Photodermatitis Disease

DESCRIPTION

Light-induced eruptions seen in a pattern of photo-distribution

Phototoxic reactions - result of the acute toxic effect on skin of ultraviolet light alone (sunburn) or together with a photosensitizing substance (non-allergic)
Photoallergic eruptions - a form of allergic dermatitis resulting from combined effects of a photosensitizing substance (drugs or chemical) plus ultraviolet light (immunologic/delayed hypersensitivity)
Polymorphous light eruption (PLE) - chronic, intermittent light-induced eruption with erythematous papules, urticaria, or vesicles on areas exposed to sunlight
System(s) affected: Skin/Exocrine
Genetics: Predisposition occurs in inbred populations (e.g., Pima Indians)
Incidence/Prevalence in USA: Unknown
Predominant age: All ages
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Phototoxic
- Erythema
- With increasing severity - vesicles and bullae
- Classic example - sunburn
- Nails may exhibit onycholysis
- Chronic - epidermal thickening, elastosis, telangiectasia and pigmentary changes
- Sharp lines of demarcation between involved and uninvolved skin (sunlight exposure)
- Phototoxic eruption due to topicals - area of application
- Usually develops shortly after sun exposure
- Hyperpigmentation may follow resolution
- Pain
Photoallergic
- Papules with erythema and occasionally vesicles
- Area exposed to light with less distinct borders
- Usually delayed - 24 hours or more after exposure
- May spread to unexposed areas
- Pruritus
Polymorphous light eruption (PLE)
- Erythematous papules
- Occasionally urticaria or vesicles
- Scattered over sun exposed areas with normal skin in between
- Can spread to non-exposed areas
- Often flares in spring or early summer
- Desensitization affect (less over the course of the summer)
- Burning or pruritus may precede lesions

CAUSES

Sunlight
Phenothiazines
Diuretics
Tetracyclines
Sulfonamides
Oral contraceptives
Topicals - psoralens, coal tars, photo-active dyes (eosin, acridine orange)

RISK FACTORS

N/A

LABORATORY

Antinuclear antibody (ANA) to rule out systemic lupus erythematosus

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Nonspecific

SPECIAL TESTS

Photo-testing
Photopatch testing
Skin biopsy - to rule out other disorders

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Physical examination and medical history

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Avoid sunlight/limit exposure
Protective clothing/sunscreens
Ice packs/cold water compresses

SURGICAL MEASURES

N/A

ACTIVITY

Avoid sunlight

DIET

No special diet

PATIENT EDUCATION

Avoidance of sunlight
Avoidance of photosensitizing drugs
Protective clothing
Sunscreens

PREVENTION/AVOIDANCE

Sunlight avoidance/protective clothing
Identification and avoidance of causative drugs (see under Causes)
Sunscreens - apply before exposure
- Zinc oxide - opaque, cosmetically less acceptable
- Chemical - use sun-protective factor > 15 for maximum protection; substantively resistant to sweat and swimming; cosmetically more acceptable

POSSIBLE COMPLICATIONS

N/A

EXPECTED COURSE AND PROGNOSIS

Good with avoidance/protection measures

ASSOCIATED CONDITIONS

Sunlight aggravation of systemic lupus
Persistent light reactivity
Actinic reticuloid

AGE-RELATED FACTORS

N/A

Pediatric: N/A
Geriatric: More likely to experience adverse reactions to causative drugs
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

NSAID = nonsteroidal anti-inflammatory drugs

Clinical Investigations

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