6/22/2005. La dermite des prés

If any of you are wondering if I'm for real--whether I ever stop traveling long enough to get my hands dirty, whether I ever stop waxing rhapsodic long enough to really do some gardening--well, I can now claim to have gone jusqu'au bout, "all the way", in my gardening adventures. For I am in the midst of an ailment caused by the plants in my garden and my perhaps over-enthusuastic care of them.

See that ghastly looking photo? That's the skin on my leg, circa last night. Currently, a total of about a square foot of the skin of my legs, stomach, and arms looks as if someone held a hot iron to it until the skin sizzled and huge blisters erupted. But let me back up to the origin of this bizarre incident.

Three days ago, a beautifully clear Sunday dawned in Normandie, where we were at our country house. By the time we had finished a lazy breakfast and I stuck my nose outside, it felt as if the temperature was already around 84 degrees--hot for Normandie! I donned a two-piece bathing suit and headed out to the garden for a weeding session. Our property is totally surrounded by thick hornbeam hedges which make it impossible for any passersby to see my indiscreet gardening attire. And for comfort's sake, it's always been my habit to strip down to the minimum for gardening work in the midst of summer. Soon enough, needless to say, I was perspiring.

I spent about three hours weeding, then harvested some huge angelica stems, cutting off their leaves and throwing them on the compost heap. I loaded them into a basket and took them into the kitchen, in order to begin candying them that afternoon. I headed upstairs to take a bath, as we planned to spend the hot afternoon at the beach. In the bath, I noticed some strange irregular red marks on the inside of one thigh, but I couldn't figure out what they were from. Giving a mental shrug, I forgot about them.

At Varengeville-sur-mer, the tide was way out, presenting ideal conditions for swimming. The water temperature was chilly but delicious once you took the plunge. After a long bout in the water, I stretched out in the sun to let my skin dry. After a few minutes, I noticed a disagreeable burning sensation on my stomach and thighs. I had put powerful sunscreen all over my body, as the sun is incredibly intense in northern France at this time of year. Nevertheless, it felt so unpleasant that I withdrew to the shade of a nearby boulder.

That evening, the skin on my thighs and around the front of my waist became downright painful, especially where my clothing chafed it. I took a look, and sure enough, it seemed I must have missed some enormous areas when applying sunscreen. Around my navel and on my thighs were some huge, bright red blotches. On the way home back to Paris, I had to tuck my tee shirt into the elastic waist of my pants to be able to stand the elastic against my skin. Back in Paris, the temperature was still 90 degrees at midnight! I took a peek at my burning skin, which felt like it was at the boiling point. I noticed grimly that it was even redder than before, now assuming the dark red tint of a real burn such as I sometimes get reaching into a hot oven. I cursed myself for my carelessness with the sunscreen and hid the unpleasant view from Denis' doctor eyes, knowing he would upbraid me for not paying attention to his warnings.

I passed a restless night, tossing and turning with the discomfort of my burning skin. Every time the sheet touched the inflamed spots I awoke, and so I was still in bed trying to get a bit more sleep when Denis left for his office. When I finally dragged myself from bed, I gazed at my thigh with horror. Huge blisters were popping up on the scorched skin patches on my legs. And during the ensuing hours, each of the strange red marks I'd noticed on my legs in the bath, as well as huge swatches of skin on my stomach, erupted in blisters that soon merged into confluent water-balloons of lymphatic fluid, all surrounded by wide zones of angry, deep red inflammation. All of this was exquisitely painful. The slightest touch sent an electrical charge of pain to my brain.

While it had been plausible that I had missed patches of my stomach and upper thighs when I applied sunscreen, it was not plausible that the strange, isolated marks on the inside of my thighs were places that the sunscreen had missed. As more spots popped into blisters, including some on the inside of my arms, I began to mentally scratch my head. What on earth did I have?

When Denis came home that evening, I lifted the loose gown I had put on (the only garment I could stand to wear, at that point), and sheepishly showed him the damage. "I seem to have a hell of a solar reaction," I admitted.

After his initial gasp of horror at the sight I now presented, Denis assumed what I call his "doctor examination" expression as he examined what could now only be described as ghastly, suppurating lesions. As a radiologist, dermatology is hardly his thing. But he took out an old diagnostic manual and looked up dermatitis with blisters. After a rapid perusal, he announced his verdict: la dermite des prés--meadow dermatitis, a phototoxic reaction to certain plants when the skin is moist. It is often seen in people who swim in a lake or stream, and then lie down in the grass. The next day, the image of the plants they lay on is scorched into their skin. You need to go see your dermatologist, Denis ordered. As it was now 5 in the afternoon, I made an appointment for the next day.

As I waited for the hour of the appointment to arrive, I began to doubt Denis' diagnosis. I started wondering if this horrible attack wasn't shingles--a re-eruption of the Herpes zoster virus that causes chicken pox in childhood. I have always found the very name "shingles" repugnant. Siezed by hypochondriac paranoia provoked by my burning skin, I googled "shingles" and with horrified eyes scanned over the images of skin that looked just like mine. "Lesions often appear around the waist," I read, and usually just on one side of the body. Well, all my welts were on the front of my body; none on the back. Did that qualify as "one side"? I knew that shingles breaks out along the distribution of a nerve. "An affliction most common in the aged..." Oh, even more depressing than the immediacy of my pain; now I have an affliction of the aged! Had Denis had the chicken pox? If not, according to what I'd read, he could catch it from my horrid toxic shingles blisters! This is how I whiled away the painful hours until my appointment.

