Hematoxylin-eosin staining of the skin biopsy specimen showed widespread spongiosis with an intraepidermal blister. Prominent “sunburn” cells (apoptotic keratinocytes) were seen situated predominantly in the superficial epidermis. The dermis contained a mild lymphocytic infiltrate. The results of direct immunofluorescence were negative.
Initially, the patient denied applying any product to his skin. However, further questioning revealed that 24 hours before the symptoms began he had visited a sauna, where he had applied an exfoliating rub containing lime rind. After he applied the phototoxin, he showered and drove home in a convertible automobile with the roof down, exposing himself to 30 minutes of sunshine.
Acute Severe Blistering in a 24-Year-Old Man—Diagnosis. Arch Dermatol. 2006;142(8):1059-1064. doi:10.1001/archderm.142.8.1059-h