We’ve all suffered a bad burn or two, ones that blister and leave the skin ultra-sensitive. Some are caused by the most peculiar things and others, with a little common sense, could have easily been avoided. Some, we wouldn’t wish upon our worst enemies.
Adam Levy, a 52-year-old father of two from Minneapolis, suffered option #3 late last month. After squeezing limes outside in preparation for his daughter’s graduation party, he got a blistering second-degree burn on his hand.
In the two days that followed, Levy’s hand swelled to four times its normal size, and he also experienced dizziness and nausea, reports Daily Mail.
Once at the hospital, The Honeydogs singer was treated with an IV and given steroids and antihistamines to stop the swelling. He was then diagnosed with phytophotodermatitis, a reaction that occurs when a chemical called psoralen, found in lemons, limes and some other fruits and plants, interact with ultraviolet light. “This makes the skin photosensitive means that when the skin comes into contact with the sun, it is more sensitive to it, causing bad burns with redness and blisters,” explains Dr. Debra Jaliman, M.D., a board-certified dermatologist based in New York City.
Symptoms are equivalent to photodermatitis, an extreme burn sometimes referred to as sun poisoning.
“I noticed I had some sunburn on my hand and thought it was odd,” Levy told Daily Mail. “It started off as a small blistering and turned into this really large, lymph-filled blister that was the size of half a peach.”
Levy continued, “The skin was really tight and it went from a stinging, burning sensation to itching all around the edges of it. The next day it was blistering and it seemed like I was having an allergic reaction, as well as feeling dizzy, nauseated and my tongue swelling.”
Once Levy’s blister grew to be two inches wide, he had it drained and bandaged.
“After this reaction, the skin can become much darker, something called hyperpigmentation,” Dr. Jaliman explains. “It takes a lot of time and effort to get rid of this and can be treated with topical treatments, but may even need lasers.”
Jaliman recommends using Silvadene, a cream usually prescribed for burns, and steroids if need be to combat swelling. For over-the-counter treatment, she suggests using an anti-inflammatory cream as well as a cool compress to reduce inflammation.
Levy’s own swelling has since gone down, and he admits it’s a process — that he has to be careful with how he uses his hand.
So the next time you’re making chimichurri, margaritas or anything that requires squeezing limes, don’t expose yourself to the sun. And if you must go outside to enjoy summer’s rays, use a lemon squeezer to avoid contact with your skin.
Luckily, Levy is recovering. “You think of citrus being one of the healthiest things in the world,” he said, “not that it’s capable of creating a toxic burn.”
[h/t Daily Mail
Samantha Brodsky Editorial Fellow Samantha is an editorial fellow for GoodHousekeeping.com and HouseBeautiful.com.
Your margarita can burn your skin if you’re not careful
Effects of the reaction begin within minutes, with a rash forming within 24 hours. Skin once covered in lime juice becomes red and sometimes blisters. The rash can burn and feel painful, taking on its worst appearance by 72 hours, deShazo said.
The fairer the skin, the nastier the reaction, she noted, and wet skin, excessive heat and sweating can make things worse, too. Blisters or an infected rash can lead to scarring.
Eventually, a blistering, red rash will crust over, leaving “a brownish discoloration of the skin,” deShazo said. This discoloration slowly improves over months or even years.
“The classic scenario we talk about is a rash after squeezing limes for margaritas, but phytophotodermatitis is also seen in fruit and vegetable processing,” deShazo said.
Reactions can occur while hiking or gardening, she added, even when wearing certain Hawaiian leis made from mokihana trees found in the state.
Other plants well-known to cause phytophotodermatitis include celery, fennel, cow parsnip and parsley as well as citrus fruits such as key lime, lemon and grapefruit, she noted.
The best treatment option for phytophotodermatitis is prevention, deShazo said. Sip that margarita while wearing a wide-brimmed hat. Cover legs and sleeves, if you can, or sit underneath an umbrella. An SPF-50 sunscreen with broad-spectrum UVA/UVB protection helps, too, she added.