An immediate challenge as the time approached: how to put on underwear? Since the eruption of the hideous lesions, I had simply not worn any. My sole garment had been an antique cotton underslip from a Norman fleamarket, whose soft, loose cotton didn't hurt my skin. I had to bandage my hips and waist enough to permit me to gingerly draw on a pair of underwear. I had trouble finding enough clear skin to apply tape to. After gently settling the waistband of my underwear at the least traumatized level possible, I finally found a soft cotton jersey sundress I could stand to wear. Anything with a waistband was out of the question.

My dermatologist opened the door of the waiting room, a most un-doctor-like, sumptuous 18th century salon. As he steered me down the hall to his exam room, he asked me how I was. "Absolutely awful!" I babbled. Something horrible has happened to me, and I'm nearly convinced it's shingles (here, I actually said la varicelle, French for "chicken pox", since I didn't know the French equivalent of shingles.) I had had la varicelle in childhood, I told him.

"No, no, " he soothed, understandably thinking I had said I had a second case of chicken pox. "You can only get that once." He shushed me as I tried to explain that I meant the dread shingles, asking me to remove my dress so that he could see the problem. The dapper doctor now crouched down the better to view my hideous leprous lesions which were festooned with ragged bits of gauze and tape hanging pathetically from deep crimson skin. His aristocratic nose was now just a few inches from my groin. In a sort of agony of suspense, I could only look inanely at the top of his head, trying to live through the ignominy the moment.

After several interminable seconds, my heroic dermatologist cocked an eye upward. He pronounced me free of zona--French for "shingles." I immediately felt I might float up to the ceiling with relief as the burden of a dread, chronic, disfiguring, and intensely painful disease was lifted from my personal destiny.

With his face back up on level with mine, the dermatologist arched his eyebrows. "Chère Madame," he queried, have you been in contact with any particular plants...? What you have is La dermite des prés. (Denis was right!) For this to occur, he explained, three factors must converge: the contact of certain plants with skin, moisture on the skin, and bright sunlight. The result of this combination is a phototoxic dermatitis.

Which plants, I immediately wanted to know. The doctor reached for a tome behind his desk, and settled into his chair with his glasses on the tip of his nose. Finding the appropriate page, he listed 4 culprit families: Rutaceae, Apiaceaie, Moraceae, and Leguminaceae, all of which potentially contain a class of offending molecules known as furocoumarins. These he listed in his beautiful script on a piece of paper for my future edification. Next, he wrote me several prescriptions and gave me detailed instructions on how to use them. A comforting squeeze of the shoulder and an order to return in three weeks, and I was on my way.

While I was still in the doctor's office, I was already thinking that I would have to write a postcard about this less-than-idyllic episode in a gardener's life. So when I got home, I googled away and found lots of information on this sort of dermatitis and on the offending molecules. But curiously, almost all of the references are in French or German, which makes me think that this offbeat malady is best recognized in Europe.

I learned that florists and people working with vegetable crops or processing often suffer from meadow dermatitis. Celery handlers are especially prone, as well as people who work extensively with chrysanthemums. The four plant families cited as causing the most problems comprise a lot of plants! Included would be not only celery, but parlsey, angelica, lovage, carrots, Queen Anne's lace, rue, all citrus, certain species of Ficus, and so on. And, as the problem with chrysanthemum shows, members of other plant families can contain furocoumarins as well. In my case, I'm almost sure it was my harvesting of the angelica in a bathing suit with sweaty skin that triggered the reaction.

Not to make you paranoid, but certain essential oils and perfume ingredients can cause the same reaction, and for the same reason--that is, they are derived from the culprit plants. On the other hand, eating these same plants (the ones that are comestible, that is), never causes the problem, even in people who are sensitive to this reaction.

From what I've been able to read, some people are apparently more sensitive than others to this sort of reaction. For myself, I once suffered a prolonged phototoxic reaction after being given a new antibiotic belonging to the quinolone class of compounds (similar to tetracycline). My dermatologist was very interested by this and suggested I try to avoid all potential causative agents of such reactions.

Interestingly, the furocoumarins are sometimes used in tanning products, as well as in treating some skin conditions such as psoriasis. You can bet that I'll be reading the ingredient lists on such products quite carefully from now on.

Just to be on the safe side, I recommend that if you're going out to harvest celery, parsley, oranges, angelica, or any other suspect plant on a hot summer day, protect your skin with long pants and a long-sleeved shirt. The fact that you've never had a bad reaction does not mean that you are immune. After all, I had spent hundreds if not thousands of hot summer days scantily clad, handling hundreds of different plants, all without ever a hint of this horrible reaction. Much as I love to garden, I don't ever want to live through another episode of the gardener's malady: La dermite des prés!

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