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Photosensitivity and Photoreaction

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Abstract

This chapter describes clinical findings, recommended laboratory investigations, and treatment options for acquired and inherited photosensitive skin disorders in pediatric patients. Photosensitive cutaneous disorders discussed include solar urticaria, polymorphous light eruption, juvenile spring eruption, actinic prurigo, hydroa vaccinoforme, pellagra, cutaneous porphyrias (erythropoietic protoporphyria, x-linked dominant protoporphyria, congenital erythropoietic porphyria, hepatoerythropoietic porphyria, porphyria cutanea tarda), and pseudoporphyria. Emphasis is placed on the approach to treatment of these conditions, and an annotated bibliography with evaluation of the strength of available evidence for various treatments is included.

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References

  1. Choi D, Kannan S, Lim HW. Evaluation of patients with photodermatoses. Dermatol Clin. 2014;32(3):267–75.

    Article  CAS  PubMed  Google Scholar 

  2. Monfrecola G1, Masturzo E, Riccardo AM, Balato F, Ayala F, Di Costanzo MP. Solar urticaria: a report on 57 cases. Am J Contact Dermat. 2000;11(2):89–94.

    Article  CAS  PubMed  Google Scholar 

  3. Monfrecola G, Masturzo E, Riccardo AM, Del Sorbo A. Cetirizine for solar urticaria in the visible spectrum. Dermatology. 2000;200(4):334–5.

    Article  CAS  PubMed  Google Scholar 

  4. Harris A, Burge SM, George SA. Solar urticaria in an infant. Br J Dermatol. 1997;136(1):105–7.

    Article  CAS  PubMed  Google Scholar 

  5. Calzavara-Pinton P, Zane C, Rossi M, Sala R, Venturini M. Narrowband ultraviolet B phototherapy is a suitable treatment option for solar urticaria. J Am Acad Dermatol. 2012;67(1):e5–9.

    Article  PubMed  Google Scholar 

  6. Roelandts R. Phototherapy of photodermatoses. J Dermatolog Treat. 2002;13(4):157–60.

    Article  CAS  PubMed  Google Scholar 

  7. Levi A, Enk CD. Treatment of solar urticaria using antihistamine and leukotriene receptor antagonist combinations tailored to disease severity. Photodermatol Photoimmunol Photomed. 2015;31(6):302–6.

    Google Scholar 

  8. Waibel KH, Reese DA, Hamilton RG, Devillez RL. Partial improvement of solar urticaria after omalizumab. J Allergy Clin Immunol. 2010;125(2):490–1.

    Article  CAS  PubMed  Google Scholar 

  9. Arasi S, Crisafulli G, Caminiti L, Guarneri F, Aversa T, Porcaro F, et al. Treatment with omalizumab in a 16-year-old Caucasian girl with refractory solar urticaria. Pediatr Allergy Immunol. 2015;26(6):583–5.

    Google Scholar 

  10. Levi A, Tal Y, Dranitzki Z, Shalit M, Enk CD. Successful Omalizumab treatment of severe solar urticaria in a 6-year old child. Pediatr Allergy Immunol. 2015;26(6):588–90.

    Google Scholar 

  11. Hughes R, Cusack C, Murphy GM, Kirby B. Solar urticaria successfully treated with intravenous immunoglobulin. Clin Exp Dermatol. 2009;34(8):e660–2.

    Article  CAS  PubMed  Google Scholar 

  12. Mang R, Stege H, Budde MA, Ruzicka T, Krutmann J. Successful treatment of solar urticaria by extracorporeal photochemotherapy (photopheresis) – a case report. Photodermatol Photoimmunol Photomed. 2002;18(4):196–8.

    Article  CAS  PubMed  Google Scholar 

  13. Haylett AK, Nie Z, Brownrigg M, Taylor R, Rhodes LE. Systemic photoprotection in solar urticaria with α-melanocyte-stimulating hormone analogue [Nle4-D-Phe7]-α-MSH. Br J Dermatol. 2011;164(2):407–14.

    Article  CAS  PubMed  Google Scholar 

  14. Ten Berge O, Sigurdsson V, Bruijnzeel-Koomen CA, van Weelden H, Pasmans SG. Photosensitivity testing in children. J Am Acad Dermatol. 2010;63(6):1019–25.

