Limes Responsible for Severe Burns to Young California Girls

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Jewels and Jazmyn Ellwanger and three friends were having a pool party in mid-August when they decided to play with some limes from a tree in a neighbor’s yard. They picked the fruits and squeezed them into imaginary tea cups in their play lemonade stand. After, they spent five hours in and out of the pool in the hot summer sun. The mothers noticed redness on the skin, assumed sunburn, and treated them accordingly.

However, the next day, those spots became blisters that continued to worsen. All five girls were hospitalized with severe second degree burns over 15% of their bodies that the doctors initially diagnosed as chemical burns. But from what? Then Ellwanger remembered the lime tree.

Phytophotodermatitis is a chemical reaction that makes bare skin hypersensitive to ultraviolet light – UV rays from the sun. It is caused by contact with photosensitizing compounds that occur naturally in some fruits and vegetables. The reaction starts about 24 hours after exposure, and over the next one to three days the rash worsens.

The chemicals that cause phytophotodermatitis are found most commonly in citrus fruits, including lemons, oranges and grapefruits – but most especially, limes. Other plants with the offending compound include wild parsnip, wild dill, wild parsley, and buttercups.

The condition typically affects people who frequently run, walk or hike through wooded areas or other wild places where the plants that cause this grow. However, doctors in the Ellwanger case say they have seen cases from backyard barbecues where someone squeezes a lime into their drink and the juice sprays on the skin or from chefs/bartenders who regularly handle citrus fruits.

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Most sun-related skin conditions affect all areas of the skin exposed to sunlight. However, phytophotodermatitis will only show up where the chemicals actually touched the skin. This means the reaction may appear in unusual patterns, such as streaks, drips or even as fingerprints or handprints.

The chemicals that cause phytophotodermatitis quickly come off with soap and water, so prevention is as easy as washing thoroughly after handling the offending plant or fruit. In addition, wear long sleeves and pants when in the woods or other wild areas. When camping, be careful when making a campfire. Use only firewood and never put wild plants into the fire.

Should you become exposed, treatment involves removing any remaining plant oils, avoiding sun during the acute phase of the rash and treating symptoms with ice packs to relieve severe pain, over the counter first-aid creams and sprays, and hydrocortisone cream to reduce inflammation. Get prompt medical attention if the pain increases, the blistering worsens, increasing redness, swelling or pus coming from the wound, or for fever of 100.4 degrees F or higher.

The five California girls were kept in intensive care for three days and then in the pediatric hospital wing for almost two weeks. The doctors are advising they stay indoors for at least six months to prevent possible reactivation of the skin reaction. Unfortunately, they all still bear scars on their hands, face, legs, arms and torso.

“I feel guilty. When you send your kids off with another parent, you expect them to come back unharmed,” Ellwanger said. “I guess we learn the hard way. Who would’ve known that these innocent little fruits could do so much damage? If we can prevent this from happening to anyone else, then we want to get our story out there. I don’t want to see anyone else go through what we’ve been through.”

References:
The Hanford Sentinel
Mayo Clinic
University of Minnesota Medical Center

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