An Unusual Cause of Burn Injury: Fig Leaf Decoction Used as a Remedy for a Dermatitis of Unknown Etiology Erkut O ¨ zdamar, MD, Serhat O ¨ zbek, MD, Selc ¸uk Akın, MD Medicinal plant extracts are commonly used worldwide. Their use relies mostly on historical and anecdotal evidence and might be so hazardous. Phytophotodermatitis is a well-known entity that is caused by the sequential exposure to certain species of plants containing furo- coumarins and then to sunlight. In this article, superficial burn lesions caused by fig leaf decoction that was applied to a patient’s both upper extremity as a remedy for a dermatitis of unknown etiology is reported. Direct sun exposure is an essential component of phyto- photodermatitis. All reported cases to date have in common that patients are exposed to direct sunlight or to artificial UVA lights (like solarium) of varying durations. In our case neither direct sun exposure, other than inevitable indoor UVA influence, nor blister forma- tion was present. The etiologic factors, symptoms, signs, course, and treatment alternatives for phytophotodermatitis are also reviewed briefly. (J Burn Care Rehabil 2003;24: 229 –233) Traditional herbal medicines have been widely used by many people for treating several disorders. Ap- proximately one third of all traditional herbal medi- cines are used for the treatment of wounds or skin disorders compared with only 1–3% of modern drugs. 1 The use of medicinal plant extracts are mostly based on nonscientific evidences and beliefs and, therefore, unsupervised use of them can cause haz- ardous complications. We present a case of phytophotodermatitis that oc- curred after use of a fig leaf decoction as a remedy for a dermatitis of unknown etiology. Phytophotodermatitis is a phototoxic dermatitis induced by the sequential ex- posure to certain plants containing furocoumarins and then to sunlight, especially to the fraction of UVA light with a wavelength between 320 and 380 nm. 2– 4 Prin- cipal plant families provoking phototoxic reactions are Umbelliferae (celery, giant hogweed, parsnip, carrot), Rutacea (lemon, lime), Moracea, and Leguminoseae (prairie turnip). Furocoumarins are a group of antifun- gal dyestuffs produced by certain plants and consist of psoralens, 5-methoxypsoralens, 8-methoxypsoralens, angelicin, bergaptol, and xanthotal. 3 It is well documented that psoralen and bergap- tol are found in the leaves of fig tree. 5 Because its concentration is significantly greater than that of bergaptol, psoralen is the primary causative agent of phototoxic reaction caused by the fig leaf. 6 En- zymes like protease, lipodiastase, and amylase, which have keratolytic effects, are also found in fig latex, which may enhance the phototoxic effects of furocoumarins. 7 Phytophotodermatitis is manifested by a burning sensation and pain, intensely itchy erythema, and edema, which usually begin 24 hours after a contact with any photosensitizing agent and exposure to sun- light. 6 After approximately 48 to 72 hours, the devel- opment of small vesicles that coalesce into large bul- lae can be observed. 2 The full extent of lesions cannot be determined until a period of at least 1 week after the exposure. 8 In the chronic phase, hyperpigmenta- tion may ensue at the contact side. 3,6,9 CASE REPORT A homemade fig leaf decoction applied to a 22-year- old female, who was suffering from skin eruptions at From the Department of Plastic and Reconstructive Surgery, Division of Hand Surgery, Burn Center, Medical Faculty of Uludag ˘ University, Bursa, Turkey. Presented at the Burn Symposium, held by the Turkish Society of Aesthetic, Plastic and Reconstructive Surgeons, Eskis¸ehir, Tu ¨rkiye, April 1 to 2, 2002. Address correspondence to Dr. Serhat O ¨ zbek, Uludag ˘U ¨ niversitesi Tıp Faku ¨ltesi, Plastik ve Rekonstru ¨ktif Cerrahi, Anabilim Dalı, 16059, Go ¨ru ¨kle, Bursa, Turkey. Copyright © 2003 by the American Burn Association. 0273-8481/2003 DOI: 10.1097/01.BCR.0000076058.74339.C6 229