    Article  PubMed  Google Scholar 

  15. Schleyer V, Weber O, Yazdi A, Benedix F, Dietz K, Röcken M, et al. Prevention of polymorphic light eruption with a sunscreen of very high protection level against UVB and UVA radiation under standardized photodiagnostic conditions. Acta Derm Venereol. 2008;88(6):555–60.

    CAS  PubMed  Google Scholar 

  16. Bissonnette R, Nigen S, Bolduc C. Influence of the quantity of sunscreen applied on the ability to protect against ultraviolet-induced polymorphous light eruption. Photodermatol Photoimmunol Photomed. 2012;28(5):240–3.

    Article  CAS  PubMed  Google Scholar 

  17. Ortel B, Tanew A, Wolff K, Hönigsmann H. Polymorphous light eruption: action spectrum and photoprotection. J Am Acad Dermatol. 1986;14(5 Pt 1):748–53.

    Article  CAS  PubMed  Google Scholar 

  18. Dummer R, Ivanova K, Scheidegger EP, Burg G. Clinical and therapeutic aspects of polymorphous light eruption. Dermatology. 2003;207(1):93–5.

    Article  PubMed  Google Scholar 

  19. Patel DC, Bellaney GJ, Seed PT, McGregor JM, Hawk JL. Efficacy of short-course oral prednisolone in polymorphic light eruption: a randomized controlled trial. Br J Dermatol. 2000;143(4):828–31.

    Article  CAS  PubMed  Google Scholar 

  20. Marini A, Jaenicke T, Grether-Beck S, Le Floc’h C, Cheniti A, Piccardi N. Prevention of polymorphic light eruption by oral administration of a nutritional supplement containing lycopene, β-carotene, and Lactobacillus johnsonii: results from a randomized, placebo-controlled, double-blinded study. Photodermatol Photoimmunol Photomed. 2014;30(4):189–94.

    Article  CAS  PubMed  Google Scholar 

  21. Pareek A, Khopkar U, Sacchidanand S, Chandurkar N, Naik GS. 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(1):18–22.

    Article  PubMed  Google Scholar 

  22. Saul A, Flores O, Novales J. Polymorphous light eruption: treatment with thalidomide. Australas J Dermatol. 1976;17(1):17–21.

    Article  CAS  PubMed  Google Scholar 

  23. Neumann R, Rappold E, Pohl-Markl H. Treatment of polymorphous light eruption with nicotinamide: a pilot study. Br J Dermatol. 1986;115(1):77–80.

    Article  CAS  PubMed  Google Scholar 

  24. Rhodes LE, Durham BH, Fraser WD, Friedmann PS. Dietary fish oil reduces basal and ultraviolet B-generated PGE2 levels in skin and increases the threshold to provocation of polymorphic light eruption. J Invest Dermatol. 1995;105(4):532–5.

    Article  CAS  PubMed  Google Scholar 

  25. Norris PG, Hawk JL. Successful treatment of severe polymorphous light eruption with azathioprine. Arch Dermatol. 1989;125(10):1377–9.

    Article  CAS  PubMed  Google Scholar 

  26. Caccialanza M, Percivalle S, Piccinno R, Brambilla R. Photoprotective activity of oral polypodium leucotomos extract in 25 patients with idiopathic photodermatoses. Photodermatol Photoimmunol Photomed. 2007;23(1):46–7.

    Article  CAS  PubMed  Google Scholar 

  27. Hofer A, Legat FJ, Gruber-Wackernagel A, Quehenberger F, Wolf P. Topical liposomal DNA-repair enzymes in polymorphic light eruption. Photochem Photobiol Sci. 2011;10(7):1118–28.

    Article  CAS  PubMed  Google Scholar 

  28. Gruber-Wackernagel A, Bambach I, Legat FJ, Hofer A, Byrne SN, Quehenberger F, et al. Randomized double-blinded placebo-controlled intra-individual trial on topical treatment with a 1,25-dihydroxyvitamin D3 analogue in polymorphic light eruption. Br J Dermatol. 2011;165(1):152–63.

    Article  CAS  PubMed  Google Scholar 

  29. Hadshiew IM, Treder-Conrad C, v Bülow R, Klette E, Mann T, Stäb F, et al. Polymorphous light eruption (PLE) and a new potent antioxidant and UVA-protective formulation as prophylaxis. Photodermatol Photoimmunol Photomed. 2004;20(4):200–4.

