Citrus juice can cause severe burns in the sun

Medical Watch
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CHICAGO — The dangers of a lemonade stand or making margaritas — kids and adults could get burns!

WGN’s Medical Watch Team first learned about this bizarre occurrence after a viewer wrote in about her experience and shared the photos to prove it.

Phytophotodermatitis is a skin reaction that’s one-part citrus juice, typically lemon or lime, and one-part sun exposure. Mix them together and you could end up with a red, blistering rash.

“We really don’t know any way to predict who is more likely to develop it,” said Dr. Anthony Mancini, a dermatologist with Lurie Children’s Hospital. “The juice alone won’t cause the reaction, but the juice in combination with the sun, the ultraviolet A exposure, and it tends to occur in really bizarre shapes and streaks, wherever you may have come into contact with the juice.”

Like it did for the young daughter of one WGN viewer. The girl was helping her mom make ceviche at an outdoor barbecue. Lime juice is a key ingredient.

“And you can see, all areas exposed to the lime juice, even in between the fingers where the juice might drip. And then exposed to the sun developed redness, swelling, blisters,” Mancini said. “There are many fruits and plant-based products that contain this chemical we call furanocoumarins, those include limes and lemons but also oranges, grapefruits, dill, parsley, parsnips, figs, carrots, celery. They can all cause the same reaction.”

It takes about one to two days for the rare reaction to appear.

“This girl was treated with warm compresses, antibiotic ointments, and we put her on oral antibiotics because of high risk for secondary infection,” Manicini said.

Mancini said he sees only about five to 10 cases of phytophotodermatitis a year. Still, he wants parents to be aware. That’s because the condition doesn’t always present with a blistering red rash. There can be a change in skin pigmentation, which could be mistaken for abuse.

“If somebody is not familiar with phytophotodermatitis and they see pigmentation changes on a child or even blisters in funny shapes and configurations, it’s a natural jump to think about the possibility of abuse,” Manicini said. “So, we have been consulted to come to the emergency room at times to see a child for possible abuse when, in fact, it was phytophotodermatitis.”

He explained on case in particular: “In this case they would envision a parent slapping their kid. It turns out the parents had lemon juice on their hands and had simply held her, and that’s why she developed phytophotodermatitis. There shouldn’t be any hysteria, and it’s important to remember that most individuals exposed to these products and sunlight will not develop phytophotodermatitis. There’s no need to take down lemonade stands.”

You can limit your risk by washing your hands and avoiding sun exposure after working with foods that cause the skin reaction.

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