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Correspondence |

Mexican Beer Dermatitis: A Unique Variant of Lime Phytophotodermatitis Attributable to Contemporary Beer-Drinking Practices

Scott L. Flugman, MD
Arch Dermatol. 2010;146(10):1194-1195. doi:10.1001/archdermatol.2010.297.
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The phenomenon of phytophotodermatitis (PPD) induced by lime juice has been recognized for centuries. Limes contain varying concentrations of phototoxic coumarin compounds, including bergapten, 5-methoxypsoralen, xanthotoxin, and limettin. These chemicals absorb light in the UV-A range.1 Contact with lime juice or rind results in these phototoxic compounds being transferred to the skin, where their interaction with UV light results in phototoxic reactions of varying severity. Owing to the external causes of lime PPD, affected patients may exhibit bizarre patterns of phototoxic effects reflecting the pattern of cutaneous exposure to lime-derived phototoxins. Frequently, affected patients will have linear lesions that may mimic signs of allergic contact dermatitis, child abuse, cellulitis, impetigo, erythema migrans, and even jellyfish evenomation.24

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Figure 1

Linear hyperpigmentation is seen on the thigh patient 1, who was exposed to lime spray while drinking Mexican beer on a cruise ship.

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Figure 2

Hyperpigmentation in a linear splash pattern (A) and a finger swipe pattern (B) on the neck of patient 2, who was exposed to lime while drinking Mexican beer.

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