    Article  CAS  PubMed  Google Scholar 

  30. Berth-Jones J, Norris PG, Graham-Brown RA, Burns DA, Hutchinson PE, Adams J. Juvenile spring eruption of the ears: a probable variant of polymorphic light eruption. Br J Dermatol. 1991;124(4):375–8.

    Article  CAS  PubMed  Google Scholar 

  31. Stratigos AJ, Antoniou C, Papadakis P, Papapostolou A, Sabatziotis D, Tranaka K. Juvenile spring eruption: clinicopathologic features and phototesting results in 4 cases. J Am Acad Dermatol. 2004;50(2 Suppl):S57–60.

    Article  PubMed  Google Scholar 

  32. Ohshita A, Nakai N, Katoh N, Konishi K. Atypical case of juvenile spring eruption with photosensitivity to a single dose of ultraviolet A irradiation. J Dermatol. 2014;41(4):356–7.

    Article  PubMed  Google Scholar 

  33. Dogru S, Gungor A, Cekin E, Cincik H, Alga OH. Juvenile spring eruption: a report of two cases. Laryngoscope. 2006;116(7):1279–80.

    Article  PubMed  Google Scholar 

  34. Hojyo-Tomoka MT, Vega-Memije ME, Cortes-Franco R, Domínguez-Soto L. Diagnosis and treatment of actinic prurigo. Dermatol Ther. 2003;16(1):40–4.

    Article  PubMed  Google Scholar 

  35. Herrera-Geopfert R, Magaña M. Follicular cheilitis. A distinctive histopathologic finding in actinic prurigo. Am J Dermatopathol. 1995;17(4):357–61.

    CAS  PubMed  Google Scholar 

  36. Fusaro RM, Johnson JA. Topical photoprotection for hereditary polymorphic light eruption of American Indians. J Am Acad Dermatol. 1991;24(5 Pt 1):744–6.

    Article  CAS  PubMed  Google Scholar 

  37. Collins P, Ferguson J. Narrow-band UVB (TL-01) phototherapy: an effective preventative treatment for the photodermatoses. Br J Dermatol. 1995;132(6):956–63.

    Article  CAS  PubMed  Google Scholar 

  38. Les DY, Youn JI, Park MH, Chung JH. Actinic prurigo: limited effect of PUVA. Br J Dermatol. 1997;136(6):972–3.

    Article  Google Scholar 

  39. Estrada-G I, Garibay-Escobar A, Núñez-Vázquez A, Hojyo-Tomoka T, Vega-Memije E, Cortés-Franco R. Evidence that thalidomide modifies the immune response of patients suffering from actinic prurigo. Int J Dermatol. 2004;43(12):893–7.

    Article  CAS  PubMed  Google Scholar 

  40. Lane PR, Moreland AA, Hogan DJ. Treatment of actinic prurigo with intermittent short-course topical 0.05% clobetasol 17-propionate. A preliminary report. Arch Dermatol. 1990;126(9):1211–3.

    Article  CAS  PubMed  Google Scholar 

  41. Torres-Alvarez B, Castanedo-Cazares JP, Moncada B. Pentoxifylline in the treatment of actinic prurigo. A preliminary report of 10 patients. Dermatology. 2004;208(3):198–201.

    Article  CAS  PubMed  Google Scholar 

  42. Durán MM, Ordoñez CP, Prieto JC, Bernal J. Treatment of actinic prurigo in Chimila Indians. Int J Dermatol. 1996;35(6):413–6.

    Article  PubMed  Google Scholar 

  43. Umaña A, Gómez A, Durán MM, Porras L. Lymphocyte subtypes and adhesion molecules in actinic prurigo: observations with cyclosporin A. Int J Dermatol. 2002;41(3):139–45.

    Article  PubMed  Google Scholar 

  44. Ortiz-Castillo JV, Boto-de-Los-Bueis A, De-Lucas-Laguna R, Pastor-Nieto B, Pelaez-Restrepo N, Fonseca-Sandomingo A. Topical cyclosporine in the treatment of ocular actinic prurigo. Arch Soc Esp Oftalmol. 2006;81:661–4.

    Article  CAS  PubMed  Google Scholar 

  45. Crouch R, Foley P, Baker C. Actinic prurigo: a retrospective analysis of 21 cases referred to an Australian photobiology clinic. Australas J Dermatol. 2002;43(2):128–32.

