Beware of the margarita burn: the unfortunate side effect of limes and sun

After making a round of margaritas by the lake, Amber Prepchuk said the next day she woke up with blisters so severe a doctor told her they were first degree burns.

'I woke up the next morning and I was in pain. I was crying my eyes out.'

Amber Prepchuk discovered she had a case of phytophotodermatitis after making a round of margaritas. (Amber Prepchuk)

On a sunny day in June, Amber Prepchuk spent an afternoon by the lake making margaritas for a group of friends. 

The following morning she ended up with much more than she bargained for — a painful side effect entirely unrelated to tequila. 

"I can handle pain, but I woke the next morning and I was in pain. I was crying my eyes out." she told CBC's Radio Active. "I was covered in little blisters."

Prepchuk brought 18 limes for juicing at a picnic during a cabin getaway, but she said her friend forgot the lime squeezer, so she started juicing with her hands. 

Ten limes in, her friend found the squeezer but by then the damage was done. 

Even though Prepchuk washed her hands, she realized later there must have been residue from the fruit between her fingers. 

Prepchuk had a case of phytophotodermatitis, a condition more commonly known as 'margarita burn.'

Wasting away in Margaritaville

"It's like you cook from the inside out. It happens after sun exposure so you wouldn't know it's happening," she said. 

Prepchuk had never heard of the condition before she visited the doctor. 

Amber Prepchuk said she woke up covered in blisters after squeezing limes at the beach. (Amber Prepchuk)

When she told him the only possible cause she could think of was an allergic reaction to the fruit, he was incredulous. 

"He told me, 'This is a first-degree burn,'" she said. "He looked at me like I'm nuts. Limes, really? Limes?!?" 

Prepchuk is a makeup artist in Edmonton and said she was sent home with bandages on her hands to recover. 

That week she was applying make-up for author Cheryl Strayed, who was in the city for an appearance at Rogers Place with Oprah Winfrey. 

Prepchuk continued to work but three weeks later, her hands still have the scars as proof of her injuries. 

The ordeal was a surprise to Prepchuk, but dermatologist and University of Alberta professor Dr. Jaggi Rao said he sees patients with the condition at least once a week. 

 Not a sunburn

"It's actually super common," Rao said. "It's not just due to limes, but what we call furocoumarins." 

The chemical compound is in a variety of fruits and vegetables including limes, lemons, celery, parsnip and parsley.

"By itself it doesn't cause any problems, but when you have high intensity UV light it will release oxygen radicals that cause an eczema to occur," he said. 

Some cases can cause symptoms so severe they resemble second-degree burns, but Dr. Rao said the condition is not a sunburn. While it typically leaves a long-lasting brown skin rash behind, phytophotodermatitis rarely leaves people with permanent scarring. 

"I see it almost every other day," he said. "Usually people come back from vacation, from a trip to Mexico, or I see it in grocers." 

In most cases, he said, it results in a burning and itching sensation that heals as the skin turns red and discolours. 

Patients often come to him speculating it was the result of a jellyfish sting, because it creates a splatter pattern where someone spilled part of a drink. 

Three weeks after her hands blistered from 'margarita burn', Amber Prepchuk still has the scars to show for it. (Craig Ryan/CBC)

While Prepchuk's case was unusually severe, Dr. Rao said it can happen to anyone and it is not necessarily more acute for people with allergic sensitivities.

However, people with more pigment in their skin can have a longer lasting and darker stain left on their body as it heals. 

Prepchuk, for her part, said she has learned her lesson about making margaritas and will be more careful in the future.

"Nobody is really juicing carrots with their hands and going in the sun all that often," she said. 

"So calling it margarita burns, it makes sense that's the street name for it, because that's probably the most likely way you'll get it."

With files from Julia Lipscombe


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