Monday, June 17, 2013


A 25 year old bartender (or celery farmer or child playing in a wild parnsip field) presents with the rash shown above. He normally sleeps during the daytime and works at night and doesn't have the rash. Last weekend, however, he went out sailing and developed erythema, edema, and bullae on his hands a day later. They are painful but not pruritic. After the acute rash resolves, the patient has some hyperpigmentation of the skin lasting for months.

Challenge: What's the diagnosis?

Image shown under Fair Use.


Sarah said...


Craig Chen said...

i'm impressed! i thought this was a cool clinical scenario

This is phytophotodermatitis, a phototoxic reaction after exposure to plant-derived substances. Common offenders include limes, lemons, celery, wild parsnip, and celery. The substances are activated by UVA light.

Sources: UpToDate;