Erythematous streaks over the chest

A 40-year-old male presented with pruritic hyperpigmented to erythematous streaks over the central chest, abdomen, and right side of the rib cage in the bizarre configuration for the past 6 days. The patient went to a citrus garden on a sunny day wearing a sleeveless shirt, taking photos by touching the plants and fruits, after which he developed the above symptoms. There is no history of scald injury. On examination, the patient had irregularly shaped, well-demarcated patches of hyperpigmentation with desquamation over the central chest [Figure 1]. The patient also had linear streak-like hyperpigmentation marks over the right infraaxillary area and the volar aspect of the left forearm [Figure 2a and b]. Based on history and clinical examination, a diagnosis of phytophotodermatitis was made. The patient was treated with topical clobetasol ointment.

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Figure 1:

Well-demarcated bizarre-shaped patches of hyperpigmentation with desquamation over the central chest.

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Figure 2:

(a and b) Linear streak-like hyperpigmentation marks over the right infra axillary area and the volar aspect of the left forearm.

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Phytophotodermatitis is a rash that occurs after contact between sunlight and furanocoumarins. It is usually nonpruritic and has various appearances; it is often asymmetrically distributed and bizarrely shaped. Persistent hyperpigmentation is expected and can last up to weeks to months.^[1]

Phytophotodermatitis is a clinical diagnosis and should be suspected when patients present with an irregularly shaped rash, exposure to sunlight, and a psoralen-containing substance.