Evaluation of the Patient with Photosensitivity

  • Ann K. Haylett
  • Lesley E. Rhodes
Part of the Allergy Frontiers book series (ALLERGY, volume 4)

Photosensitivity encompasses a range of conditions characterised by altered sensitivity to solar ultraviolet (UV) and/or visible radiation. Photosensitivity disorders can be divided into four broad categories: (i) idiopathic/immune-based dermatoses; (ii) drug and chemically induced reactions, including exogenously mediated reactions and the cutaneous porphyrias; (iii) disorders associated with defects in DNA excision repair; (iv) photoaggravated dermatoses, a wide range of disorders that may be worsened by light exposure. Photosensitive individuals develop abnormal skin reactions following sunlight exposure, and these can be replicated by exposure to artificial light sources in the laboratory. Characterisation of the photosensitive patient includes clinical evaluation with detailed history including details of symptoms of onset and current medication. Phototesting, i.e. assessment of skin responses following application of defined wavelengths and doses of UVB, UVA and visible radiation provides information on the action spectrum of the disorder and permits clinical assessment of rash morphology. Associated tests including autoantibody screening, porphyrin fluorescence scanning and histocompatability locus antigen subtyping further assist in diagnosis.


Trospium Chloride Porphyria Cutanea Tarda Polymorphic Light Eruption Variegate Porphyria Erythropoietic Protoporphyria 
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.


