An outbreak of phototoxic dermatitis due to limes

Safety Assessment of Citrus Fruit-Derived Ingredients as Used in Cosmetics

The Expert Panel for Cosmetic Ingredient Safety (Panel) assessed the safety of 80 Citrus fruit-derived ingredients, which are most frequently reported to function in cosmetics as fragrances and/or skin-conditioning agents. The Panel reviewed the available data to determine the safety of these ingredients. Because final product formulations may contain multiple botanicals, each containing similar constituents of concern, formulators are advised to be aware of these constituents and to avoid reaching levels that may be hazardous to consumers. Industry should use good manufacturing practices to limit impurities that could be present in botanical ingredients. The Panel concluded that these ingredients are safe for use in both rinse-off and leave-on cosmetic products when formulated to be non-sensitizing and non-irritating, provided that leave-on products do not contain more than 0.0015% (15 ppm) 5-methoxypsoralen (5-MOP).

Phytodermatitis in eastern Turkey: a retrospective, observational study

BACKGROUND

Plant life is extremely diverse, with a great deal of geographic and seasonal variation. Consequently, the range of reported adverse reactions is large, and there are important differences worldwide in the incidence and prevalence of these reactions. Systemic ingestion of some plants containing furocoumarins can cause erythema, edema, vesicle and bulla formation and later hyperpigmentation, after exposure to sunlight. They may at times exhibit clinical manifestations that mimic angioedema, and rarely progress to necrosis. This condition is named phyto-phototoxic reaction.

OBJECTIVE

Our aim was to identify plant dermatitis such as allergic contact dermatitis, irritant contact dermatitis, and phyto-phototoxic dermatitis in eastern Turkey and to add new data to the literature.

METHODS

Thirty patients diagnosed with plant dermatitis were evaluated retrospectively. The demographic and clinical characteristics of the patients (age, gender, the type of dermatitis, and the name of the causative plant) were recorded.

CONCLUSIONS

A phyto-phototoxic reaction to Chenopodium album (Chenopodiaceae) developed in 12 cases. Irritant contact dermatitis developed due to Ranunculus kotschyi (Ranunculaceae) in 11 cases. The other plants studied were Malva neglecta Wallr (Malvaceae), Mandragora autumnalis (Solanaceae), Eryngium billardieri (Apiaceae), Ceratocephalus falcatus (Ranunculaceae), Ranunculus damascenus (Ranunculaceae), and Plantago lanceolata (Plantaginaceae).

Carbohydrate control over carotenoid build-up is conditional on fruit ontogeny in clementine fruits

The final contents of primary and secondary metabolites of the ripe fruit depend on metabolic processes that are tightly regulated during fruit ontogeny. Carbohydrate supply during fruit development is known to influence these processes but, with respect to secondary metabolites, we do not really know whether this influence is direct or indirect. Here, we hypothesized that the sensitivity of clementine fruit metabolism to carbohydrate supply was conditional on fruit developmental stage. We applied treatments increasing fruit load reversibly or irreversibly at three key stages of clementine (Citrus clementina Hort. ex Tan.) fruit development: early after cell division, at the onset of fruit coloration (color break) and near maturity. The highest fruit load obtained by early defoliation (irreversible) had the highest impact on fruit growth, maturity and metabolism, followed by the highest fruit load obtained by early shading (reversible). Final fruit size decreased by 21 and 18% in these early irreversible and reversible treatments, respectively. Soluble sugars decreased by 18% in the early irreversible treatment, whereas organic acids increased by 46 and 29% in these early irreversible and reversible treatments, respectively. Interestingly, total carotenoids increased by 50 and 18%, respectively. Changes in leaf starch content and photosynthesis supported that these early treatments triggered a carbon starvation in the young fruits, with irreversible effects. Furthermore, our observations on the early treatments challenge the common view that carbohydrate supply influences positively carotenoid accumulation in fruits. We propose that early carbon starvation irreversibly promotes carotenoid accumulation.

Phototoxicity of herbal plants and herbal products

Plants are used by humans in daily life in many different ways, including as food, herbal medicines, and cosmetics. Unfortunately, many natural plants and their chemical constituents are photocytotoxic and photogenotoxic, and these phototoxic phytochemicals are widely present in many different plant families. To date, information concerning the phototoxicity and photogenotoxicity of many plants and their chemical constituents is limited. In this review, we discuss phototoxic plants and their major phototoxic constituents; routes of human exposure; phototoxicity of these plants and their constituents; general mechanisms of phototoxicity of plants and phototoxic components; and several representative phototoxic plants and their photoactive chemical constituents.

