Phytophotodermatitis simulating child abuse

We explored the history in two children who had bizarre, hyperpigmented skin lesions suggestive of child abuse. A final diagnosis of phytophotodermatitis was established. The lesions resulted from inadvertent application of squeezed lime juice to the children's skin by their parents during the routine preparation of drinks, followed by sun exposure, which activated the applied plant psoralens (furocoumarins). Phytophotodermatitis can be induced by a number of plants, and, when unrecognized, may lead to inappropriate investigation of child abuse.