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American Journal of Clinical Dermatology

, Volume 10, Issue 3, pp 169–180 | Cite as

Immunologically Mediated Photodermatoses

Diagnosis and Treatment
  • Thilo Gambichler
  • Raida Al-Muhammadi
  • Stefanie Boms
Review Article Immunologically Mediated Photodermatoses

Abstract

Electromagnetic radiation may cause distinct skin conditions. The immunologically mediated photodermatoses (IMP, previous term: idiopathic photodermatoses) represent a heterogenous group of disorders presenting with pathologic skin reactions caused by optical radiation, particularly in the UVA wavelength region. The exact pathomechanism in IMP remains to be elucidated; however, it is very likely (auto)-immunologic in nature. Polymorphic light eruption, actinic prurigo, hydroa vacciniforme, chronic actinic dermatitis, and solar urticaria are the most important conditions that may be summarized under the term IMP. IMP frequently result in a significant reduction in quality of life in affected individuals, mainly because of troublesome symptoms such as intractable itch and pain.

Photodiagnostic procedures are mandatory for the exact determination of action spectra and the degree of photosensitivity. Broad-spectrum photoprotection is essential in the prevention of IMP. Photo(chemo)therapeutic regimens are predominantly used to increase the cutaneous immunologic tolerance against ambient UV radiation. In severe forms of IMP, immunomodulatory and immunosuppressive therapies may need to be considered. Overall, IMP form a significant group of skin conditions that can be extremely disabling to the patient and are difficult to diagnose and treat.

Keywords

Atopic Dermatitis Minimal Erythematous Dose Oxybenzone Polymorphic Light Eruption Photopatch Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