Illness and injury among children attending summer camp in the United States, 2005

OBJECTIVES

The purpose of this work was to describe illnesses and injuries sustained by campers at summer camps, calculate illness and injury rates, and identify risk factors for camp-related illness and injury.

METHODS

A convenience sample of camps selected from the US summer camp population participated in this pilot illness and injury surveillance study. Camps completed weekly reports detailing the number of campers on site and the number of adverse events sustained and provided specific information about each adverse event.

RESULTS

A total of 177 camper illnesses and injuries occurred during 122,379 camper-days, with a median rate of 1.15 adverse events per 1000 camper-days. The majority of reported events were illnesses (68.0%), 11.8% of which were communicable and seen in multiple individuals at camp. Of the injury events (32.0%), cut/scratch/scrape were the most common diagnoses (33.3%), followed by fracture (14.6%) and sprain/strain (10.4%); horseback riding and capture the flag were identified as injury-producing activities.

CONCLUSIONS

Internet- and telephone-based surveillance systems can be successfully used to conduct illness and injury surveillance among children attending summer camp. Data collected via such systems can be used to calculate illness and injury rates, to describe patterns of illness and injury, and to identify risk factors for camper-related illness and injury. Given the millions of children attending summer camp yearly, a surveillance system such as this can provide the data needed to develop evidence-based prevention interventions to decrease the number of youth whose camp experiences are negatively affected by illness and injury.

Experimental phytophotodermatitis

BACKGROUND/AIMS

Phytophotodermatitis (PPD) is defined as a phototoxic reaction of the skin after contact with substances derived from plants and subsequent exposure to sunlight. It is a frequent disease in our outpatient clinics during summer because of contact with Tahitian lemon. Our objectives were to experimentally reproduce PPD in rats, to identify whether PPD is induced by minimal exposure periods to sunlight, to find what kinds of lemons and which parts of the lemon (the fruit juice or the peel juice) may trigger the disease; to know whether the use of sunblock prevents the reaction; and to perform light microscopy of the lesions to describe their histology.

METHODS

Adult rats (Rattus norwegicus), three in each experiment, were used. After painting the rats with the fruit juice or the peel juice they were exposed to sunlight for 2.5, 5, 7.5, and 10 min. Tahitian and Sicilian lemons were used in the experiments. Biopsies with 3-mm punches of different times of exposure were performed.

RESULTS

The peel juice of both lemons reproduced PPD, which was clinically evident after 48 h. When the peel juice was alone applied there was no reaction; moreover, exposure to sunlight alone triggered no reaction. Two and a half minutes of exposure time was sufficient to induce phototoxic reaction, which was time dependent (the longer the exposure the more intense the reaction). Histopathological studies showed epithelial time-dependent vacuolar degeneration. The use of sunblock diminished the intensity of the reaction but did not prevent it.

CONCLUSION

PPD can be reproduced in an animal model. It may be caused by the peel juice of Tahitian and Sicilian lemon. Because of an extremely short time of exposure (2.5 min) is sufficient to induce PPD it is necessary to alert the population, of the need for caution when handling lemons, especially outdoors despite using sunblock.

Photosensitivity Reaction in a Woman Using an Herbal Supplement Containing Ginseng, Goldenseal, and Bee Pollen

Photosensitivity, an abnormal skin reaction to light, is a rare adverse event associated with herbal medicine use. Case reports in the literature most commonly implicate St. John's wort. In this report, we describe the case of a 32-year-old woman who suffered a phototoxic reaction after taking a dietary supplement containing ginseng, goldenseal, bee pollen, and other ingredients. On presentation, she had a pruritic, erythematous rash, localized to the sun-exposed surfaces of her neck and extremities. She had no significant past medical history and was not taking any other medications. The skin rash slowly resolved after discontinuation of the supplement and with treatment including subcutaneous and topical corticosteroids. Although the individual ingredients in this dietary supplement have not been associated with cases of photosensitivity, it is possible that the combination of ingredients may have interacted to cause this toxic reaction. Therefore, we recommend caution in the combining of multiple herbs and supplements into new formulations.