And if you suspect some lime juice dripped onto your skin, simply clean the area with soap and water as soon as possible.
Follow Josh Hafner on Twitter: @joshhafner
More: Man gets second-degree burns from lime juice, sun
Some other fruits and plants, including wild carrots and parsnip, also contain photosensitizers. According to the Mayo Clinic, bartenders, chefs, and other people who routinely handle citrus fruits are among those most at risk of developing phytophotodermatitis. Burns mostly happen on people’s hands, but they also can pop up on arms and legs, where citrus juice has splattered or citrus-based drinks have splashed or dripped.
“The head nurse in the burn unit told me I had a classic case,” Justin told me. His idyllic work station in the estate’s backyard—“basically on the beach,” in his words—had kept him under hours of direct sunlight. Another bartender he worked with also suffered phytophotodermatitis, but not as severely, because she was assigned a bar in the shade.
Margarita burn is treated just like any other burn, says Jeremy Goverman, a burn expert at Massachusetts General Hospital and professor at Harvard Medical School. “Moisturizer and sunscreen for first-degree burns, and for second-degree burns, we drain the blisters then apply bacitracin or a triple antibiotic, nonstick dressing and gauze once a day until the burns are healed.”
But treatment can only happen if phytophotodermatitis is recognized in the first place—which, according to Goverman, isn’t always likely. In Justin’s case, it took seeing an experienced clinician in a hospital burn unit to arrive at his diagnosis, as the attending doctors in the hospital’s intake unit had no idea what was going on. Goverman has only seen three cases of phytophotodermatitis in his career—all of which could have been mistaken for other skin conditions—and has heard of others where doctors initially suspected their patients’ burns were poison ivy or oak, or some other kind of skin irritation.
“In a sense, it’s a different type of ‘lime disease,’ in that phytophotodermatitis is often misdiagnosed; it’s that rare,” he says. Phytophotodermatitis is so unusual that its frequency hasn’t been well established in the United States.
Despite its rarity, Jason Foust, the Midwest regional vice president of the U.S. Bartenders’ Guild, thinks that margarita burn needs to be recognized as a very real hazard among bartenders. “Today there is a big commitment to using fresh juices, and that means squeezing more limes so there is more risk,” he says. “So, it should be a bigger part of discussions.”
The U.S. Bartenders’ Guild regularly holds national and local educational events for its members, in addition to providing them with online resources on bartender health and safety. These include workshops on product knowledge, bartending skills, career development, and wellness. Foust, who advises bartenders to wear gloves, regularly wash their hands, and avoid working in direct sunlight when handling citrus fruits, says adding phytophotodermatitis to the educational agenda of U.S. Bartenders’ Guild just makes sense.
Beware! Here’s What Happens When You Make Margaritas in the Sun
Making cocktails can be risky: You could cut yourself with a knife while slicing citrus fruits, a la avocado hand. You could set yourself on fire as you attempt to navigate the infamous flaming shot. You could hit yourself in the head as you vigorously shake a cocktail, or develop or worsen a stress injury in your hands and arms.
But there’s a lesser known danger that could strike in the middle of a sunny afternoon: It’s called citrus burn, and you better not underestimate it. Citrus burns, aka phytophotodermatitis, aka lime disease (not Lyme disease, mind you), can turn a summer Margarita drinking session into a seriously regrettable trip to the emergency room. Here’s how to avoid it.
Know Thy Enemy
Phytophotodermatitis is a phototoxic reaction between the chemical compound furocoumarins (a photosensitizer found in the little green citrus fruit) and ultraviolet A radiation. The chemicals make skin super-sensitive to sunlight, which causes it to burn more easily than normal. Limes aren’t the only culprit to inflict their namesake disease. Lemons, carrots, celery, parsnips, figs, parsley and bergamot oranges are all armed with the same photosensitizers. Adding injury to injury, other factors like wet skin, sweating and heat can all worsen the effects of lime disease.
