How to Protect Your Kids From ‘Margarita Burn’

Citrus and sunshine don’t mix when there’s skin involved

Lime juice on the skin can cause a phototoxic reaction when exposed to sunlight.

By Perry Santanachote

The scene is sweet and pleasant enough: Your little ones set up a makeshift booth and squeeze lemons and limes into pitchers for their summer business—a lemonade and limeade stand. What these young entrepreneurs and their parents might not know is that they can have a bit of a problem on their hands when citrus and sun mix.

If kids help prepare the beverages—or get sugar-high on their own supply—and sit out in the sun, skin that comes in contact with the citrus juices can burn, blister, and become discolored.

The reaction is called phytophotodermatitis, commonly known as margarita burn, and develops when skin comes into contact with furocoumarins, a class of chemicals in some plants and fruits, and then exposed to sunlight’s ultraviolet A rays.

Limes are a common perpetrator, but Shehla Admani, MD, a pediatric dermatologist at Stanford Medicine Children’s Health in California, says celery, carrots, parsley, figs, and mangoes also contain furocoumarins.

What a Margarita Burn Looks Like

“It can be as mild as some redness, like an enhanced sunburn, to as dramatic as a blistering effect,” says Robert Sidbury, MD, the dermatology division chief at Seattle Children’s Hospital and a professor of pediatrics at the University of Washington School of Medicine. 

Unlike a sunburn, Sidbury says margarita burns often look very asymmetric. “So if someone’s making lemonade and the juice drips or squirts onto their hands or body and they are fine everywhere else but get this rip-roaring reaction in those spots, that’s phytophotodermatitis,” he says. “And if you’ve got a child gnawing on a piece of celery, it can be all around their mouth where the celery was hitting.”

Margarita Burns and Children

“While phytophotodermatitis can affect people of all ages, children are messier when they eat and are more likely to have skin contact with these foods,” Admani says. “Adults are more likely to remove themselves from light exposure when they feel discomfort, compared to kids, who often will continue playing or may be so young that they cannot verbalize the discomfort or remove themselves from the environment.”

Another challenge with phytophotodermatitis and children is that the pattern and coloration of the burns can sometimes be mistaken for child abuse. 

“The tricky part is when phytophotodermatitis heals, it becomes hyperpigmented and takes on a greyish cast that almost looks like a bruise,” Sidbury says. “Now, let’s imagine a parent making lemonade, and then they pick up their baby, and their baby gets a burn in the shape of a hand print on their back that heals with this sort of brownish-grayish groove.” He says doctors should always ask for any history of phytophotodermatitis if they discover marks like this, but that isn’t always the case. Parents should be prepared to explain the situation.

How Common Are Margarita Burns?

“It’s common enough that every dermatologist who will encounter it knows what it is,” Sidbury says. “But it’s not so common that even every pediatrician will know what it is, so if that’s the case, then certainly not every parent does.”

How to Treat a Margarita Burn

If you notice it in the moment, Sidbury says to get out of the sun and wash off immediately. More often, however, people don’t notice until a day has passed. At that point, it’s just a matter of symptomatic pain control.

  • Tylenol or Motrin as needed for pain
  • Cool compress for the skin
  • Over-the-counter hydrocortisone for inflammation

If at least 30 percent of the body is affected, or you’re concerned about open skin wounds getting infected, go see your pediatrician, primary care doctor, or dermatologist.

Best Ways to Prevent Margarita Burns

“The ultimate prevention is avoidance of relevant substances,” Sidbury says. “A good broad-spectrum sunscreen does protect against UVA, but almost no one, myself included, uses sunscreens perfectly all the time.” 

Kids still need to wear sunscreen when outside for many other reasons; it just won’t necessarily prevent margarita burns, which is why you still need to take precautions and avoid or remove these residues in the first place.

Have Your Lemonade and Drink It, Too

Remember these prevention tips before heading outside for fun in the sun to ensure that margarita burns don’t hamper your summer.

  • Wash hands and other exposed parts of the skin immediately after handling or eating citrus, celery, carrots, parsley, figs, mangoes, and real-juice popsicles.
  • Don’t slather on personal body products containing citrus or some plant oils.
  • Wear pants and long sleeves in wooded areas and the garden because certain plants, such as Queen Anne’s lace, contain furocoumarins, too.

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