Photoallergic contact dermatitis to 8-methoxypsoralen in Ficus carica

Unique Acute Phytophotodermatitis Reaction and a Visual Diagnostic Guide

Here, we describe a case of a 48-year-old caucasian female with no significant past medical history who presented to the outpatient dermatology clinic with an extremely painful and significant phytophotodermatitis (PPD) reaction to over 30% of her body surface area. The patient presented after partaking in a ritualistic ceremony where she was exposed to plant and citrus juices and subsequently sunbathed while on a tropical vacation. While not an infrequent diagnosis, this patient presented to the dermatologist in extreme pain after having no education on avoiding such triggers. This diagnosis is relatively underdiagnosed and leads to a lack of patient counseling on the hazards of UV exposure secondary to contact with certain plant and fruit juices. Lack of patient awareness leads to an increase in disease burden. Furthermore, this patient suffered a large body surface area reaction in contrast to the pathognomonic description of phytophotodermatitis secondary to the exposure to lime juice which causes relatively less total body surface area exposure.

Allergic Contact Dermatitis Associated With Religious Practices: Review of the Literature

Allergic contact dermatitis (ACD) may occur secondary to devotional practices in various religions. A systematic review of PubMed was conducted from inception of database to September 9, 2022. Key terms were "contact dermatitis" or "devotional dermatosis" in association with major world religions including "Christianity," "Islam," "Hinduism," "Buddhism," "Sikhism," and "Judaism." Inclusion criteria were determined by presence of a religious practice and associated ACD. Articles referencing other cutaneous reactions such as chemical leukoderma were excluded. In total, 36 of 102 unique articles identified met inclusion criteria. Twenty-two articles referenced Hinduism, 8 referenced Judaism, 5 referenced Islam, 3 referenced Christianity, and 1 article each mentioned Buddhism and Sikhism. Four articles referenced multiple religions. Para-phenylenediamine was the most common contact allergen overall and is found in blackening ingredients mixed with henna for temporary tattoos. Henna tattooing is a cultural practice associated with Hinduism, Islam, and Judaism. Nine unique contact allergens associated with religious practices were identified. Increasing awareness of religious practices that cause ACD will facilitate culturally competent dermatological care.

Fig Tree-Induced Phytophotodermatitis: A Case Report on the Perils of a Hobby

Phytophotodermatitis, a condition that results from sequential skin exposure to phototoxic chemicals contained within plants, followed by exposure to solar ultraviolet radiation, has been described with several plants and plant-based foods, namely members of the Moraceaefamily, which include Ficus carica L. This tree's branches, leaves, and fruit skin exude a milky sap or latex containing proteolytic enzymes and furocoumarins known to be photoirritants, easily absorbed upon skin contact. Oxygen-dependent and independent toxic reactions subsequent to sun exposure promote cell membrane damage and oedema, consequently leading to cell death. The diagnosis is confirmed with a detailed anamnesis, and photopatch testing is often useful to rule out a differential diagnosis. It is typically a self-limited condition, with few cases requiring treatment with topical or systemic corticosteroids. We report on a 55-year-old male patient who, following picking figs and pruning a fig tree while exposed to sunlight, developed erythematous and pruritic maculopapular lesions that progressed to blisters with residual hyperpigmentation. The diagnosis was further corroborated through photopatch testing, and the patient was recommended to avoid this recreational activity without symptoms' relapse. This case highlights the importance of considering phytophotodermatitis as a differential diagnosis when evaluating cases of dermatitis on exposed body surfaces and the importance of an exhaustive anamnesis. Identification of specific plant triggers and the performance of photopatch tests are essential to help confirm the diagnosis and guide avoidance recommendations.

Safety Profile of Nutraceuticals Rich in Coumarins: An Update

Coumarins are a family of benzopyrones largely distributed in the natural kingdom, being present in the seeds, fruits, flowers, or roots of various plant species. Natural coumarin compounds are found in significant concentrations in some herbs or spices used as nutraceuticals, but they are also present in cosmetics or household products, due to their pleasant odor. Therefore, an accidental exposure to high doses of coumarins, could lead to the development of harmful effects in some patients. This review summarizes the latest published data from preclinical and clinical studies with natural coumarins, focused on the investigation of general and specific toxicity, with the aim of a better understanding of the safety profile of these valuable compounds. Regulatory aspects concerning the use of natural coumarins in several world regions are also reviewed.

Severe phytophotodermatitis from fig sap: a little known phenomenon

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.

Wild parsnip (Pastinaca sativa)-induced photosensitization

Wild parsnip (Pastinaca sativa) has been associated with livestock and human photosensitization. An investigation of a natural occurrence of photosensitization of grazing horses identified wild parsnip as a possible cause. HPLC-MS and MS/MS analysis of this plant identified five furanocoumarins i.e., xanthotoxin, bergapten, isopimpinellin, imperatorin and a putative methoxyimperatorin. Goats fed this wild parsnip were largely unaffected. Xanthotoxin was not detected in the serum of parsnip-fed goats or in the serum of goats dosed orally or intravenous with purified xanthotoxin. Cutaneous application produced severe photodermatitis in goats and a horse consistent with topical exposure as the likely route to produce wild parsnip-induced photosensitivity. Wild parsnip-induced superficial necrotizing dermatitis was consistent with photodermatitis with no evidence of other allergic or inflammatory components.