References

  1. 1.
    Lim HW, Hönigsmann H, Hawk JLM, editors. Photodermatology. New York: Informa Healthcare USA Inc., 2007Google Scholar
  2. 2.
    Ferguson J, Dover JS, editors. Photodermatology. London: Manson Publishing Ltd, 2006Google Scholar
  3. 3.
    Yashar SS, Lim HW. Classification and evaluation of photodermatoses. Dermatol Ther 2003; 16: 1–7PubMedCrossRefGoogle Scholar
  4. 4.
    Millard TP, Hawk LM. Photosensitive disorders: cause, effect, and management. Am J Clin Dermatol 2002; 3: 239–46PubMedCrossRefGoogle Scholar
  5. 5.
    Palmer RA, Hawk JL, Young AR, et al. The effect of solar-simulated radiation on the elicitation phase of contact hypersensitivity does not differ between controls and patients with polymorphic light eruption. J Invest Dermatol 2005 Jun; 124 (6): 1308–12PubMedCrossRefGoogle Scholar
  6. 6.
    Stratigos AJ, Antoniou C, Papathanakou E, et al. Spectrum of idiopathic photodermatoses in a Mediterranean country. Int J Dermatol 2003; 42: 449–54PubMedCrossRefGoogle Scholar
  7. 7.
    Hölzle E. Photodermatosen. Akt Dermatol 1996; 22: 15–9Google Scholar
  8. 8.
    Sassa S. The porphyrias. Photodermatol Photoimmunol Photomed 2002; 18: 56–67PubMedCrossRefGoogle Scholar
  9. 9.
    Meffert B, Meffert H. Optische Strahlung und ihre Wirkungen auf die Haut. Biomed Technik 2000; 45: 98–104CrossRefGoogle Scholar
  10. 10.
    Mathes R, Sliney D, editors. Measurements of optical radiation hazards. Munich: Märkl-Druck, 1998Google Scholar
  11. 11.
    McKinlay AF, Diffey BL. A reference action spectrum for ultraviolet induced erythema in human skin. CIE J 1987; 6: 17–22Google Scholar
  12. 12.
    Lehmann P. Diagnostic approach to photodermatoses. J Dtsch Dermatol Ges 2006; 4: 965–75PubMedCrossRefGoogle Scholar
  13. 13.
    Roelandts R. The diagnosis of photosensitivity. Arch Dermatol 2000; 136: 1152–7PubMedCrossRefGoogle Scholar
  14. 14.
    Wolf R, Oumeish OY. Photodermatoses. Clin Dermatol 1998; 16: 41–57PubMedCrossRefGoogle Scholar
  15. 15.
    Van de Pas CB, Hawk JL, Young AR, et al. An optimal method for experimental provocation of polymorphic light eruption. Arch Dermatol 2004; 140: 286–92PubMedCrossRefGoogle Scholar
  16. 16.
    Dummer R, Ivanova K, Scheidegger EP, et al. Clinical and therapeutical aspects of polymorphous light eruption. Dermatology 2003; 207: 93–5PubMedCrossRefGoogle Scholar
  17. 17.
    Ling TC, Richards HL, Janssens AS, et al. Seasonal and latitudinal impact of polymorphic light eruption on quality of life. J Invest Dermatol 2006; 126: 1648–51PubMedCrossRefGoogle Scholar
  18. 18.
    Boonstra HE, van Weelden H, Toonstra J, et al. Polymorphous light eruption: a clinical, photobiologic and follow-up study of 110 patients. J Am Acad Dermatol 2000; 42: 199–207PubMedCrossRefGoogle Scholar
  19. 19.
    Ling TC, Gibbs NK, Rhodes LE. Treatment of polymorphic light eruption. Photodermatol Photoimmunol Photomed 2003; 19: 217–27PubMedCrossRefGoogle Scholar
  20. 20.
    Kölgen W, van Meurs M, Jongsma M, et al. Differential expression of cytokines in UV-B-exposed skin of patients with polymorphous light eruption: correlation with Langerhans cell migration and immunosuppression. Arch Dermatol 2004; 140: 295–30PubMedCrossRefGoogle Scholar
  21. 21.
    Hjorth N, Sjolin KE, Sylvest B, et al. Acne aestivalis: Mallorca acne. Acta Derm Venerol 1972; 52: 61–3PubMedGoogle Scholar
  22. 22.
    Verbov J. Actinic folliculitis. Br J Dermatol 1985; 113: 630–1PubMedCrossRefGoogle Scholar
  23. 23.
    Veysey EC, George S. Actinic folliculitis. Clin Exp Dermatol 2005; 30: 659–61PubMedCrossRefGoogle Scholar
  24. 24.
    Hojyo-Tomoka MT, Vega-Memije ME, Cortes-Franco R, et al. Diagnosis and treatment of actinic prurigo. Dermatol Ther 2003; 16: 40–4PubMedCrossRefGoogle Scholar
  25. 25.
    Lippert U, Schauder S, Neumann C. Aktinische Prurigo. Hautarzt 2000; 51: 597–603PubMedCrossRefGoogle Scholar
  26. 26.
