HERPES INFECTION OR ITS DIFFERENTIAL DIAGNOSIS PHYTOPHOTODERMATITIS

Background: Many years of experiencing negative herpes samples gave ground to investigate activities capable of triggering phytophotodermatitis. High on the list are gardening, hiking and climbing. Especially gardeners are prone after contact with plants, bushes and trees, where stems and leaves are crushed during pruning and transplantation. Most susceptible are children playing in the sun, Absorption of the plant juice takes 30 -120 minutes Phytophotodermatitis is a non-immunological reaction after contact with psoralen-containing plants followed by exposure to ultraviolet radiation. Symptoms are varying reactions ranging from erythema, edema and blisters resembling herpes infection with itching and burning skin.

Treatment is symptomatic. Cortisone may be necessary applied locally while in severe cases systemic. Blistering skin may result in skin lesions becoming gateways for bacterial infections resulting in Erysipelas and fever. Phytophotodermatitis is followed by a characteristic hyperpigmentation, which may persist for months.

1) To illustrate reasons for negative herpes virus analysis:

2) Enlighten on activities, which increase the risk of developing the differential diagnosis

3) Enlighten on various clinical manifestations of Phytophotodermatitis and other differential

Methods: Clinical photos from Caucasian patients and one Somalian patient are presented after contact with psoralen-containing plants followed by exposure to UVA radiation.

Results: Nineteen Danes and one Somalian patient with varying skin manifestations such as erythema, eruptions, swelling due to edema, discoloration, vesicles and hyper pigmentation are presented.  Some of these manifestations even resulted in the differential diagnosis child abuse due to the discoloring of the skin as seen after herpes zoster infection or phytophotodermatitis.

a)      The sample is insufficient.

b)      The patient is not infected with herpes virus.

Conclusion: Perception depends on previous education and phytophotodermatitis may prove to be a difficult diagnosis if not experienced before. Anti-viral-treatment, Zovir is ineffective.

After healing, a typical brown hyper pigmentation of diagnostic importance can be observed and may persist for months with great diagnostic value.

Caucasian patients are presented along with a Somalian patient to illustrate the dermatology of the black skin, where especially hyperpigmentations are indistinct. Children are most susceptible as they are unaware of the risk of contact with fourocoumarines in psoralen-containing plants while playing in the sunshine. Important differential diagnoses are child abuse and Herpes zoster.

Damaged blisters may become the gateway for bacterial infection causing Erysipelas requiring treatment with Penicillin and Diclocil. The anamnesis is especially significant as this infection can veil the pathological pictures initial etiology.