American Journal of Clinical Dermatology

, Volume 3, Issue 4, pp 239–246 | Cite as

Photosensitivity Disorders

Cause, Effect and Management
Therapy in Practice

Abstract

Abnormal photosensitivity syndromes form a significant and common group of skin diseases. They include primary (idiopathic) photodermatoses such as polymorphic light eruption (PLE), chronic actinic dermatitis (CAD), actinic prurigo, hydroa vacciniforme and solar urticaria, in addition to drug- and chemical-induced photosensitivity and photo-exacerbated dermatoses. They can be extremely disabling and difficult to diagnose.

PLE, characterized by a recurrent pruritic papulo-vesicular eruption of affected skin within hours of sun exposure, is best managed by restriction of ultraviolet radiation (UVR) exposure and the use of high sun protection factor (SPF) sunscreens. If these measures are insufficient, prophylactic phototherapy with PUVA, broadband UVB or narrowband UVB (TL-01) for several weeks during spring may be necessary. CAD manifests as a dermatitis of chronically sun-exposed skin. Again, UVR exposure needs to be restricted; cyclosporine, azathioprine or PUVA may also be necessary. Actinic prurigo is characterized by the presence of excoriated papules and nodules on the face and limbs, most prominent and numerous distally. Actinic prurigo is managed again by restriction of UVR and the use of high SPF sunscreens; PUVA or broadband UVB therapy, or low doses of thalidomide may be necessary. Hydroa vacciniforme causes crops of discrete erythematous macules, 2 to 3mm in size, that evolve into blisters within a couple of days of sun exposure. Treatment for this rare disease is difficult; absorbent sunscreens and restricted UVR exposure may help. Solar urticaria is characterized by acute erythema and urticarial wealing after exposure to UVR. Treatment options for solar urticaria include non-sedating antihistamines such as fexofenadine and cetirizine; other options include absorbent sunscreens, restriction of UVR at the relevant wavelength, maintenance of a non-responsive state with natural or artificial light exposure and plasmapheresis.

Industrial, cosmetic and therapeutic agents can induce exogenous drug- or chemical-induced photosensitivity. The clinical pattern is highly varied, depending on the agent; treatment is based on removal of the photosensitizer along with restriction of UVR exposure.

Predominantly non-photosensitive dermatoses may also be exacerbated or precipitated by UVR; exposure to UVR should be reduced and sunscreens should be advocated, along with appropriate treatment of the underlying disease.

Keywords

Cetirizine Fexofenadine Porphyria Cutanea Tarda Polymorphic Light Eruption Variegate Porphyria 

Notes

Acknowledgments

The authors declare no conflict of interest. Dr Millard is funded by a research grant from the Special Trustees of St Thomas’ Hospital.

References

  1. 1.
    Diffey B.L. Human exposure to ultraviolet radiation. In: Hawk J.L.M., editor. Photodermatology. London: Arnold, 1999: 5–24Google Scholar
  2. 2.
    Norris P.G., Hawk J.L.M. The idiopathic photodermatoses: polymorphic light eruption, actinic prurigo and hydroa vacciniforme. In: Hawk J.L.M., editor. Photodermatology. London: Arnold, 1999: 103–112Google Scholar
  3. 3.
    Pao C., Norris P.G., Corbett M., et al. Polymorphic light eruption: prevalence in Australia and England. Br J Dermatol 1994; 130: 62–64PubMedCrossRefGoogle Scholar
  4. 4.
    Millard T.P., Bataille V., Snieder H., et al. The heritability of polymorphic light eruption. J Invest Dermatol 2000; 115: 467–470PubMedCrossRefGoogle Scholar
  5. 5.
    Millard T.P., Hawk J.L.M., Travis L.B., et al. Treatment of polymorphic light eruption. J Dermatol Treat 2000; 11: 195–199CrossRefGoogle Scholar
  6. 6.
    Bilsland D., George S.A., Gibbs N.K., et al. A comparison of narrow band phototherapy (TL-01) and photochemotherapy (PUVA) in the management of polymorphic light eruption. Br J Dermatol 1993; 129 (6): 708–712PubMedCrossRefGoogle Scholar
  7. 7.
    Hawk J.L.M., Magnus I.A. Chronic actinic dermatitis: an idiopathic photosensitivity syndrome including actinic reticuloid and photosensitive eczema. Br J Dermatol 1979; 101 Suppl. 17: 24PubMedGoogle Scholar
  8. 8.
    Ive F.A., Magnus I.A., Warin R.P., et al. Actinic reticuloid; a chronic dermatosis associated with severe photosensitivity and the histological resemblance to lymphoma. Br J Dermatol 1969; 81: 469–485PubMedCrossRefGoogle Scholar
  9. 9.
    Ramsay C.A., Kobza-Black A. Photosensitive eczema. Trans St. Johns Hosp Dermatol Soc 1973; 59: 152–158PubMedGoogle Scholar
  10. 10.
    Frain-Bell W., Lakshmipathi T., Rogers J., et al. The syndrome of chronic photosensitivity dermatitis and actinic reticuloid. Br J Dermatol 1974; 91: 617–634PubMedCrossRefGoogle Scholar
  11. 11.
    Menagé H, Hawk J.L.M. The idiopathic photodermatoses: chronic actinic dermatitis. In: Hawk J.L.M., editor. Photodermatology. London: Arnold, 1999: 127–210Google Scholar
  12. 12.
    Grabczynska S.A., McGregor J.M., Kondeatis E., et al. Actinic prurigo and polymorphic light eruption: common pathogenesis and the importance of HLADR4/DRB1 *0407. Br J Dermatol 1999; 140 (2): 232–236PubMedCrossRefGoogle Scholar
  13. 13.
    Ferguson J. Idiopathic solar urticaria: natural history and response to non-sedative antihistamine therapy, a study of 26 cases. Br J Dermatol 1988; 119 Suppl. 33: 16CrossRefGoogle Scholar
  14. 14.
    Hölzle E. The idiopathic photodermatoses: solar urticaria. In: Hawk J.L.M., editor. Photodermatology. London: Arnold, 1999: 113–126Google Scholar
  15. 15.
    Ferguson J. Drug and chemical photosensitivity. In: Hawk J.L.M., editor. Photodermatology. London: Arnold, 1999: 155–170Google Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Department of PhotobiologySt John’s Institute of Dermatology, St Thomas’ HospitalLondonUK

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