Defence mechanisms of Ficus: pyramiding strategies to cope with pests and pathogens

Ficus species have adapted to diverse environments and pests by developing physical or chemical protection strategies. Physical defences are based on the accumulation of minerals such as calcium oxalate crystals, amorphous calcium carbonates and silica that lead to tougher plants. Additional cellular structures such as non-glandular trichomes or laticifer cells make the leaves rougher or sticky upon injury. Ficus have also established structures that are able to produce specialized metabolites (alkaloids, terpenoids, and phenolics) or proteins (proteases, protease inhibitors, oxidases, and chitinases) that are toxic to predators. All these defence mechanisms are distributed throughout the plant and can differ depending on the genotype, the stage of development or the environment. In this review, we present an overview of these strategies and discuss how these complementary mechanisms enable effective and flexible adaptation to numerous hostile environments.

The Curious Cases of Burn by Fig Tree Leaves

Phytophotodermatitis is a condition which is caused by contact with some plants containing furocoumarins. Furocoumarins in sap of fig tree are the main cause of its irritability when come in contact with the skin. The main symptoms are burning sensation and pain, itchy erythema, and edema, which usually begin 24 h after exposure. The leaf and root sap of the fig tree are the most potent parts causing irritant reaction. We report four children who were playing with fig tree leaves during a family picnic. They were referred to a burn center with second-degree burn in about 10% of total body surface area, due to phytophotodermatitis. Most people are not aware of the potential adverse effect of the plant. The improvement in general knowledge about the dangers of contacting fig tree leaves and sap and the benefits of suitable coverage at the time of harvesting or contacting fig tree may prevent such adverse effects.

New approach to predict photoallergic potentials of chemicals based on murine local lymph node assay

Photoallergic dermatitis, caused by pharmaceuticals and other consumer products, is a very important issue in human health. However, S10 guidelines of the International Conference on Harmonization do not recommend the existing prediction methods for photoallergy because of their low predictability in human cases. We applied local lymph node assay (LLNA), a reliable, quantitative skin sensitization prediction test, to develop a new photoallergy prediction method. This method involves a three-step approach: (1) ultraviolet (UV) absorption analysis; (2) determination of no observed adverse effect level for skin phototoxicity based on LLNA; and (3) photoallergy evaluation based on LLNA. Photoallergic potential of chemicals was evaluated by comparing lymph node cell proliferation among groups treated with chemicals with minimal effect levels of skin sensitization and skin phototoxicity under UV irradiation (UV+) or non-UV irradiation (UV-). A case showing significant difference (P < .05) in lymph node cell proliferation rates between UV- and UV+ groups was considered positive for photoallergic reaction. After testing 13 chemicals, seven human photoallergens tested positive and the other six, with no evidence of causing photoallergic dermatitis or UV absorption, tested negative. Among these chemicals, both doxycycline hydrochloride and minocycline hydrochloride were tetracycline antibiotics with different photoallergic properties, and the new method clearly distinguished between the photoallergic properties of these chemicals. These findings suggested high predictability of our method; therefore, it is promising and effective in predicting human photoallergens.

Five Cases of Phytophotodermatitis Caused by Fig Leaves and Relevant Literature Review

Phytophotodermatitis is a condition caused by sequential exposure to photosensitizing substances present in plants followed by ultraviolet light. Several plants (e.g., limes, celery, fig, and wild parsnip) contain furocoumarin compounds (psoralens). It is important for dermatologists to be aware of phytophotodermatitis because it may be misdiagnosed as cellulitis, tinea, or allergic contact dermatitis. We present five patients with a sharply defined erythematous swollen patch with bullae on both feet. They described soaking their feet in a fig leaves decoction to treat their underlying dermatologic diseases. Within 24 hours, all patients had a burning sensation in their feet, and erythema and edema had developed on the feet dorsa with exception of the portion of the skin covered by the sandals. Histopathologic examinations revealed sub-epithelial blisters with intensive epidermal necrosis. Phytophotodermatitis was ultimately diagnosed and, after several days, the patients' skin lesions began to recover upon treatment with systemic and topical corticosteroids. Unfortunately, since there are no studies providing sufficient evidence on the benefits of fig leaves, they should be used with caution.

Oxygenated heterocyclic compounds to differentiate Citrus spp. essential oils through metabolomic strategies

This study aimed to characterise and discriminate 44 authenticated commercial samples of citrus essential oils (EO) from seven species (bergamot, lemon, bigarade, orange, mandarin, grapefruit, lime) by analysing the non-volatile oxygenated heterocyclic compounds (OHC) by UHPLC/TOF-HRMS, multivariate data analysis (PCA, PLS-DA) and metabolomic strategies; the OHC fraction includes coumarins, furocoumarins, and polymethoxylated flavonoids. Two different approaches were adopted: (i) targeted profiling based on quantifying 18 furocoumarins and coumarins, some of which are regulated by law, and (ii) targeted fingerprinting based on 140 OHCs reported in citrus essential oils, from which 38 discriminant markers were defined. This approach correctly discriminated the Citrus species; its "sensitivity" to relatively low adulteration rate (10%) was highly satisfactory. The proposed method is complementary to that of analysing the citrus EO volatile part by GC techniques.

A review of hepatoprotective plants used in saudi traditional medicine

Liver disease is one of the major causes of morbidity and mortality across the world. According to WHO estimates, about 500 million people are living with chronic hepatitis infections resulting in the death of over one million people annually. Medicinal plants serve as a vital source of potentially useful new compounds for the development of effective therapy to combat liver problems. Moreover herbal products have the advantage of better affordability and acceptability, better compatibility with the human body, and minimal side effects and is easier to store. In this review attempt has been made to summarize the scientific data published on hepatoprotective plants used in Saudi Arabian traditional medicine. The information includes medicinal uses of the plants, distribution in Saudi Arabia, ethnopharmacological profile, possible mechanism of action, chemical constituents, and toxicity data. Comprehensive scientific studies on safety and efficacy of these plants can revitalise the treatment of liver diseases.