What are the potential skin lesions arising from working with plants or gardening?

Potential Skin Lesions from Plant and Gardening Exposure

Working with plants and gardening can cause several distinct types of skin lesions, primarily including allergic contact dermatitis, irritant contact dermatitis, phytophotodermatitis, mechanical injuries, and various infections. 1

Types of Plant-Related Skin Lesions

1. Allergic Contact Dermatitis (ACD)

• Presentation: Pruritic, erythematous, vesicular eruptions that develop 24-48 hours after exposure
• Common causes:
  • Toxicodendron plants (poison ivy, poison oak, poison sumac) - most common cause 1
  • Compositae family plants (daisies, chrysanthemums, marigolds)
  • Alstroemeriaceae (Peruvian lilies)
  • Rutaceae (citrus plants)

2. Irritant Contact Dermatitis (ICD)

• Presentation: Burning, stinging, erythema, and edema developing shortly after exposure
• Common causes:
  • Euphorbia species (spurge plants)
  • Ranunculus species (buttercups)
  • Tragopogon porrifolius (salsify)
  • Mentha species (mint plants) 2
  • Repeated exposure to wet soil, fertilizers, and pesticides 3

3. Phytophotodermatitis

• Presentation: Bizarre-shaped, hyperpigmented patches in sun-exposed areas
• Common causes:
  • Rutaceae (lime, lemon, bergamot)
  • Apiaceae/Umbelliferae (celery, parsnip, parsley, dill)
  • Heracleum species (giant hogweed)
  • Ferula orientalis 2

4. Mechanical Injuries

• Presentation: Puncture wounds, abrasions, lacerations
• Common causes:
  • Thorns, spines, and sharp plant edges
  • Rose thorns
  • Cactus spines
  • Palm fronds

5. Infections

• Presentation: Pustules, abscesses, cellulitis, lymphangitis
• Common causes:
  • Bacterial infections (often Staphylococcus or Streptococcus) following skin barrier disruption 3
  • Sporotrichosis from rose thorns or sphagnum moss (Sporothrix schenckii)
  • Mycobacterial infections from soil exposure

6. Contact Urticaria

• Presentation: Immediate wheal and flare reactions within minutes of exposure
• Common causes:
  • Schlumbergera cacti (Christmas cactus)
  • Euphorbia pulcherrima (poinsettia)
  • Ficus species
  • Hibiscus rosa-sinensis 4

Risk Factors

• Personal or family history of atopy 4
• Previous sensitization to plant allergens
• Occupational exposure (gardeners, florists, farmers)
• Damaged skin barrier (e.g., from frequent hand washing) 3
• Wet work and occlusion (sweating in gloves) 3

Diagnosis and Management

Diagnosis

• Detailed exposure history (specific plants handled, timing of symptoms)
• Characteristic distribution of lesions (hands, forearms, face)
• Patch testing for suspected allergic contact dermatitis 3
• Prick or scratch testing for immediate reactions 4

Management

Prevention

• Protective measures:
  • Appropriate gloves (nitrile for most exposures) 3
  • Long sleeves and pants
  • Barrier creams before exposure 3
  • Thorough washing after plant exposure

Treatment

• For allergic and irritant contact dermatitis:

  • Avoidance of triggering plants 3
  • Topical corticosteroids for inflammation
  • Oral antihistamines for pruritus
  • Systemic corticosteroids for severe cases

• For phytophotodermatitis:

  • Cool compresses
  • Topical corticosteroids
  • Sun protection to prevent hyperpigmentation

• For infections:

  • Appropriate antibiotics based on suspected pathogen
  • For recurrent furunculosis: clindamycin 150mg daily for 3 months 3
  • Wound care and debridement if needed

Special Considerations

• Occupational gardeners and farmers:

  • Higher risk of sensitization due to repeated exposure
  • May need occupational modification if severe reactions occur 3
  • Regular skin examinations for early detection of skin cancers due to sun exposure 3

• Common pitfalls:

  • Misdiagnosis of phytophotodermatitis as abuse (due to bizarre patterns)
  • Failure to recognize plant-induced contact urticaria presenting as dermatitis 4
  • Overlooking plant exposures in the history
  • Inadequate protection leading to recurrent dermatitis

By understanding the various types of plant-related skin lesions and implementing appropriate preventive measures, gardeners can minimize their risk of developing these conditions and enjoy their gardening activities safely.