Carolyn J. Kesler, RN, BSN, replies: Found throughout the world, euphorbias are one of the largest genera of flowering plants, and include weeds such as spurge and cultivated plants such as the poinsettia. Many euphorbias have gray-blue foliage with lime green flowers and characteristic milky latex sap, which quickly congeals when exposed to air. The sap contains esters that cause skin rashes and pain.

As with your patient, dermal contact with euphorbia sap occurs when the plant stem is broken. The causticity of the sap varies depending on the species of euphorbia. The patient will notice edema and erythema that increases in intensity over time. This irritation can progress to oozing and blistering, resembling partial-thickness burns, and may cause permanent scarring. Treatment for the skin rash consists of an antihistamine, such as diphenhydramine. Tell the patient to return to the ED if the rash becomes more severe or if she develops respiratory distress or fever.

The patient's eyes also can be affected if sap is transferred from her hands. She may develop complications ranging from mild conjunctivitis to severe keratoconjunctivitis or temporary or permanent blindness. Treatment consists of an ocular anesthetic, irrigation with sterile water or lactated Ringer's solution, topical steroids, and ocular antibiotics as indicated.

Teach patients who have latex allergies to identify and avoid euphorbia plants, because they have a tendency to react to them. To maintain a latex-free environment, medical and dental facilities should eliminate euphorbia plants such as poinsettias.

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