What is the treatment for a bartender with lime phytophotodermatitis?

Treatment of Lime Phytophotodermatitis in Bartenders

Treat lime phytophotodermatitis with topical corticosteroids applied 3-4 times daily to affected areas, combined with cold compresses for symptomatic relief, and strict avoidance of further lime contact and UV exposure. 1, 2

Immediate Management

Topical Corticosteroid Therapy

• Apply hydrocortisone cream or ointment to affected areas not more than 3-4 times daily 1
• Use potent topical corticosteroids for more severe reactions with significant inflammation 2
• Continue treatment until erythema and inflammation resolve, typically over several days to weeks 2, 3

Symptomatic Relief Measures

• Apply cold compresses to reduce pain and inflammation 2
• Consider systemic antihistamines for pruritus if present, though evidence is limited for phototoxic reactions 4
• For severe bullous reactions (rare but documented with prolonged lime exposure), consider referral to burn unit or dermatology 5, 4

Critical Avoidance Measures

Workplace Modifications

• Immediately cease direct lime handling without barrier protection 2, 3
• Use gloves when cutting or squeezing limes during bartending duties 2
• Avoid UV exposure (including sunlight and tanning beds) to affected areas until complete resolution 2, 6

Long-term Prevention

• Implement consistent glove use when handling citrus fruits, particularly limes which contain high concentrations of furanocoumarins (especially bergapten in the rind at 6-182 fold higher than pulp) 5
• Wash hands thoroughly immediately after any lime contact, even with gloves 2
• Apply broad-spectrum sunscreen (SPF ≥30) to hands and exposed areas during work shifts 7

Important Clinical Considerations

Diagnostic Recognition

• Phytophotodermatitis is frequently misdiagnosed as fungal infection, cellulitis, allergic contact dermatitis, or even chemical burns 2, 3
• The key distinguishing feature is the history of lime contact followed by UV exposure, often with a delay of 24-48 hours before symptom onset 3, 6
• Expect post-inflammatory hyperpigmentation to develop in the chronic phase, which may persist for weeks to months 6

Severity Assessment

• Most cases present with mild to moderate erythema and edema 6
• Bullous reactions can occur with prolonged lime juice exposure (as in limeade preparation) combined with high furanocoumarin concentrations 5
• Extensive exposures can rarely cause severe systemic symptoms requiring burn unit management 4

Common Pitfall

• Do not treat this as allergic contact dermatitis - this is a phototoxic reaction, not an allergic one, meaning it can occur in anyone with sufficient exposure to furanocoumarins plus UV light 3, 6
• The reaction does not require prior sensitization and will recur with repeated exposure 2