How to Avoid Getting Burned
There are a couple of things you can do to prevent burns, depending on your level of care. The most extreme option, if you have a high tolerance for socially awkward situations, is to wear gloves and long sleeves as you slice your citrus—granted, not a great option for outdoor activities, especially when the sun is beating down. Instead, you can prepare your limes inside, away from the sunlight, before taking your drinks outside. This will reduce the chance that lime juice has any time to interact with the sun’s rays.
Whether or not you prep your drinks inside, soap and water easily clears away any lingering citrus on your skin. Be sure to wash your hands after making drinks, and you should be safe.
How to Know if You’ve Been Burned
Lime burns look like poison oak—so much so that doctors often confuse emergency room patients’ symptoms for poison ivy or oak. Symptoms of a citrus burn usually emerge about 24 hours after initial contact and start with redness and irritation. About 48-72 hours after juice and sunlight go to work on your skin, you’ll experience peak groty “eruptions” as the burn blisters into a disgusting bulbous mass that follows the path of the juice stain like an itchy, sensitive Jackson Pollack.
How to Treat a Burn
A minor first-degree burn just needs moisturizer to treat sensitivity, plus sunblock to protect the vulnerable area from more damage. Second-degree burns warrant a trip to the doctor, who will drain the blisters. Then, patients will need to apply antibiotics and gauze daily until the burns are fully healed.
How Long Will the Scar Last?
Long after the swelling and sensitivity fade away, victims of lime disease are left with a dark brown splotch where the blister once erupted. But don’t worry about covering up this embarrassing spotty tan forever—the patches fade within a few months. So, this summer of fun may be seriously hampered, but by pool season next year, you should be fully recovered (and more prepared for how to prevent it). If you are truly so self-conscious of your burn marks that you must do something to cover them up, hydroquinone will lighten the dark patches somewhat. We say wear your scars proudly as badges of your courageous summer bartending.
It’s all fun and games until your poolside margarita causes a legit chemical burn. Phytophotodermatitis, also called margarita burn and margarita dermatitis, causes painful blisters when UV light and certain vegetables or fruit (limes are a popular offender) come in contact on your skin. And it’s not pretty.
According to Good Housekeeping, the photochemical reaction that happens causes “cell death” (um, YIKES) and a variety of other symptoms, including blisters, redness, burning, and pain. And while, yes, citrus fruits are major culprits, celery, wild parsnip, parsley, hogweed, and more contain the furocoumarins that spur the condition.
“It only develops in areas where the chemical touches the skin, explaining odd shapes like streaks or dots where lime juice may have dripped down the skin or splashed,” director of cosmetic and clinical research at Mount Sinai Hospital, Dr. Joshua Zeichner, told the outlet. “The initial rash is fiery red, and it often heels with a dark brown black.”
Before you freak (because what is summer without margs??) there are ways to prevent it. Namely, avoiding contact by wearing gloves and washing up thoroughly after handling. But if you do develop Phytophotodermatitis, there is treatment. Topical steroidal creams are recommended for moderate blisters, inflammation, and itching, while more severe cases will require an oral corticosteroids or antihistamines.
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Souvenir from Mexico but the fresh hand squeezed lime margaritas were amazing! #itsreal #phytophotodermatitis #margaritaburn #limeburn #chemicalburn #ouch #whoknew #sunandlimesdontmix #citrusburn #juicinglimes #photosensitive
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Crazy #dermpicoftheday Can you guess it? Watch thrown in for the heck of it. #tudor #submariner #snowflake is #womw on #kangaroo #nato Hint: Patient ate something…that dripped. #notblood Perfect #halloweencostume
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And while, clearly, it’s not fun, as long as you take proper care to avoid scarring you should be fine. “It only rarely causes any permanent changes to the skin,” Dr. Zeichner added. But also, I might keep my drinking activities indoors for now.
Megan Schaltegger Editorial Fellow Megan is a Delish editorial fellow and University of Missouri alum.