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Limes and zebras in Lemoore

Joe Johnson from the Hanford Sentinel reported a story last week of five Hanford girls who were brought to the hospital with blisters and second-degree burns. As the girls had been playing all day in the sun by the pool it was thought to be a simple case of overexposure to the sun at first, yet the girls had all been wearing sunscreen and the symptoms seemed far too severe, with soft-ball sized blisters and burns over 15% of their bodies requiring intravenous morphine for the pain, to be caused by one afternoon in the backyard.

Differential diagnosis included exposure to chemicals, but the children had not been around any dangerous substances. It was one of the parents who finally found a description of something called phytophotodermatitis on the internet. The doctors wouldn’t even consider it at first because it’s such a rare condition, but in this case the hoof beats actually did turn out to be zebras, not horses.

Phytophotodermatitis, also called Lime Disease, is a chemical reaction resulting from contact with certain botanical substances –such as citrus – which makes the skin hypersensitive to sunlight. The girls had been playing all afternoon with limes from a neighbor’s overhanging tree, squeezing them and getting juice all over their hands and faces. It is sometimes referred to as Margarita disease, because as rare as it is, when it is seen it is usually someone who has been drinking alcoholic beverages with lime juice, like

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The girls were released after several days in intensive care. The blisters are gone, but they will have to stay out of the sun and it may take up to a year for the skin to heal.

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