Phytophotodermatitis due to ficus 
Case report 
PHYTOPHOTODERMATITIS DUE TO FICUS CARICA 
F. Ayala, C. Patruno, F.M. Cuccurullo, O. Letizia and N. Balato 
ABSTRACT 
A case ofphytophotodermatitis due to comact with Ficus carica in a 35-year-old man is reported. An erythematous vesiculo-
bullous eruption occurred every summer following the contact with this plant since 25 years ago. The photostimulated open tests 
with the leaf and fruit were positive, whereas the patch tests were negative. 
Phytophotodermatitis possibly of allergic origin caused by a contact with Ficus carica is relatively frequent in Southem Italy 
and other Mediterranean areas where this plant is largely cultivated. It seems that this condition remains often misdiagnosed. 
KEYWORDS 
phytophotodermatitis, ficus carica, positive photopatch test. 
INTRODUCTION 
Ficus carica is a plant of the Moraceae family widely 
diffused in Southem Italy. 
It is well known that Ficus carica can induce both irritant 
and allergic contact dermatitis, mainly with a photomediated 
mechanism (1). 
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CASEREPORT 
A35-year-oldman was firstrefeITed to us duringJuly 1993 
for an erythematous, vesicular and bullous ernption located 
at the dorsal aspect of his forearms, hands, legs and feet (fig. 
1, 2). The lesions were itching and painful. 
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Phytophotodermatitis due to ficus 
The treatment with systemic and topical steroids led to the 
recovery of the disease in about one week. 
Anamnesis revealed that similar cutaneous lesions had 
occurred aftercontact with Ficus carica plants durin'.g summer 
tirne over a period of 25 years. As a rule, the cutaneous 
eruption spontaneousl y cleared in about two weeks, sometimes 
with slight postinflammatory hyperpigmentation. 
Fig. 1 Phytophotodermatitis from Ficus carica 
Clinical lesions 
Phototests (MED-UV A, MED-UVB), patch test with the 
GIRDCA (Grupa Italiano Ricerca Dermatiti da Contatto e 
Ambientali) standard series and open test with leaf and fruit 
of Ficus carica were negative. 
Fig. 2 Phytophotodermatitis from Ficus carica 
Clinical lesions 
Subsequently, open tests with the same materials were 
photostimulated with UV A (5J/cm2)plus UVB (20mJicm2 .).At 
128 
24 hours these areas showed erythematous, vesicular and 
bullous reactions. 
Two biopsy specimens were taken, the first from a lesi on 
on the right mm, the second from a lesion provoked by 
positive photostimulated open test with the fruit. Histo-
pathologic examination of the tw o biopsies showed identical 
features. Beneath a basket wave stratum corneum 
Fig 3. Histopathology: Beneath a basket-wave stratum 
comeum a partially necrotic epide1mis can be seen. W ithin an 
intraepidermal cleavage there is fibrinous material 
inte1mingled with inflarnmatory cells. In the epidermis at the 
bottom of the cleft a slight spongiosis may be observed. In the 
superficial de1mis a sparse mononuclear infiltrate is present. 
a partially necrotic epide1mis could be observed, within an 
intraepidermal cleavage fibrinous material intermingled with 
inflarnmatory cells was noted. In the superficial de1mis a 
acta dermatovenerologica A.P.A. Vol 2, 93, No 4 
Phytophotodermatitis due to ficus 
sparse mononuclear infiltrate was present Thus the 
histopathology confirmed the clinical diagnosis of photo-
dermatitis. The allergic etiology is possible but this remains 
to be proved by further investigations. 
DISCUSSION 
Photoallergic contactdermatitis from Ficus carica probably 
is a quite common condition in Southern Italy, due to the 
large cultivation of this plant (2). In spite of this, few cases 
have been reported (2-4). 
Furocumarins, namely 5-methylpsoralen, 8-methyl-
psoralen, and 4'-5'-dihydropsoralen, are the known 
photoactive compounds contained in the plant. On the other 
hand, the presence of other unidentified substances with 
phototoxic or photoallergic properties cannot be excluded 
(5). 
The cases occur almost exclusively during spring and 
summer because of the high solar irradiation and due to the 
increase in the concentration of furocumarins in the plants 
during these seasons (3). 
REFERENCE S 
l. Kauli G, Valden G.: Phytophotodermatitis. 
Photodermatology 1984; 1: 65-75. 
2. Lembo G, Lo Presti M, Balato N.: Phytophotodermatitis 
due to Ficus carica. Photodermatology 1985; 2: 119-120. 
from Ficus carica. In: Frosh PJ, Dooms-Goossens A, 
Lachapelle J-M, Rycroft RJG, Scheper RJ (eds), CuITent 
Topics in Contact Dermatitis, Springer-Verlag, Berlin 
Heidelberg, 1989; pp 163-167. 
3. Angelini G, Vena GA, Meneghini CL.: Contactdermatitis 
4. Goi tre M, Bedello PB, CaneD, Alovis V.: Fitofotodermatite 
da fico. Giom Ital Derm Venereol 1984; 119: 435-436. 
AUTHORS' ADDRESSES 
F. Ayala M.D., professore ordinario, Cattedra di De1matologia, Universita di Reggio Calabria, via T. Campanella 
88100 Catanzaro, Italy 
C. Patruno M.D., dottore di ricerca, Clinica Dermatologica, Universita di Napoli ·'Federico II", via S. Pansini 5 
80131 Na.poli, Italy 
F.M. Cuccurullo M.D., spezzializzanda, same address 
O. Latizia M.D., medico interno, same address 
N. Balato M.D., ricercatore, same address 
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