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CAN YOUR VITAMIN C SKINCARE CAUSE PHYTOPHOTODERMATITIS BLISTERS?

A mother and daughter's distressing story, advice from a dermatologist on preventing phytotoxic dermatitis, and facts from a cosmetic chemist on topical Vitamin C's blistering potential
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Can Vitamin C skincare cause phytophotodermatitis

Can Vitamin C in skincare cause phytophotodermatitis blisters? If you already know what these blisters are and what causes them, I'll put your mind at ease right now: your Vitamin C serum is safe. Need more info on what, why and how to prevent? Read on for all the details, including a mother and daughter's shocking story.

WHAT IS PHYTOPHOTODERMATITIS?

According to report published in the Canadian Medical Association Journal (CMAJ),  phytophotodermatitis is a "phototoxic, nonimmunologic reaction similar to a burn." Submitted by dermatologists Margaret Mioduszewski, MD, and Jennifer Beeker, MD, the paper focusses on a 2015 emergency-room case involving a young woman with "painful, blistering eruption on her hands."

WHAT CAUSES PHYTODERMATITIS BLISTERS?

Not an immune response, not an allergy, phytophotodermatitis is a reaction on the skin between natural, botanical compounds (or phytochemicals) and ultraviolet (UV) light. Blisters occur in severe cases (milder eruptions can look like "bizzare inflammatory patterns" or oddly shaped rashes), can happen to anyone, and can happen repeatedly if precautions aren't taken. (The above-mentioned patient had been to the ER twice before with the same, severe, blistering symptoms.)

A blistering case of phytophotodermatitis via Susie Griffin (@latseen17 on tiktok)

A blistering case of phytophotodermatitis via Susie Griffin (@latseen17 on tiktok)

Secreted by certain plants as self-defence, those light-sensitive phytochemicals are called furocoumarins (or furanocoumarins), and more specifically psoralens. You'll find psoralen furocoumarins all too easily in the leaves and/or stems of plants that produce carrots, parsley, fennel, parsnip, celery – and it's in citrus fruit, such as  oranges, lemons and particularly grapefruit and limes.

The day before her emergency-room visit, the patient in the CMAJ report had been hand-juicing lemons and limes for sangria before she'd "spent the rest of the day outdoors in the sun without sunscreen."

For Susie Griffin's child, UV exposure was less than an hour. See below, after some prevention advice from a medical professional.

HOW TO PREVENT PHYTOPHOTODERMATITIS

According to Dr. Julia Carroll, a dermatologist at Compass Dermatology in Toronto and go-to, on-camera expert for programs such as ET Canada, The Global Morning Show and CTV News, blistering cases of phytophotodermatitis are rare, although she has seen a few. More prevalent, she says, are patients exhibiting "minimal blistering, with redness that then turns to semi-persistent hyperpigmentation, in a drip pattern, or in swipes or streaks, as if wiped on extremities."

how to prevent phytophotodermatitis

Washing with soap and water isn't enough; sunscreen is a must to avoid even mild phytophotodermatitis. LaSpa Mineral Sunscreen SPF 30 is an emollient mineral formula; also available in mini SPF 50 stick.

Prevention is simple, and two steps: 1) a thorough wash with soap and water, and 2) good, regular sunscreen habits. Not only is sunscreen essential, the right amount and reapplication is key. "You need an ounce – about a shot-glass full or the size of a golf ball – of sunscreen for your entire body, and reapply every two hours."

And if you're wondering whether phytophotodermatitis cases were high when putting lemon juice on your hair to lighten it in the sun was a thing, "I've seen it!" says Dr. Carroll. As for the risk when making lime-dependent beverages, such as sangria and margaritas, it's resulted in the terms "margarita burn" and "lime disease."

"Look out for drips on the legs," warns Dr. Carroll. "That's the most common spot."

SUSIE GRIFFIN'S PHYTOPHOTODERMATITIS PSA

"I wish I were joking when I say I accidentally marinated my daughter and gave her second-degree burns," says artist and content creator Susie Griffin of the harrowing incident that occurred four years ago. "The dermatologist said that it was like if you were to put mirrors inside your skin and exacerbate the UV rays." 

That dermatologist also told the mother of two that because the resulting hyperpigmentation can look like bruises, even handprints, she "has gone to court on behalf of parents who about had their kids taken away" over suspected signs of child abuse that were in fact startling leftovers from phytophotodermatitis.

Susie (@latseen17), who lives with her kids in Washington State, USA, includes images of  the phototoxic dermatitis blisters on her daughter's hands with her permission:

CAN TOPICAL VITAMIN C CAUSE PHYTOPHOTODERMATITIS?

In the comments under Susie's video, several people expressed alarm about topical Vitamin C as a potential phytophotodermatitis trigger because Vitamin C in the form of ascorbic acid is a natural component of citrus fruit and juice. 

Vitamin C skincare does NOT cause phytophotodermatitis

Does Vitamin C in skincare cause phytophotodermatitis? Concern in the comments on Susie Griffin's PSA

No need to worry that Vitamin C or L-ascorbic acid (the most common cosmetic-industry version) in your skincare will lead to phytophotodermatitis rashes, hyperpigmentation, or blisters, however. "It's not the Vitamin C that causes the dramatic reaction, it's the furocoumarins," explains Annie Graham, a cosmetic chemist, self-proclaimed skin-nerd and owner of XO Treatment Room in Calgary. "L-ascorbic acid is more pH-dependent and can be irritating to some, but it's not the same as phytophotodermatitis."

Dr. Carroll (who also describes herself as a skin nerd) agrees. "The ingredient that causes the phototoxic reaction is a furocoumarin," she re-iterates. "There is no expected cross-reaction with l-ascorbic acid."

"This is a good example of how synthetics and processed nature can isolate the good parts of stuff and leave out what we don't need," adds Graham. "Now if only they could make a cookie and leave out the calories."

MORE PLANTS THAT CAN CAUSE PHYTOPHOTODERMATITIS

Oh snap. Queen Anne's Lace can cause phytophotodermatitis; giant hogweed (enormous!) is even more phototoxic on skin.

Oh snap. Queen Anne's Lace can cause phytophotodermatitis; giant hogweed (enormous!) is even more phototoxic on skin.

In addition to the triggers mentioned earlier, watch for these botanicals capable of phototoxic reactions on skin exposed to UV without protection: 

Oh snap. Queen Anne's Lace, aka wild carrot, can cause phytophotodermatitis as well. Good to know; I recently spent some time taking iPhone photos of the stuff on a local trail. Buttercups too! 😳 (Am now even more thankful I was slathered in sunscreen and don't like to touch foliage if I can help it.)

Found a longer list of common plants that cause phytophotodermatitis; check it out!

🇨🇦 OH CANADA 🇨🇦

I'm not certain whether Dr. Margaret Mioduszewki is Canadian, although she did attend the University of Ottawa; Dr. Jennifer Beeker, Dr. Julia Carroll and Annie Graham are Canadian. Also Canadian: LaSpa Mineral Sunscreen SPF 30 and pocket-size SPF 50 stickConsonant Skincare Perfect Sunscreen SPF 30 and 15mL-mini too; and The Ordinary Mineral UV Filters SPF 30 and great, well-priced Vitamin C options. Ombrelle sunscreen started as Canadian, but now belongs to Garnier/L'Oreal, so I don't think it counts. *grin*

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