Limes and Sunshine Don’t Mix.

Did you know that lime juice can cause a profound rash to appear when the skin is exposed to sunlight? Apparently not many people do. When the rash below appeared on a 10-year old girl in Hawaii, none of the locals nor hotel staff had any idea what could have caused it. And hotel guests who caringly (or horrifyingly) asked what had happened stated that they had never heard of their being a problem with lime juice and sunshine.

Lime Rash Phytophodermatitis

Rash on the back of the legs from lime juice followed by sun exposure. (Formally referred to as “phytophotdermatitis”).

There are many case studies, and even more personal tales, of people developing severe rashes from “lime dermatitis”. This includes people in Mexico getting severe rashes on their chins as a result of drinking margaritas by the pool, or using slices of lime on their faces while sunbathing in an attempt to “cleanse toxins” from their skin.

My first encounter with this perplexing rash was with a friend’s daughter who had a terribly dark red rash on both arms after making Limeade on a Spring Vacation to visit grandparents in Los Angeles.

The skin condition is formally referred to by dermatologists as “phytophotodermatitis”. (“phyto” = plant, “photo” = light, and “dermatitis” = rash). Phytophotodermatitis can result following exposure to a variety of plant and plant substances, including celery, parsley and hogweed.

In the case shown here, the girl and her 3 friends had found limes growing in a garden and had fun squeezing the limes before wiping the juices onto the backs of their legs and heading onto a day at the beach. (See the telltale pattern of a hand on the back of the legs and the lines created by wiping the fingers.)

The rash started to appear on all 4 children the next day on their legs, arms, and or fingers with progressive worsening over the following 2 weeks. Those with the greatest exposure developed blisters.

The rash started off pink and progressed to a deep red. The dark color was remarkable and appeared like a bruise. Signs of the rash persisted for nearly 8 weeks, but eventually resolved with NO SCARS.

To avoid the rash, people should wash their hands after handling fruits and vegetables that may cause phytophotodermatitis. Once the rash has begun, treatment options are limited and the rash usually needs to run its course. Topical corticosteroids may reduce the risk of blistering and may lead to less darkening, though hydrocortisone that is available over-the-counter may not offer as much benefit as a prescription-strength formulation (clobetasol).

A rash that appears so starkly and suddenly can be very worrisome, especially when it appears on a child. However, patients and their parents should be reassured that the skin will eventually recover its normal appearance.

More awareness by those in the tourist industry, especially by those serving margaritas poolside to sunbathers, might help reduce the number of people who have their vacation (and skin) disrupted by this completely preventable rash.

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