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  1. 1.
    Ros AM, Wennersten G (1986) Current aspects of polymorphous light eruptions in Sweden. Photodermatol 3:298–302PubMedGoogle Scholar
  2. 2.
    Pao C, Norris PG, Corbett M, Hawk JL (1994) Polymorphic light eruption: prevalence in Australia and England. Br J Dermatol. 130:62–64PubMedCrossRefGoogle Scholar
  3. 3.
    Ling TC, Richards HL, Janssens AS, Anastassopoulou L, Antoniou C, Aubin F, Diepgen TL, Fazakerley R, de Gruijl FR, Jansen CT, Pavel S, Smedley A, Stratigos AJ, Webb AR, Gibbs NK, Rhodes LE (2006) Seasonal and latitudinal impact of polymorphic light eruption on quality of life. J Invest Dermatol 126:1648–1651PubMedCrossRefGoogle Scholar
  4. 4.
    Ling TC, Gibbs NK, Rhodes LE (2003) Treatment of polymorphic light eruption. Photodermatol Photoimmunol Photomed. 19:217–227PubMedCrossRefGoogle Scholar
  5. 5.
    Epstein S (1942) Studies on abnormal human sensitivity to light I V. Photoallergic concept of prurigo aestivalis. J Invest Dermatol 5:289–298Google Scholar
  6. 6.
    Norris PG, Hawk JL (1990) Polymorphic light eruption. Photodermatol Photoimmunol Photomed 7:186–191PubMedGoogle Scholar
  7. 7.
    Norris PG, Barker JN, Allen MH, Leiferman KM, MacDonald DM, Haskard DO, Hawk JL (1992) Adhesion molecule expression in polymorphic light eruption. J Invest Dermatol 99:504–508PubMedCrossRefGoogle Scholar
  8. 8.
    Kolgen W, Van Weelden H, Den Hengst S, Guikers KL, Kiekens RC, Knol EF, Bruijnzeel-Koomen CA, Van Vloten WA, de Gruijl FR (1999) CD11b + cells and ultraviolet-B-resistant CD1a + cells in skin of patients with polymorphous light eruption. J Invest Dermatol 113:4–10PubMedCrossRefGoogle Scholar
  9. 9.
    Palmer RA, Friedmann PS (2004) Ultraviolet radiation causes less immunosuppression in patients with polymorphic light eruption than in controls. J Invest Dermatol 122:291–294PubMedCrossRefGoogle Scholar
  10. 10.
    Millard TP, Bataille V, Snieder H, Spector TD, McGregor JM (2000) The heritability of polymorphic light eruption. J Invest Dermatol 115:467–470PubMedCrossRefGoogle Scholar
  11. 11.
    Rhodes LE (2004) Polymorphic light eruption reassessed. Arch Dermatol 140:351–352PubMedCrossRefGoogle Scholar
  12. 12.
    Hawk JL, Magnus IA (1979) Chronic actinic dermatitis — an idiopathic photosensitivity syndrome including actinic reticuloid and photosensitive eczema. Br J Dermatol 101(Suppl 17):24PubMedGoogle Scholar
  13. 13.
    Ferguson J (2006) Chronic actinic dermatitis. In: Ferguson J, Dover JS (eds) Photodermatology. Manson, London, pp. 39–43Google Scholar
  14. 14.
    Russell SC, Dawe RS, Collins P, Man I, Ferguson J (1998) The photosensitivity dermatitis and actinic reticuloid syndrome (chronic actinic dermatitis) occurring in seven young atopic dermatitis patients. Br J Dermatol 138:496–501PubMedCrossRefGoogle Scholar
  15. 15.
    Ogboli MI, Rhodes LE (2000) Chronic actinic dermatitis in young atopic dermatitis sufferers. Br J Dermatol 142:845PubMedCrossRefGoogle Scholar
  16. 16.
    Yap LM, Foley P, Crouch R, Baker C (2003) Chronic actinic dermatitis: a retrospective analysis of 44 cases referred to an Australian photobiology clinic. Australas J Dermatol 44:256–262PubMedCrossRefGoogle Scholar
  17. 17.
    Menage H du P, Ross JS, Norris PG, Hawk JLM, White IR (1995) Contact and photocontact sensitization in chronic actinic dermatitis: sesquiterpene lactone mix is an important allergen. Br J Dermatol 132:543–547PubMedCrossRefGoogle Scholar
  18. 18.
    Fujita M, Miyachi Y, Horio T, Imamura S (1990) Immunohistochemical comparison of actinic reticuloid with allergic contact dermatitis. J Dermatol Sci 1:289–296PubMedCrossRefGoogle Scholar
  19. 19.
    Menage H du P, Hawk JLM (1993) The red face: chronic actinic dermatitis. Clin Dermatol 11:297–305PubMedCrossRefGoogle Scholar
  20. 20.
    Brandt R (1958) Dermatological observations on the Navaho reservation. AMA Arch Derm 77:581–585PubMedGoogle Scholar
  21. 21.
    National Radiological Protection Board (2002) Health effects from Ultraviolet Radiation. Report of an advisory group on non-ionizing radiation. National Radiation Protection Board 13:162–190Google Scholar
  22. 22.
    Umana A, Gomez A, Duran MM, Porras L (2002) Lymphocyte subtypes and adhesion molecules in actinic prurigo: observations with cyclosporin A. Int J Dermatol 41:139–145PubMedCrossRefGoogle Scholar
  23. 23.
    Arrese JE, Dominguez-Soto L, Hojyo-Tomoka MT, Vega-Memije E, Cortes-Franco R, Guevara E, Pierard GE (2001) Effectors of inflammation in actinic prurigo. J Am Acad Dermatol 44:957–961PubMedCrossRefGoogle Scholar
  24. 24.
    Grabczynska SA, McGregor JM, Kondeatis E, Vaughan RW, Hawk JL (1999) Actinic prurigo and polymorphic light eruption: common pathogenesis and the importance of HLA-DR4/ DRB1*0407. Br J Dermatol 140:232–236PubMedCrossRefGoogle Scholar
  25. 25.
    Frain-Bell W. (1985) The idiopathic photodermatoses. In: Frain-Bell W (eds) Cutaneous Photobiology. Oxford University Press, Oxford, pp 24–59Google Scholar
  26. 26.
    Rose RF, Bhushan M, King CM, Rhodes LE (2005) Solar angioedema: an uncommonly recognized condition? Photodermatol Photoimmunol Photomed 2005 21:226–228CrossRefGoogle Scholar
