Abstract • We detected 19 cases of phytophotodermatitis during a cross-sectional epidemiological investigation of two Oregon grocery stores that were part of the same supermarket chain. Outdoor sunlight exposure during the workshift and tanning salon use were identified as risk factors; the most severe cutaneous reactions tended to occur among tanning salon users. Although both stores carried the same brands and varieties of produce, all 19 cases occurred among employees of one store, which had held a celery sale coincident with the outbreak, resulting in a quadrupling of the usual volume of celery sold. We found elevated psoralen levels in two of three celery samples obtained from the affected store; cutaneous provocation tests with trimmed surfaces of these celery samples produced phototoxic reactions. Preliminary experiments with one brand of celery have demonstrated psoralen levels as high as 25 μg/cm2 of trimmed surface. These observations suggest that clinical phytophotodermatitis among grocery store workers may be caused by healthy celery and results from a complex interaction of exposure variables, including ultraviolet radiation from tanning salon use, frequency of handling celery, celery brand, and sporadic elevations of psoralen content from environmental stresses. (Arch Dermatol 1987;123:1478-1482) References 1. National Institute for Occupational Safety and Health: Health Hazard Evaluation Determination Report No. HE 80-225, Cincinnati, Ohio, June 1982. 2. Centers for Disease Control: Phototoxic dermatitis in grocery workers . MMWR 1984;34:11-13. 3. Berkley SF, Hightower AW, Beier RC, et al: Dermatitis in grocery workers associated with high natural concentrations of furanocoumarins in celery . Ann Intern Med 1986;105:351-355.Crossref 4. Arndt KA: Manual of Dermatologic Therapeutics , ed 2. Boston, Little Brown & Co, 1978, p 124. 5. Parrish JA, White HAD, Pathak MA: Photomedicine , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 2. New York, McGraw-Hill International Book Co, 1979, pp 942-994. 6. Beier RC, Ivie GW, Oertli EH, et al: HPLC analysis of linear furocoumarins (psoralens) in healthy celery (Apium graveolens) . Food Chem Toxicol 1983;21:163-165.Crossref 7. Ivie WG, Holt DL, Ivey MC: Natural toxicants in human foods: Psoralens in raw and cooked parsnip root . Science 1981;213:909-910.Crossref 8. Ashwood-Smith MJ, Ceska O, Chaudhary SK: Mechanism of photosensitivity reactions to diseased celery . Br Med J 1985; 290:1249.Crossref 9. Birmingham DJ, Key MM, Tubich GE, et al: Phototoxic bullae among celery harvesters . Arch Dermatol 1961;83:127-141.Crossref 10. Pathak MA, Fitzpatrick TB: Relationship of molecular configuration to the activity of furocoumarins which increase the cutaneous responses following long-wave ultraviolet radiation . J Invest Dermatol 1959;32:255-262.Crossref 11. Beier RC, Oertl EH: Psoralen and other linear furanocoumarins as phytoalexins in celery . Phytochemistry 1983;22:2595-2597.Crossref 12. Komives T, Casida JE: Acifluorfen increases the leaf content of phytoalexins and stress metabolites in several crops . J Ag Food Chem 1983;31:751-755.Crossref 13. Chaudhary SK, Ceska O, Warrington PJ, et al: Increased furocoumarin content of celery during storage . J Ag Food Chem 1985;33:1153-1157.Crossref 14. Photobiology Task Force of the American Academy of Dermatology: Risks and benefits from high-intensity ultraviolet A sources used for cosmetic purposes . J Am Acad Dermatol 1985;12:380-381.Crossref
Archives of Dermatology – American Medical Association
Published: Nov 1, 1987
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