A sudden rash and blisters on the left leg in Bali. 'Lime disease' or phytophotodermatitis as a result of exposure of lime juice to her left leg.

A 23-year-old previously healthy Dutch woman developed an erythematous, non-itching rash in a handprint pattern at the lateral side of her left thigh on the fourth day of a beach holiday in Bali. Apart from her stay on the beach and an enjoyable nightlife, her further exposure and travel history was unremarkable. In the following 24 hours, the rash became extremely painful with development of blisters at the sites of the erythema. Physical examination (figure 1A) revealed a tender skin with coalescing vesicles and bullae (figure 1B and 1C) atop streaky erythematous plaques on her left thigh (figure 1A). The patient was afebrile and the rest of the physical examination was unremarkable.