Polymorphic Light Eruption Research Articles

Chronic actinic dermatitis as a diagnostic clue for Adult T-cell leukemia/lymphoma

Chronic actinic dermatitis as a diagnostic clue for Adult T-cell leukemia/lymphoma

Exploring Preventive Measures and Disease Dynamics of Hereditary Polymorphic Light Eruption in American Indian Children

Hereditary polymorphic light eruption (HPLE) is a condition related to polymorphic light eruption (PLE). Unlike PLE, HPLE is unique to American Indian populations demonstrating autosomal dominant inheritance pattern with incomplete penetrance. Affected individuals possess hypersensitivity to long UV radiation, which heightens the risk for skin damage. Onset is typically childhood and disease severity results in complications including psychosocial trauma, streptococcal pyoderma, and glomerulonephritis. HPLE can be difficult to diagnose due to its overlapping qualities with other conditions, underscoring the importance of accurate diagnosis and management. Preventive measures play critical roles in mitigating disease occurrence and complications. Literature analysis of five articles using PubMed and Google was conducted to understand HPLE among the Native American community, particularly children. Search terms included hereditary polymorphic light eruption, Native Americans, American Indians, polymorphic light eruption, actinic prurigo, UV toxicity, and photosensitivity. Literature delineated the disease process of HPLE and preventive measures. Studies revealed a higher incidence among children/adolescents who presented with rashes within two hours of sun exposure. Rash severity increased as seasons progressed to summertime. It is imperative that affected individuals utilize broad spectrum coverage sunscreen, covering UVA and UVB rays. Other measures proven to be effective include protective clothing, limiting time outdoors during peak sun hours, and using specially formulated lip balm. HPLE creates a unique challenge among American Indian populations necessitating increased awareness and educational strategies to minimize and avoid complications. Providing education on prevention and actively implementing measures can help decrease the complications of HPLE and increase quality of life.

Photopatch testing: Clinical characteristics, test results, and final diagnoses from the North American Contact Dermatitis Group, 2009-2020.

Photoallergic contact dermatitis (PACD) is a delayed hypersensitivity reaction to allergens only in the presence of ultraviolet radiation in sunlight. Photopatch testing (PhotoPT) is necessary to confirm the diagnosis of PACD. There are few published studies of PhotoPT in North America. To summarise the results of patients photopatch tested by members of the North American Contact Dermatitis Group (NACDG), 2009-2020. Retrospective analysis of patient characteristics and PhotoPT results to 32 allergens on the NACDG Photopatch Test Series. Most of the 454 tested patients were female (70.3%), 21-60 years old (66.7%) and White (66.7%). There were a total of 119 positive photopatch tests. Sunscreen agents comprised 88.2% of those, with benzophenones responsible for over half of them. Final diagnoses included PACD in 17.2%, allergic contact dermatitis (ACD) in 44.5%, polymorphous light eruption (PMLE) in 18.9% and chronic actinic dermatitis (CAD) in 9.0% of patients. In 454 patients with suspected photosensitivity referred for photopatch testing in North America, approximately one-fifth had PACD. Sunscreen agents, especially benzophenones, were the most common photoallergens. Other common diagnoses included ACD, PMLE and CAD. Photopatch testing is an important tool for differentiating these conditions.

Efficacy and safety of azathioprine versus mycophenolate mofetil in chronic actinic dermatitis in skin of color: results of a randomized controlled trial.

Chronic actinic dermatitis (CAD) is an immunologically mediated photodermatosis that has been effectively treated with azathioprine and mycophenolate mofetil (MMF) in uncontrolled studies. We conducted a prospective randomized controlled trial to compare the efficacy and safety of azathioprine and MMF in CAD treatment, aiming to address existing evidence gaps. Consecutive CAD patients were randomized into two groups: azathioprine (Group A) or MMF (Group B) for 12 weeks. Primary outcomes included Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI) at baseline and Week 12. Secondary outcomes included various clinicodemographic factors predictive of treatment response, defined at least a 75% reduction in EASI score (EASI75) by Week 12. The median (IQR) percentage reduction in EASI at 12 weeks was higher in Group B than in Group A [78.3% (75.0-83.30%) vs. 68.3% (31.2-80.10%), P = 0.034]. Baseline DLQI scores indicated a moderate impact on quality of life, with significant reductions by Week 12 in both groups and no intergroup differences at baseline (P = 0.291) or Week 12 (P = 0.599). Overall, 23 patients were classified as non-responders, with more extended illness duration (P = 0.026) and outdoor occupations (P = 0.042) associated with poorer responses. Adverse effects were consistent with known profiles, with one patient discontinuing azathioprine due to hypersensitivity. Our study highlights the efficacy and safety of azathioprine and MMF in CAD treatment, with MMF showing superior outcomes. However, further research is warranted to explore emerging therapies and prognostic factors in CAD management.

