Patient Spotlight: Life-threatening rash, or harmless side-effect of a margarita?

A few years ago, a 25 year old patient walked into my office with a new rash. Upon examination, there were well-demarcated reddish-brown linear yet irregular thin plaques on her left hand. She explained that the marks had appeared out of the blue a week ago, and she had been anxiously waiting to find out why. She was really worried that this could be something serious, as her family had a history of skin cancer and other serious ailments. I looked and felt her hand, and then asked a question that took her by surprise: “Had you by chance been using limes or drinking margaritas prior to onset of the rash?” She replied, “Well, I was in Central Park on Cinco De Mayo having a few drinks with some friends. And, yes, maybe the lime juice did drip on my hand outside while sitting in the sun.”

“Had you by chance been using limes or drinking margaritas prior to onset of the rash?”

This patient did not have something life threatening, she had phytophotodermatitis, essentially a photosensitive eruption that is caused from contacting light-sensitizing furocoumarins (found in limes, lemons, celery, parsnips, and even figs) combined with long-wave ultraviolet.

In that instance, her rash was an indicator of a non-life threatening condition; however, some physical symptoms can be a sign of more acute medical conditions. If you came into my office with one leg that was swollen and redness and pain that was spreading, we’d be worried about a cellulitis induced by staphylococcus aureus. If both legs were swollen with redness, however, then we’d be looking at your heart or your kidneys not being able to balance water properly anymore. The most fascinating part of dermatology is that your patients could see it too and share in the process of diagnosis.

“Our job as dermatologists is to help heal your skin in its entirety.”

In my training, this is what I found fascinating about dermatology, how you could often see what was going on the inside of a body by simply looking at the outside. No tests, no labs, just eyes and your skin.

The process of treating skin conditions is not just limited to the skin, however. More than just treating a topical issue, it is also our job to address the patient as a whole. As your skin is the largest organ of your body, you need to treat it comprehensively - physically, mentally and emotionally. That’s why we created KitavaMD - to allow more people, not just our patients, a chance at a comprehensive solution for their acne.