  27. 27.
    Beattie P (2006) Solar Urticaria. In Ferguson J. and Dover JS. (eds) Photodermatology. Manson Publishing, London, pp 45–50Google Scholar
  28. 28.
    Miyauchi H, Horio T (1995) Detection of action inhibition and augmentation spectra in solar urticaria. Dermatol 191:286–291CrossRefGoogle Scholar
  29. 29.
    Hawk JLM, Eady RAJ, Challoner AVJ, Kobza-Black A, Keahey TM, Greaves MW (1980) Elevated blood histamine levels and mast cell degranulation in solar urticaria. Br J Clin Pharmacol 9:183–186PubMedGoogle Scholar
  30. 30.
    Soter NA, Wasserman SI, Pathak MA, Parish JA, Austen KF (1979) Solar urticaria release of mast cell mediators into the circulation after experimental challenge. J Invest Dermatol 72:282Google Scholar
  31. 31.
    Rajka E (1942) Passive transfer in light urticaria. Clin Immunol 13:327–345Google Scholar
  32. 32.
    Leenutaphong V, Holzle E, Plewig G (1989) Pathomechanisms and classification of solar urticaria: a new concept. J Am Acad Dermatol 21:237–240PubMedCrossRefGoogle Scholar
  33. 33.
    Horio T, Hoelzle E (2007) Solar urticaria In: Lim HW, Hoenigsmann H, Hawk JLM (eds) Photodermatology. Informa Healthcare, New YorkGoogle Scholar
  34. 34.
    Magana M, Sangueza P, Gil-Beristain J, Sanchez-Sosa S, Salgado A, Ramon G, Sangueza OP (1998) Angiocentric cutaneous T-cell lymphoma of childhood (hydroa-like lymphoma): a distinctive type of cutaneous T-cell lymphoma. J Am Acad Dermatol 138:574–579CrossRefGoogle Scholar
  35. 35.
    Iwatsuki K, Xu Z, Takata M, Iguchi M, Ohtsuka M, Akiba H, Mitsuhashi Y, Takenoshita H, Sugiuchi R, Tagami H, Kaneko F (1999) The association of latent Epstein-Barr virus infection with hydroa vacciniforme. Br J Dermatol 140:715–721PubMedCrossRefGoogle Scholar
  36. 36.
    Halasz CL, Leach EE, Walther RR, Poh-Fitzpatrick MB (1983) Hydroa vacciniforme: induction of lesions with ultraviolet A. J Am Acad Dermatol 8:171–176PubMedCrossRefGoogle Scholar
  37. 37.
    Rhodes LE, White SI, (1998) Dietary fish oil as a photoprotective agent in hydroa vaccini-forme. Br J Dermatol 138:173–178PubMedCrossRefGoogle Scholar
  38. 38.
    Elder GH (1999) The cutaneous porphyrias. In: Hawk JLM (ed) Photodermatology. Arnold, London, pp 171–197Google Scholar
  39. 39.
    Stenson PD, Ball EV, Mort M, Phillips AD, Shiel JA, Thomas NS, Abeysinghe S, Krawczak M, Cooper DN (2003) Human Gene Mutation Database (HGMD): 2003 update. Hum Mutat 21:577–581PubMedCrossRefGoogle Scholar
  40. 40.
    Elder GH. (1990) The cutaneous porphyrias. Semin Dermatol 9:63–69PubMedGoogle Scholar
  41. 41.
    Nacht S, San Martin de Viale LC, Grinstein M (1970) Human porphyria cutanea tarda. Isolation and properties of the urinary porphyrins. Clin Chim Acta 27:445–452PubMedCrossRefGoogle Scholar
  42. 42.
    Korda V, Deybach JC, Martasek P, Zeman J, da Silva V, Nordmann Y, Houstkova, H, Rubin A, Holub J (1984) Homozygous variegate porphyria. Lancet 1:851PubMedCrossRefGoogle Scholar
  43. 43.
    Gould JW, Mercurio MG, Elmets CA (1995) Cutaneous photosensitivity diseases induced by exogenous agents. J Am Acad Dermatol 33:551–573PubMedCrossRefGoogle Scholar
  44. 44.
    Moore DE (2002) Drug induced cutaneous photosensitivity Incidence Mechanism Prevention and Management. Drug Safety 25:345–372PubMedCrossRefGoogle Scholar
  45. 45.
    Ibbotson SH, Farr PM, Beck MH, Diffey BL, Ferguson J, George SA, Green C, Du P, Menage H, Murphy GM, Norris PG, Rhodes LE, White IR (1997) Workshop Report. Photopatch testing; methods and indications. Br J Dermatol 136:371–376CrossRefGoogle Scholar
  46. 46.
    Kraemer KH, Lee MM. Scotto J (1987) Xeroderma Pigmentosum. Cutaneous ocular and neurological abnormalities in 830 published cases. Arch Dermatol 123:241–250PubMedCrossRefGoogle Scholar
  47. 47.
    Johnson RE, Kondratick CM, Prakash S, Prakash L (1999) hRAD30 mutations in the variant form of xeroderma pigmentosum. Science 285:263–265PubMedCrossRefGoogle Scholar
  48. 48.
    Norris PG, Lehmann AR (1999) The repair deficient photodermatoses. In: Hawk JML (ed) Photodermatology. Arnold, LondonGoogle Scholar
  49. 49.
    Nance MA, Berry SA (1992) Cockayne syndrome: review of 140 cases. Am J Med Genet 42:68–84PubMedCrossRefGoogle Scholar
  50. 50.
    Deng JS, Sontheimer RD, Gilliam JN (1984) Relationships between antinuclear and anti-Ro/SS-A antibodies in subacute cutaneous lupus erythematosus. J Am Acad Dermatol 11:494–499PubMedCrossRefGoogle Scholar
  51. 51.
    Werth VP, Honigsmann H (2007) Photoaggravated dermatoses. In: Lim HW Honigsmann H, Hawk JLM (eds) Photodermatology. Informa Healthcare, New York, pp 251–266Google Scholar
  52. 52.
    Sanders CJ, Van Weelden H, Kazzaz GA, Sigurdsson V, Toonstra J, Bruijnzeel-Koomen CA (2003) Photosensitivity in patients with lupus erythematosus: a clinical and photobiological study of 100 patients using a prolonged phototest protocol. Br J Dermatol 149:131–137PubMedCrossRefGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Ann K. Haylett
    • 1
  • Lesley E. Rhodes
    • 1
  1. 1.Photobiology Unit, Dermatological SciencesUniversity of Manchester, Salford Royal Foundation HospitalStott LaneUK

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