The Unexpected Skin Risk of Summer Margaritas by the Pool

Welcome to Culture Clinic, MedPage Today‘s collaboration with Northwell Health to offer a healthcare professional’s take on the latest viral medical topics.

As weather warms, many people will imbibe in margaritas by the pool or beach. But this combination of a citrusy cocktail and sun exposure can lead to phytophotodermatitis, a phototoxic skin reaction commonly referred to as “margarita burn” or “margarita dermatitis.”

Raman Madan, MD, a dermatologist with Northwell Health in Glen Cove, New York, told MedPage Today that as summer ramps up, he sees several cases of this skin condition each week.

“[Phytophotodermatitis] happens not just because of margaritas, but mainly because of margaritas,” Madan said. While colloquially referred to as a “burn,” phytophotodermatitis is more of an allergic reaction, he said.

“It can happen after patients come in contact with certain plants that can make your skin a little bit more sensitive to the sun. So when the UVA [ultraviolet-A] rays hit the skin, you basically can develop a rash that can look almost like poison ivy on your skin,” Madan explained. He also noted that UVA exposure weakens the skin and activates the immune system in a way that increases sensitivity to irritation.

Citrus plants — such as the lime in margaritas — are the most common culprit, but it can happen with other plants like fennel, celery, and figs that also produce a class of chemical compounds known as furocoumarins, or furanocoumarins. For instance, a man developed phytophotodermatitis after pruning a fig tree, according to a recent case report in Cureus. A report in Wilderness & Environmental Medicine detailed how a hiker in Colorado developed it after being exposed to cow parsnip.

Madan said it doesn’t take much sun exposure to activate this reaction — as little as 5 minutes. But patients will likely not see a rash right away.

“A lot of times, this is a delayed reaction that does not happen immediately. The reason for this is basically your body hasn’t mounted an immune response yet to all of this,” Madan said, adding that the reaction tends to take 24 to 72 hours to present. “For most people, it starts after 24 hours and usually lasts for about 2 or 3 days, then slowly self-resolves.”

Madan typically treats phytophotodermatitis similarly to poison ivy. For mild cases, he uses topical corticosteroids and anti-inflammatories. Some severe cases warrant antibiotics or oral steroids. For most people, phytophotodermatitis is mild. However, a case report in Cureus from last month depicted a woman with an unusually severe case of red and blistering phytophotodermatitis covering 30% of her body. That patient’s symptoms “presented after partaking in a ritualistic ceremony where she was exposed to plant and citrus juices and subsequently sunbathed while on a tropical vacation.”

After the rash heals, a lot of people are left with discoloration, which goes away after several weeks or months, Madan pointed out. Another Cureus case report showed discoloration on a woman’s back after her phytophotodermatitis healed. In that case, the patient spilled a margarita on her hand on vacation and rubbed her back, which led to the reaction.

In terms of prevention and patient counseling, Madan encouraged sunscreen and washing skin thoroughly of irritants before heading outside. “If you’re wearing sunscreen, UVA rays won’t be able to penetrate as much, and then ideally, you shouldn’t have as big of a response,” he said.

Please enable JavaScript to view the

comments powered by Disqus.