotodermatitis follows the outline of the plant juice, within the sun-exposed skin. A 2024 Botanical Briefs article on fig reactions describes the presentation as a straight-lined, red, blistering rash that can seem like a sudden painful sunburn that gets worse rather than better with time. In the Korean fig-leaf series, the redness and swelling covered the tops of the feet except for the skin covered by the patients' sandals, a sharp boundary that matched both the soak and the sun.

Compared with contact dermatitis. Ordinary contact dermatitis comes in two types: irritant reactions from direct damage, and allergic reactions that need an earlier sensitising exposure. Phytophotodermatitis needs light as the second ingredient, which is why it appears only on contact areas that were then in the sun. The 2017 Korean authors list the conditions it may be misdiagnosed as: cellulitis, fungal infection (tinea) and allergic contact dermatitis. The 2026 Cureus review adds blistering skin diseases, unusual bruising, other kinds of dermatitis, infections, drug reactions, pigment disorders and trauma.

How the diagnosis is made. All the sources agree that the history carries most of the weight: what the person touched, and whether that skin was in the sun afterwards. The French plastic surgery series states that the diagnosis rests on a detailed history showing the typical sequence of plant contact followed by ultraviolet exposure. The 2024 review in Life also lists patch testing, Wood's lamp examination and skin biopsy among the tests used. Under the microscope, the Korean fig-leaf biopsies showed blisters beneath the top skin layer with intense death of the surface skin cells.

When It Becomes a Burn

Most reported cases are limited to a patch of skin, but the surgical literature describes injuries that behave like true burns. The French series of 2026 calls phytophotodermatitis a rare and poorly recognised cause of chemical burns whose appearance resembles second-degree burns. The Manchester authors wrote in 2017 that, apart from scattered case reports, the surgical literature had published nothing on plant burns for 20 years, and that burn teams were largely unaware of this way of being injured.

• Fig-leaf tanning lotion. A 2013 report describes a 42-year-old woman with severe burns over 81% of her body surface after sunbathing with fig leaf tea applied as a tanning agent. She spent 13 days in a burns intensive care unit before follow-up as an outpatient.
• Handling a fig tree. The 2023 Spanish report describes a 28-year-old man with severe reactions after handling a fig tree with widespread sun exposure, who needed care in a burn unit. The authors state that widespread exposure can be life-threatening.
• Giant hogweed, full thickness. The 2011 Dublin report describes a 10-year-old boy who arrived two weeks after the injury with a full-thickness chemical burn on his shin. Earlier reports had described partial-thickness burns that healed with simple care, but this boy needed debridement (removal of dead tissue) and a split-thickness skin graft.
• The Ankara family. The mother left hospital 6 days after admission, the father after 8 days and the boy after 14 days.

In these reports, the injuries that reached burn units involved a large area of skin, a concentrated plant preparation applied deliberately, giant hogweed, or a delay before care. Hospitals in these reports treated extensive blistering, large body surface involvement and deep skin loss as burn injuries.

What Case Series and Reviews Report About Treatment

There are no clinical trials of treatment for phytophotodermatitis. What is known comes from case reports, small case series and reviews describing what clinicians did and how patients fared. The French series summarises the general picture: treatment is mainly aimed at symptoms.

• Washing and steroid creams for limited reactions. All five French patients had the affected areas rinsed with water straight away, followed by a corticosteroid cream. None needed surgery for the skin to heal over. The authors describe management as resting mainly on pain relief and corticosteroid dressings, with quick healing in most cases.
• Corticosteroids by mouth and on the skin. In the Korean fig-leaf series, the patients' skin began to recover after several days of treatment with corticosteroids given both by mouth and on the skin.
• Antihistamines. The 2023 Spanish review lists corticosteroid creams and antihistamines by mouth as the symptom treatments used, with burn unit admission in severe cases.
• Burn care for blistering injuries. The Ankara family's wounds were dressed with silver sulfadiazine, and all three healed completely. The Arizona girl had her blisters debrided, received dressings and pain medication, and went home after 4 days. In the Austrian giant hogweed case, steroid cream was used at first on the redness, then, because of extensive blisters, the approach changed to debridement and temporary wound closure with a dressing, with a favourable outcome. The 2013 fig-leaf report states that treatment of such burns does not differ from standard treatment of heat-caused second-degree burns.
• Milder cases. The Arizona burn center reports that most of these injuries it sees are managed without hospital admission. The Cureus review describes the brown staining as often fading over time.
• Prevention as described in reviews. The 2024 review in Life discusses protective clothing, such as long sleeves and gloves, as the main preventive measure. The 2023 Spanish review names keeping away from the plant and from sun exposure as the essential pillar of management.