Dietary intakes of vitamins A, C, and E and risk of melanoma in two cohorts of women

Within the two Nurses' Health Study cohorts of US women, we examined whether higher intakes of vitamin C, vitamin E, retinol, or individual tocopherols or carotenoids are associated with a lower risk of melanoma. We confirmed 414 cases of invasive melanoma among over 162,000 Caucasian women aged 25-77 years during more than 1.6 million person-years of follow-up. Diet was measured every 4 years with a food frequency questionnaire and supplement use was reported every 2 years. Several measures of sun sensitivity were assessed and included in proportional hazards models. We found that vitamins A, C, E and their individual components were not associated with a lower risk of melanoma. Only retinol intake from foods plus supplements appeared protective within a subgroup of women who were otherwise at low risk based on nondietary factors (relative risk (RR)=0.39, 95% confidence interval (CI) 0.22-0.71 for >/=1,800 vs 400 microg day(-1), P for linear trend=0.01). Contrary to expectation, we observed higher risks of melanoma with greater intakes of vitamin C from food only (RR=1.43, 95% CI 1.01-2.00 for >/=175 vs <90 mg day(-1), P for linear trend=0.05) and a significant positive dose-response with frequency of orange juice consumption (P=0.008). Further research is needed to determine whether another component in foods such as orange juice may contribute to an increase in risk.

Zabon phytophotodermatitis: first case reports due to Citrus maxima

Zabon (Citrus maxima) is a large citrus fruit belonging to the Rutaceae family and containing a variety of psoralens including 5-methoxypsoralen. We describe the first case reports of a phytophotodermatitis caused by zabon.

An outbreak of phytophotodermatitis due to celery

BACKGROUND

Celery is known to contain psoralens, a group of substances that cause a toxic dermal reaction on exposure to ultraviolet A rays (UVA). An outbreak of phytophotodermatitis amongst 11 workers in a celery harvest in southern Israel is reported.

METHODS

Analysis of the trigger factors was carried out. The patients were questioned regarding their working conditions. Samples of the celery that the workers had been harvesting were analyzed for levels of total psoralens by means of high performance liquid chromatography (HPLC). Levels of UVA were measured.

RESULTS

It was found that the celery harvested in the south of the country contained 84 micrograms/g fresh weight (f.wt.) total psoralens as compared to 35 micrograms/g f.wt. in celery harvested in the north of the country at the same time. The following year the celery harvested in the south contained only 26 micrograms/g f.wt. total psoralens. Other risk factors noted were that the subjects had fair skin, wore no protective clothing, and worked with moist hands. In addition, the days were clear and sunny thus ensuring maximal UV radiation for that time of the year.

CONCLUSIONS

Multiple factors contributed to the outbreak of phytophotodermatitis. A late harvest in the south of the country is incriminated as the cause of the unusually high levels of psoralens in the celery of that year.

Phototoxic coumarins in limes

Coumarins in the rind and pulp of Persian and Key limes were quantified. In the rind of Persian limes, coumarin concentrations were in the order: limettin > bergapten > isopimpinellin > xanthotoxin > psoralen. In the rind of Key limes, psoralen and xanthotoxin were analytically absent; limettin was 10 times more concentrated than either bergapten or isopimpinellin, which were equal in concentration. Coumarin content in Persian lime pulp was in the order: isopimpinellin > limettin > bergapten > xanthotoxin > psoralen. For Key lime pulp, the concentrations of limettin, isopimpinellin and bergapten were equal; psoralen and xanthotoxin were not detected. Coumarins in lime pulp were 13 to 182 times less concentrated than those in the peel. Based on the amounts and types of coumarins, Persian limes appear to be potentially more phototoxic than Key limes. Although bergapten may be the main component of limes responsible for phytophotodermatitis, dermatological interaction assays with psoralen, bergapten, xanthotoxin and limettin should be conducted.

Dietary exposure to furocoumarins

Natural furocoumarins, some of which are carcinogenic, are widespread components of the diet which are frequently consumed. Because of the paucity of samples, the wide scatter of analytical values, and other limitations in the data, only broad conclusions can be drawn. Most of the exposure is from limes, with smaller amounts coming from other citrus and umbelliferous food plants. The per capita exposure is estimated to be 1.3 mg per day. Exposure can be reduced through controlling stress in growing plants and stored food products. Because furocoumarins are one class of a large group of chemicals in a defensive system essential to plant survival, their total eradication is not possible. Further research is needed to assess their health risk.