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.