The Manchester authors state directly that prospective studies are needed to assess how well topical treatments and surgical management work. No study has compared one cream with another, measured whether early washing changes the outcome, or tested any treatment for the long-lasting brown staining.

Eating Furocoumarin Foods and Light Sensitivity

Almost every reported case comes from skin contact, not from eating. The 2025 celery review states that when celery is eaten as part of a typical diet, the amount of furocoumarins it supplies is generally not enough to cause phytophotodermatitis. The celery allergy and photosensitivity page goes into the reports of reactions after very large amounts.

Diet may matter in one setting: people receiving light therapy. A 2021 multicenter study in Nutrients followed 119 adults with psoriasis receiving narrowband ultraviolet B phototherapy for 8 weeks: 40 were omnivores (eating both animal and plant foods), 41 were vegetarian and 38 were vegan. Severe redness after treatment occurred in 16 vegans (42.11%), 7 vegetarians (17.07%) and 4 omnivores (10.00%). Patients with severe redness were more likely to have a high intake of furocoumarin-rich foods (odds ratio 5.67), and the vegans ate the most of these foods. This was an observational study in people with psoriasis under controlled ultraviolet B treatment, so it says nothing directly about ordinary sun exposure in healthy people, and it cannot show that the foods caused the difference. The authors concluded that recording diet and adjusting the light-therapy protocol for vegan patients may be prudent.

What Is Not Known

• How common it is. The evidence is almost entirely case reports and small series. No study has measured how often phytophotodermatitis occurs in the general population, and the 2024 pediatric review notes that cases are probably underreported.
• How much plant and how much sun. The reports describe exposures but do not establish how much juice or sap, or how many minutes of sunlight, it takes to produce a reaction. The furocoumarin content of some sources, such as makrut lime peel, has not been well measured.
• Who gets only staining. Why some people develop painless brown marks with no burn, and others blister, is not settled. The 2018 Korean report links the pigment-only form especially to darker skin, but it was based on two patients.
• How long the pigment lasts. Reports range from staining that fades to staining that lasts for years. No study has followed a group of patients to measure how long it lasts or what helps it fade.
• Which treatment works best. Corticosteroids, antihistamines, wound dressings and burn surgery have all been used, but none has been compared with another or with no treatment in a controlled study.
• Whether diet matters outside light therapy. The psoriasis study links furocoumarin-rich diets with stronger reactions to medical ultraviolet B. Whether diet changes how people react to ordinary sunlight has not been studied.

What is well established, across many independent reports, is the core picture: plant furocoumarins plus ultraviolet A light produce a delayed reaction shaped like the contact, with redness and blisters, often followed by brown staining. It is easily confused with other conditions, including abuse in children. Questions about a specific skin reaction belong with a clinician who can take the full history.

