An unusual rash for Royal: a case series

Area of Science:

• Dermatology
• Toxicology

Background:

• Phytophotodermatitis is a skin reaction caused by contact with certain plant photosensitizing agents followed by exposure to ultraviolet radiation.
• Ficus species are known to contain photosensitizing compounds in their sap.

Observation:

• Eight individuals developed a blistering, erythematous, and itchy rash consistent with caustic burns.
• The patients had been exercising in Albania and living in dense vegetation, specifically under fig trees.
• Contact with the sap of Ficus carica was identified as the causative agent.

Findings:

• The sap of Ficus carica, upon exposure to ultraviolet A (UVA) radiation, induced phytophotodermatitis.
• The clinical presentation mimicked caustic burns, characterized by blistering, erythema, and pruritus.
• This case series highlights a specific environmental exposure leading to a distinct dermatological reaction.

Implications:

• Increased awareness of Ficus carica sap as a potential cause of phytophotodermatitis in endemic or visited regions.
• Importance of recognizing this reaction pattern, especially in outdoor recreational or occupational settings.
• Potential need for public health advisories regarding contact with fig trees in areas with high UVA exposure.