Pediatric photo puzzler: What caused this skin discoloration?

Every child with a lemonade stand hopes for hot sunny days to drive in customers. But if your kids squeeze fresh lemons for their stand, make sure they wash their hands after squeezing the lemons. Otherwise, after a sunny day, your child’s hands may turn out looking like the kid’s feet pictured to the left.The juice of some fruits or plants will cause a dark discoloration of the skin if exposed to sunlight. The reaction, called phytophotodermatitis, usually starts a day after the juice comes into contact with the skin. Redness and mild blistering eventually leads into a discoloration which can that can last for months. Citrus fruits are the most common culprits, but wild parsnip, wild dill, wild parsley and buttercups also cause the photosensitivity. Often the initial redness and blistering is missed. The kid in the photo was walking in bare feet on leaves near an apple tree. Makes you almost want to only use powdered lemonade mix…almost.

Naline Lai, MD and Julie Kardos, MD