Key Research Papers

1. Grosu Dumitrescu C, Jîjie AR, Manea HC, Moacă EA, Iftode A, Minda D, et al. New Insights Concerning Phytophotodermatitis Induced by Phototoxic Plants. Life (Basel). 2024;14(8):1019. PubMed PMID: 39202761
2. Janusz SC, Schwartz RA. Botanical Briefs: Phytophotodermatitis Is an Occupational and Recreational Dermatosis in the Limelight. Cutis. 2021;107(4):187-189. PubMed PMID: 34096846
3. Cohen PR, Ramsay BL. Margarita Dermatitis Revisited: A Case Report and Literature Review of Lime-Associated Phytophotodermatitis. Cureus. 2026;18(9):e116249. PubMed PMID: 42889495
4. Ellis CR, Elston DM. Psoralen-Induced Phytophotodermatitis. Dermatitis. 2021;32(3):140-143. PubMed PMID: 33273237
5. King A, Pope E. Dermatitis versus nonaccidental trauma: A systematic review of initial pediatric misdiagnoses. Pediatr Dermatol. 2024;41(2):215-220. PubMed PMID: 38400817
6. Choi JY, Hwang S, Lee SH, Oh SH. Asymptomatic Hyperpigmentation without Preceding Inflammation as a Clinical Feature of Citrus Fruits-Induced Phytophotodermatitis. Ann Dermatol. 2018;30(1):75-78. PubMed PMID: 29386836
7. Lacroix G, Samaran Q, Herlin C. Phytophotodermatitis: An under-recognized diagnostic pitfall in chemical burns. Ann Chir Plast Esthet. 2026;71(5):467-471. PubMed PMID: 41720680
8. Baker BG, Bedford J, Kanitkar S. Keeping pace with the media; Giant Hogweed burns - A case series and comprehensive review. Burns. 2017;43(5):933-938. PubMed PMID: 28041748
9. Son JH, Jin H, You HS, Shim WH, Kim JM, Kim GW, et al. Five Cases of Phytophotodermatitis Caused by Fig Leaves and Relevant Literature Review. Ann Dermatol. 2017;29(1):86-90. PubMed PMID: 28223753
10. Barker CS, McGovern TW, Elston DM. Botanical Briefs: Fig Phytophotodermatitis (Ficus carica). Cutis. 2024;113(4):167-169. PubMed PMID: 38820103
11. Imen MS, Ahmadabadi A, Tavousi SH, Sedaghat A. The Curious Cases of Burn by Fig Tree Leaves. Indian J Dermatol. 2019;64(1):71-73. PubMed PMID: 30745641
12. Abali AE, Aka M, Aydogan C, Haberal M. Burns or phytophotodermatitis, abuse or neglect: confusing aspects of skin lesions caused by the superstitious use of fig leaves. J Burn Care Res. 2012;33(6):e309-12. PubMed PMID: 23143617
13. Sforza M, Andjelkov K, Zaccheddu R. Severe burn on 81% of body surface after sun tanning. Ulus Travma Acil Cerrahi Derg. 2013;19(4):383-4. PubMed PMID: 23884685
14. Mansilla-Polo M, Martín-Torregrosa D, Abril-Pérez C, Botella-Estrada R. Phytophotodermatitis as a clinical problem and as a therapeutic option: Case report and review of the literature. Photodiagnosis Photodyn Ther. 2023;41:103304. PubMed PMID: 36693457
15. Chan JC, Sullivan PJ, O'Sullivan MJ, Eadie PA. Full thickness burn caused by exposure to giant hogweed: delayed presentation, histological features and surgical management. J Plast Reconstr Aesthet Surg. 2011;64(1):128-30. PubMed PMID: 20399165
16. Pfurtscheller K, Trop M. Phototoxic plant burns: report of a case and review of topical wound treatment in children. Pediatr Dermatol. 2014;31(6):e156-9. PubMed PMID: 25424227
17. Matthews MR, VanderVelde JC, Caruso DM, Foster KN. Lemons in the Arizona Sunshine: The Effects of Furocoumarins Leading to Phytophotodermatitis and Burn-like Injuries. Wounds. 2017;29(12):E118-E124. PubMed PMID: 29324427
18. Gruson LM, Chang MW. Berloque dermatitis mimicking child abuse. Arch Pediatr Adolesc Med. 2002;156(11):1091-3. PubMed PMID: 12413335
19. Koh D, Ong CN. Phytophotodermatitis due to the application of citrus hystrix as a folk remedy. Br J Dermatol. 1999;140(4):737-8. PubMed PMID: 10233333
20. Pate HF, Hill K, McGovern TW. Not as Bland as You May Think: Celery (Apium graveolens) Commonly Induces Phytophotodermatitis. Cutis. 2025;115(3):E28-E30. PubMed PMID: 40315466
21. Walling AL, Walling HW. Phytophotodermatitis induced by wild parsnip. Dermatol Online J. 2018;24(2):13030/qt0rc4v2qz. PubMed PMID: 29630166
22. Pacifico A, Conic RRZ, Cristaudo A, Garbarino S, Ardigò M, Morrone A, et al. Diet-Related Phototoxic Reactions in Psoriatic Patients Undergoing Phototherapy: Results from a Multicenter Prospective Study. Nutrients. 2021;13(9):2934. PubMed PMID: 34578812

PubMed Topic Searches

1. Lime phytophotodermatitis
2. Giant hogweed burns
3. Fig leaf phytophotodermatitis
4. Phytophotodermatitis and suspected child abuse
5. Berloque dermatitis
6. Parsnip phytophotodermatitis

Connections

• Dermatology
• Contact Dermatitis
• Melasma
• Makrut Lime: Essential Oil, Photosensitivity and Safety
• Lovage's Furanocoumarins and the Photosensitivity Question
• Angelica: Furanocoumarins and Look-Alikes
• Celery Allergy and Photosensitivity
• Parsnip
• Figs

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