    Arrese JE, Dominguez-Soto L, Hojyo-Tomoka MT, et al. Effectors of inflammation in actinic prurigo. J Am Acad Dermatol 2001; 44: 957–61PubMedCrossRefGoogle Scholar
  27. 27.
    Gomez A, Umana A, Trespalacios AA. Immune responses to isolated human skin antigens in actinic prurigo. Med Sci Monit 2006; 12: 106–13Google Scholar
  28. 28.
    Gupta G, Man I, Kemmett D. Hydroa vacciniforme: a clinical and follow-up study of 17 cases. J Am Acad Dermatol 2000; 42: 208–13PubMedCrossRefGoogle Scholar
  29. 29.
    Demachi A, Nagata H, Morio T, et al. Characterization of Epstein-Barr Virus (EBV)-positive NK cells isolated from hydroa vacciniforme-like eruptions. Microbiol Immunol 2003; 47: 543–52PubMedGoogle Scholar
  30. 30.
    Iwatsuki K, Xu ZG, Takata M, et al. The association of latent Epstein-Barr virus infection with hydroa vacciniforme. Br J Dermatol 1999; 140: 715–21PubMedCrossRefGoogle Scholar
  31. 31.
    Iwatsuki K, Satoh M, Yamamoto T, et al. Pathogenic link between hydroa vacciniforme and Epstein-Barr virus-associated hematologic disorders. Arch Dermatol 2006; 142: 587–95PubMedCrossRefGoogle Scholar
  32. 32.
    Hawk JLM. Chronic actinic dermatitis. Photodermatol Photoimmunol Photomed 2004; 20: 312–4PubMedCrossRefGoogle Scholar
  33. 33.
    Yap LM, Foley P, Crouch R, et al. Chronic actinic dermatitis: a retrospective analysis of 44 cases referred to an Australian photobiology unit. Australas J Dermatol 2003; 44: 256–62PubMedCrossRefGoogle Scholar
  34. 34.
    Menage Hdu P, Sattar NK, Haskard DO, et al. A study of the kinetics and pattern of E-selectin, VCAM-1 and ICAM-1 expression in chronic actinic dermatitis. Br J Dermatol 1996; 134: 262–8PubMedCrossRefGoogle Scholar
  35. 35.
    Chu AC, Robinson D, Hawk JL, et al. Immunologic differentiation of the Sezary syndrome due to cutaneous T-cell lymphoma and chronic actinic dermatitis. J Invest Dermatol 1986; 86: 134–7PubMedCrossRefGoogle Scholar
  36. 36.
    Bakels V, van Oostveen JW, Preesman AH, et al. Differentiation between actinic reticuloid and cutaneous T cell lymphoma by T cell receptor gamma gene rearrangement analysis and immunophenotyping. J Clin Pathol 1998; 51: 154–8PubMedCrossRefGoogle Scholar
  37. 37.
    Bilsland D, Crombie IK, Ferguson J. The photosensitivity dermatitis and actinic reticuloid syndrome: no association with lymphoreticular malignancy. Br J Dermatol 1994; 131: 209–14PubMedCrossRefGoogle Scholar
  38. 38.
    Schauder S. Solar urticaria [in German]. Hautarzt 2003; 54: 952–8PubMedCrossRefGoogle Scholar
  39. 39.
    Sams Jr WM. Solar urticaria: studies of the active serum factor. J Allerg 1970; 45: 295–301PubMedCrossRefGoogle Scholar
  40. 40.
    Kojma M, Horiko T, Nakamara Y, et al. Solar urticaria: relationship of photoallergen and action spectrum. Arch Dermatol 1986; 122: 550–5CrossRefGoogle Scholar
  41. 41.
    Leenutapong V, Hölzle E, Plewig G. Solar urticaria: studies on themechanisms of tolerance. Br J Dermatol 1990; 122: 601–6CrossRefGoogle Scholar
  42. 42.
    Fukunaga A, Horikawa T, Yamamoto A, et al. The inhibition spectrum of solar urticaria suppresses the wheal-flare response following intradermal injection with photo-activated autologous serum but not with compound 48/80. Photodermatol Photoimmunol Photomed 2006; 22: 129–32PubMedCrossRefGoogle Scholar
  43. 43.
    Das S, Lloyd JJ, Walshaw D, et al. Provocation testing in polymorphic light eruption using fluorescent ultraviolet (UV) A and UVB lamps. Br J Dermatol 2004; 151: 1066–70PubMedCrossRefGoogle Scholar
  44. 44.
    Neumann NJ, Fritsch C, Lehmann P. Photodiagnostische Testverfahren Teil 1. Hautarzt 2000; 51: 113–25PubMedCrossRefGoogle Scholar
  45. 45.
    Fitzpatrick TB. The validity and practicality of sun-ractive skin types I and IV. Arch Dermatol 1988; 124: 869–87PubMedCrossRefGoogle Scholar
  46. 46.
    Beattie PE, Dawe RS, Ferguson J, et al. Dose-response and time-course characteristics of UV-A1 erythema. Arch Dermatol 2005; 141: 1549–55PubMedCrossRefGoogle Scholar
  47. 47.
