Hyperpigmentation and vesicles after beach vacation
Diagnosis and treatment
Consider phytophotodermatitis when patients present with hyperpigmentation, often in bizarre streaks on sun-exposed areas, or with vesicles in a nondermatomal distribution. It is a clinical diagnosis based on history and physical examination. Clues in this patient included recent vacation to Florida and consumption of citrus beverages along with the bizarre pattern of rash and sparing of the skin of the upper chest covered by her bathing suit. Any laboratory data obtained are used to exclude other diseases in the differential diagnosis. For example, porphyrin levels may be obtained to rule out porphyria cutanea tarda. If the clinical diagnosis remains in question, a skin biopsy may be performed to confirm the diagnosis.
Treatment involves use of topical steroids such as triamcinolone 0.1% cream applied to the skin two to three times per day, and the application of cool compresses for comfort. Advise patients to use sunscreen to prevent further hyperpigmentation. A topical bleaching agent such as hydroquinone may help reduce hyperpigmentation, although most lesions fade with time1 (strength of recommendation: C, based on usual practice or opinion).
CORRESPONDENCE
Andrea L. Darby-Stewart, MD, Assistant Professor of Family Medicine, Mayo Thunderbird Family Medicine, 13737 North 92nd Street, Scottsdale, AZ 85260. E-mail: darbystewart.andrea@mayo.edu