    Article  PubMed  Google Scholar 

  46. Sunohara A, Mizuno N, Sakai M, Kawabe Y, Sakakibara S. Action spectrum for UV erythema and reproduction of the skin lesions in hydroa vacciniforme. Photodermatology. 1988;5(3):139–45.

    CAS  PubMed  Google Scholar 

  47. Gupta G, Man I, Kemmett D. Hydroa vacciniforme: a clinical and follow-up study of 17 cases. J Am Acad Dermatol. 2000;42(2 Pt 1):208–13.

    Article  CAS  PubMed  Google Scholar 

  48. Hirai Y, Yamamoto T, Kimura H, Ito Y, Tsuji K, Miyake T. Hydroa vacciniforme is associated with increased numbers of Epstein–barr virus–infected γδT cells. J Invest Dermatol. 2012;132(5):1401–8.

    Article  CAS  PubMed  Google Scholar 

  49. Wisuthsarewong W, Leenutaphong V, Viravan S. Hydroa vacciniforme with ocular involvement. J Med Assoc Thai. 1998;81(10):807–11.

    CAS  PubMed  Google Scholar 

  50. Collins P, Ferguson J. Narrow-band UVB “(TL-01) phototherapy: an effective preventative treatment for the photodermatosesBr”. J Dermatol. 1995;132(6):956–63.

    Article  CAS  Google Scholar 

  51. Jury CS, McHenry P, Burden AD, Lever R, Bilsland D. Narrowband ultraviolet B (UVB) phototherapy in children. Clin Exp Dermatol. 2006;31(2):196–9.

    Article  CAS  PubMed  Google Scholar 

  52. Jaschke E, Hönigsmann H. Hydroa vacciniforme – action spectrum UV-tolerance following photochemotherapy. Hautarzt. 1981;32(7):350–3.

    CAS  PubMed  Google Scholar 

  53. Sonnex TS, Hawk JLV. Hydroa vacciniforme: a review of ten cases. Br J Dermatol. 1988;118:101–8.

    Article  CAS  PubMed  Google Scholar 

  54. Lysell J, Wiegleb Edström D, Linde A, Carlsson G, Malmros-Svennilson J, Westermark A. Antiviral therapy in children with hydroa vacciniforme. Acta Derm Venereol. 2009;89(4):393–7.

    Article  CAS  PubMed  Google Scholar 

  55. Bruderer P, Shahabpour M, Christoffersen S, André J, Ledoux M. Hydroa vacciniforme treated by a combination of beta-carotene and canthaxanthin. Dermatology. 1995;190(4):343–5.

    Article  CAS  PubMed  Google Scholar 

  56. Bickers DR, Demar LK, DeLeo V, Poh-Fitzpatrick MB, Aronberg JM, Harber LC. Hydroa vacciniforme. Arch Dermatol. 1978;114(8):1193–6.

    Article  CAS  PubMed  Google Scholar 

  57. Rhodes LE, White SI. Dietary fish oil as a photoprotective agent in hydroa vacciniforme. Br J Dermatol. 1998;138(1):173–8.

    Article  CAS  PubMed  Google Scholar 

  58. Brauns B, Seitz CS, Schon MP, Mempel M. Sunlight Induced papulovesicular eruption in 8 year-old girl. J Dtsch Dermatol Ges. 2012;10(12):923–4.

    PubMed  Google Scholar 

  59. Creeke PI, Dibari F, Cheung E, van den Briel T, Kyroussis E, Seal AJ. Whole blood NAD and NADP concentrations are not depressed in subjects with clinical pellagra. J Nutr. 2007;137(9):2013–7.

    CAS  PubMed  Google Scholar 

  60. Piqué-Duran E, Pérez-Cejudo JA, Cameselle D, Palacios-Llopis S, García-Vázquez O. Pellagra: a clinical, histopathological, and epidemiological study of 7 cases. Actas Dermosifiliogr. 2012;103(1):51–8.

    Article  Google Scholar 

  61. Ruffin JM, Smith DT. Pellagra therapy. Trans Am Clin Climatol Assoc. 1939;55:192–205.

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Seal AJ, Creeke PI, Dibari F, Cheung E, Kyroussis E, Semedo P. Low and deficient niacin status and pellagra are endemic in postwar Angola. Am J Clin Nutr. 2007;85(1):218–24 [Erratum in: Am J Clin Nutr. 2009;89(4):1279].