    Gambichler T, Moussa G, Tomi NS, et al. Reference limits for erythema effective ultraviolet doses. Photochem Photobiol 2006; 82: 1097–102PubMedCrossRefGoogle Scholar
  48. 48.
    Murphy GM. Investigation of photosensitive disorders. Photodermatol Photoimmunol Photomed 2004; 20: 305–11PubMedCrossRefGoogle Scholar
  49. 49.
    Bruynzeel DP, Ferguson J, Andersen K, et al. Photopatch testing: a consensus methodology for Europe. J Eur Acad Dermatol Venereol 2004; 18: 679–82PubMedCrossRefGoogle Scholar
  50. 50.
    Gambichler T, Breuckmann F, Boms S, et al. Narrow-band UVB phototherapy in skin conditions beyond psoriasis. J Am Acad Dermatol 2005; 52: 660–70PubMedCrossRefGoogle Scholar
  51. 51.
    Collins P, Ferguson J. Narrow-band UVB (TL-01) phototherapy: an effective preventative treatment for the photodermatoses. Br J Dermatol 1995; 132: 956–63PubMedCrossRefGoogle Scholar
  52. 52.
    Jeanmougin M, Peyron JL, Thomas P, et al. Polymorphic light eruption: prophylaxis using a topical combination of antioxidants and UVA protection formulations. Ann Dermatol Venereol 2006; 133: 425–8PubMedCrossRefGoogle Scholar
  53. 53.
    Beissert S, Ständer H, Schwarz T. UVA rush hardening for the treatment of solar urticaria. J Am Acad Dermatol 2000; 42: 1030–2PubMedCrossRefGoogle Scholar
  54. 54.
    Uetsu N, Okamoto H, Fujii K, et al. Treatment of chronic actinic dermatitis with tacrolimus. J Am Acad Dermatol 2002; 47: 881–4PubMedCrossRefGoogle Scholar
  55. 55.
    Edstrom DW, Ros AM. Cyclosporin A therapy for severe solar urticaria. Photodermatol Photoimmunol Photomed 1997; 13: 61–3PubMedCrossRefGoogle Scholar
  56. 56.
    Mang R, Stege H, Budde MA, et al. Successful treatment of solar urticaria by extracorporeal photochemotherapy (photopheresis): a case report. Photodermatol Photoimmunol Photomed 2002; 18: 196–8PubMedCrossRefGoogle Scholar
  57. 57.
    Collins P, Ahamat R, Green C, et al. Plasma exchange therapy for solar urticaria. Br J Dermatol 1996; 134: 1093–7PubMedCrossRefGoogle Scholar
  58. 58.
    Evans AV, Palmer RA, Hawk JL. Erythrodermic chronic actinic dermatitis responding only to topical tacrolimus. Photodermatol Photoimmunol Photomed 2004; 20: 59–61PubMedCrossRefGoogle Scholar
  59. 59.
    Calnan CD, Meara RH. Actinic prurigo (Hutchinson’s summer prurigo). Clin Exp Dermatol 1977; 2: 365–72PubMedCrossRefGoogle Scholar
  60. 60.
    Wu JJ, Huang DB, Pang KR, et al. Thalidomide: dermatological indications, mechanisms of action and side-effects. Br J Dermatol 2005; 153: 254–73PubMedCrossRefGoogle Scholar
  61. 61.
    Duschet P, Leyen P, Schwarz T, et al. Solar urticaria: effective treatment by plasmapheresis. Clin Exp Dermatol 1987; 12: 185–7PubMedCrossRefGoogle Scholar
  62. 62.
    Gambichler T, Laperre J, Hoffmann K. The European standard for sun-protective clothing: EN 13758. J Eur Acad Dermatol Venereol 2006; 20: 125–30PubMedCrossRefGoogle Scholar
  63. 63.
    Hampton PJ, Farr PM, Diffey BL, et al. Implication for photosensitive patients of ultraviolet A exposure in vehicles. Br J Dermatol 2004; 151: 873–6PubMedCrossRefGoogle Scholar
  64. 64.
    Gambichler T, Altmeyer P, Hoffmann K. Role of clothes in sun protection. Recent Results Cancer Res 2002; 160: 15–25PubMedCrossRefGoogle Scholar
  65. 65.
    Gambichler T, Laperre J, Altmeyer P, et al. UVA and UVB transmission of fabrics: critical wavelength based on absorbance and effective dose. Exog Dermatol 2002; 1: 290–5CrossRefGoogle Scholar
  66. 66.
    Peyron JL, Raison-Peyron N, Meynadier J, et al. Prevention of solar urticaria using a broadspectrum sunscreen and determination of a solar urticaria protection factor (SUP). In: Rougier A, Schaefer H, editors. Protection of the skin against ultraviolet radiation. Paris: John-Libbey Eurotext, 1998: 201–5Google Scholar
  67. 67.
    Van den Keybus C, Laperre J, Roelandts R. Protection from visible light by commonly used textiles is not predicted by ultraviolet protection. J Am Acad Dermatol 2006; 54: 86–93PubMedCrossRefGoogle Scholar
