Confluent vesicles and bullae arranged in linear streaks

A 36-year-old female, a fire wood collector residing near a forest area, gave a history of her hand coming in contact with the branches of a shrub in the forest area while collecting fire wood. There was a history of photodermatitis. Within hours, she noticed erythema on the area of contact with burning sensation. The next day, she noticed blisters. On examination, she had well defined and confluent vesicles and bullae arranged in a linear streaks and bizarre pattern extending from the elbow joint to just above the wrist joint of right forearm [Figure 1]. Tzanck smear showed neutrophils and eosinophils. Biopsy showed spongiotic epidermis and the dermis infiltrated with neutrophils and eosinophils. A diagnosis of phytophotodermatitis was made and the patient managed with antibiotics, systemic steroids and topical steroids to which she responded promptly. Phytophotodermatitis occurs due to contact with the branches and secretions of plant species (Anthricus, Ammi majus, and Heracleum) which contains the photosensitizer furocoumarins and on exposure to sunlight phytophotodermatitis occurs.^[1] It is now known that anti-cancer drugs and intake of photosensitising drugs can cause phytophotodermatitis without exposure to ultraviolet light after coming in contact with the plants.

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Figure 1:

Vesicles and bullae arranged in linear streaks and bizarre pattern.

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