    CAS  PubMed  Google Scholar 

  63. Goldberger J, Wariu CH, Willets DG. Nutrition classics from Public Health Reports. The prevention of pellagra. A test of diet among institutional inmates. Nutr Rev. 1973;31(5):152–3.

    Google Scholar 

  64. Okan G, Yaylaci S, Alzafer S. Pellagra: will we see it more frequently? J Eur Acad Dermatol Venereol. 2009;23(3):365–6.

    Article  CAS  PubMed  Google Scholar 

  65. Vannucchi H, Moreno FS. Interaction of niacin and zinc metabolism in patients with alcoholic pellagra. Am J Clin Nutr. 1989;50(2):364–9.

    CAS  PubMed  Google Scholar 

  66. Pellagra treated with tryptophan. [No authors listed]. Nutr Rev. 1987;45(5):142–8.

    Google Scholar 

  67. Comaish JS, Felix RH, McGrath H. Topically applied niacinamide in isoniazid-induced pellagra. Arch Dermatol. 1976;112(1):70–2.

    Article  CAS  PubMed  Google Scholar 

  68. Schulenburg-Brand D, Katugampola R, Anstey AV, Badminton MN. The cutaneous porphyrias. Dermatol Clin. 2014;32(3):369–84.

    Article  CAS  PubMed  Google Scholar 

  69. Holme SA, Anstey AV, Finlay AY, Elder GH, Badminton MN. Erythropoietic protoporphyria in the U.K.: clinical features and effect on quality of life. Br J Dermatol. 2006;155(3):574–81.

    Article  CAS  PubMed  Google Scholar 

  70. Alemzadeh R, Feehan T. Variable effects of beta-carotene therapy in a child with erythropoietic protoporphyria. Eur J Pediatr. 2004;163(9):547–9.

    Article  CAS  PubMed  Google Scholar 

  71. Tu JH, Sheu SL, Teng JM. Novel Treatment Using Cimetidine for Erythropoietic Protoporphyria in Children. JAMA Dermatol. 2016 Jul 13. Epub ahead of print.

    Google Scholar 

  72. Katugampola RP, Anstey AV, Finlay AY, Whatley S, Woolf J, Mason N, et al. A management algorithm for congenital erythropoietic porphyria derived from a study of 29 cases. Br J Dermatol. 2012;167(4):888–900.

    Article  CAS  PubMed  Google Scholar 

  73. Bruce AJ, Ahmed I. Childhood-onset porphyria cutanea tarda: successful therapy with low-dose hydroxychloroquine (Plaquenil). J Am Acad Dermatol. 1998;38(5 Pt 2):810–4.

    Google Scholar 

  74. Boffa MJ, Ead RD, Reed P, Weinkove C. A double-blind, placebo-controlled, crossover trial of oral vitamin C in erythropoietic protoporphyria. Photodermatol Photoimmunol Photomed. 1996;12(1):27–30.

    Article  CAS  PubMed  Google Scholar 

  75. Langendonk JG, Balwani M, Anderson KE, Bonkovsky HL, Anstey AV, Bissell DM, et al. Afamelanotide for Erythropoietic Protoporphyria. N Engl J Med. 2015;373(1):48–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Biolcati G, Marchesini E, Sorge F, Barbieri L, Schneider-Yin X, Minder EI. Long-term observational study of afamelanotide in 115 patients with erythropoietic protoporphyria. Br J Dermatol. 2015;172(6):1601–12.

    Article  CAS  PubMed  Google Scholar 

  77. Green JJ, Manders SM. Pseudoporphyria. J Am Acad Dermatol. 2001;44(1):100–8.

    Article  CAS  PubMed  Google Scholar 

  78. Mahon C, Purvis D, Laughton S, Bradbeer P, Teague L. Imatinib mesylate-induced pseudoporphyria in two children. Pediatr Dermatol. 2014;31(5):603–7.

    Article  PubMed  Google Scholar 

  79. Kwong WT, Hsu S. Pseudoporphyria associated with voriconazole. J Drugs Dermatol. 2007;6(10):1042–4.

    PubMed  Google Scholar 

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Huang, Y.Y.M., Hunt, R.D. (2017). Photosensitivity and Photoreaction. In: Teng, J., Marqueling, A., Benjamin, L. (eds) Therapy in Pediatric Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-43630-2_21

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