  68. 68.
    Schauder S, Schrader A, Ippen H. Göttinger Liste: Sonnenschutzkosmetik in Deutschland: 4. Neubearbeitete und erweiterte Auflage. Berlin-Wien: Blackwell Wissenschafts-Verlag, 1996Google Scholar
  69. 69.
    Tuchinda C, Lim HW, Osterwalder U, et al. Novel emerging sunscreen technologies. Dermatol Clin 2006; 24: 105–17PubMedGoogle Scholar
  70. 70.
    Hönigsmann H. Mechanisms of phototherapy and photochemotherapy for photodermatoses. Dermatol Ther 2003; 16: 23–7PubMedCrossRefGoogle Scholar
  71. 71.
    Janssens AS, Pavel S, Out-Luiting JJ, et al. Normalized ultraviolet (UV) induction of Langerhans cell depletion and neutrophil infiltrates after artificial UVB hardening of patients with polymorphic light eruption. Br J Dermatol 2005; 152: 1268–74PubMedCrossRefGoogle Scholar
  72. 72.
    Darras S, Segard M, Mortier L, et al. Treatment of solar urticaria by intravenous immunoglobulins and PUVA therapy. Ann Dermatol Venerol 2004; 131: 65–9CrossRefGoogle Scholar
  73. 73.
    Caccialanza M, Percivalle S, Piccinno R, et al. Photoprotective activity of oral polypodium leucotomos extract in 25 patients with idiopathic photodermatoses. Photodermatol Photoimmunol Photomed 2007; 23: 46–7PubMedCrossRefGoogle Scholar
  74. 74.
    Patel DC, Bellaney GJ, Seed PT, et al. Efficacy of short-course oral prednisolone in polymorphic light eruption: a randomised controlled trial. Br J Dermatol 2000; 142: 112–4CrossRefGoogle Scholar
  75. 75.
    Londono F. Thalidomide in the treatment of actinic prurigo. Int J Dermatol 1973; 12: 326–8PubMedCrossRefGoogle Scholar
  76. 76.
    Batto NC, Warshaw EM. Solar urticaria. J Am Acad Dermatol 2008; 59: 909–20CrossRefGoogle Scholar
  77. 77.
    Puech-Plottova I, Michel JL, Rouchhouse JL, et al. Solar urticaria: one case treated by intravenous globulin. Ann Dermatol Venereol 2000; 127: 831–5PubMedGoogle Scholar
  78. 78.
    Bartunkova J, Kayserova J, Shoenfeld Y. Allergy and autoimmunity: parallels and dissimilarity: the yin and yang of immunopathology. Autoimmun Rev 2009; 8: 302–8PubMedCrossRefGoogle Scholar
  79. 79.
    Hönigsmann H. Polymorphous light eruption. Photodermatol Photoimmunol Photomed 2008; 24: 155–61PubMedCrossRefGoogle Scholar
  80. 80.
    Ross G, Foley P, Baker C. Actinic prurigo. Photodermatol Photoimmunol Photomed 2008; 24: 272–5PubMedCrossRefGoogle Scholar
  81. 81.
    Tzaneva S, Volc-Platzer B, Kittler H, et al. Antinuclear antibodies in patients with polymorphic light eruption: a long-term follow-up study. Br J Dermatol 2008; 158: 1050–4PubMedCrossRefGoogle Scholar
  82. 82.
    Millard TP, Fryer AA, McGregor JM. A protective effect of glutathione-S-transferase GSTP1*Val105 against polymorphic light eruption. J Invest Dermatol 2008; 128: 1901–5PubMedCrossRefGoogle Scholar
  83. 83.
    Güzelbey O, Ardelean E, Magerl M, et al. Successful treatment of solar urticaria with anti-immunoglobulin E therapy. Allergy 2008; 63: 1563–5PubMedCrossRefGoogle Scholar
  84. 84.
    Pareek A, Khopkar U, Sacchidanand S, et al. Comparative study of efficacy and safety of hydroxychloroquine and chloroquine in polymorphic light eruption: a randomized, double-blind, multicentric study. Indian J Dermatol Venereol Leprol 2008; 74: 18–22PubMedCrossRefGoogle Scholar
  85. 85.
    Richards HL, Ling TC, Evangelou G, et al. Evidence of high levels of anxiety and depression in polymorphic light eruption and their association with clinical and demographic variables. Br J Dermatol 2008; 159: 439–44PubMedCrossRefGoogle Scholar
  86. 86.
    Jong CT, Finlay AY, Pearse AD, et al. The quality of life of 790 patients with photodermatoses. Br J Dermatol 2008; 159: 192–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Thilo Gambichler
    • 1
  • Raida Al-Muhammadi
    • 1
  • Stefanie Boms
    • 2
  1. 1.Department of DermatologyRuhr-University BochumBochumGermany
  2. 2.Department of DermatologyKatharinen HospitalUnnaGermany

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