Continuum of light sensitivity in atopic dermatitis: A retrospective analysis of 139 cases in Scotland

BackgroundPrevious reports have characterized photosensitivity in atopic dermatitis (AD), but with differences in terminology and criteria. ObjectiveThis study aims to assess outcomes in 139 AD patients referred for photodiagnostic testing and to establish diagnostic criteria for photosensitivity in AD. MethodsClinical and photodiagnostic data were reviewed, categorizing photosensitivity into Photo-Exacerbated AD (PEAD), Photo-Sensitive AD (PSAD), and Chronic Actinic Dermatitis (CAD). ResultsOf the patient cohort, mean age was 42.6±16.7 years and 61.9% were male. PEAD patients (51.1%) had normal monochromator phototesting. PSAD patients (7.9%) displayed slight-to-moderate UVA sensitivity (≥30% of normal minimal erythema dose [MED]) and mostly normal/slightly reduced UVB MEDs (≥80% of normal MED). Conversely, 41% of patients had CAD and 93% of this group demonstrated significant UVB sensitivity, with very low UVB MEDs (<80% of normal MED) and/or very low UVA MEDs (<30% of normal MED). No significant differences in sex, age, or skin phototype were observed between groups. Serial phototesting revealed changes in photosensitivity status over time in eight patients. LimitationsSmall sample size and retrospective design. ConclusionsThis study highlights the heterogeneity of photosensitivity patterns in AD patients and the importance of follow-up assessments due to potential shifts in disease spectrum over time.

Chronic actinic dermatitis

Chronic actinic dermatitis (CAD) is a chronic immune-mediated photo-dermatosis causing pruritic eczematous lesions, infiltrated lichenified papules,and plaques on sunexposed skin. It commonly affects elderly males who are chronically exposed to sunlight. The photosensitivity is mostly to ultraviolet (UV) B wavelengths and less frequently to ultraviolet (UV)A and visible light. In this article, the pathogenesis, clinical features, investigations, and treatment of CAD will be discussed.

Polymorphous light eruptions

Polymorphous light eruption (PMLE) is the most common, immunologically acquired photo-dermatosis due to delayed hypersensitivity reaction to sunlight. It presents with recurrent, pruritic, non-scarring lesions of distinct morphology affecting the sun-exposed body parts. This review article focuses on immunopathogenesis, clinical features, and treatment option of PMLE.

Actinic Reticuloid: A Literature Review of a Case

Actinic reticuloid is a chronic inflammatory skin condition that primarily affects elderly individuals and is associated with chronic sun exposure. It is characterized by the presence of papules, plaques, and fine lines that form a reticular pattern on sun-exposed areas, such as the face, neck, and extremities. Histologically, lichenification and dermal alterations are observed, suggesting a chronic response to sun exposure. Actinic reticuloid is often diagnosed clinically, but confirmation may require a skin biopsy. Managing this condition involves measures to protect the skin from the sun, such as the use of sunscreens and protective clothing. Topical and systemic treatments, such as corticosteroids and ultraviolet light therapy, may also be beneficial in some cases. Although the actinic reticuloid is not malignant, its chronic course and the aesthetic changes it produces can have a significant impact on patients' quality of life. Therefore, it is important for doctors to properly recognize and manage this condition in order to provide effective relief to affected patients.

Polymorphic light eruption

Polymorphic light eruption

Eradication of skin microbiota restores cytokine production and release in polymorphic light eruption.

Polymorphic light eruption (PLE) has been mechanistically linked to cytokine abnormalities. Emerging preclinical evidence posits the skin microbiome as a critical modulator of ultraviolet (UV)-induced cytokine expression, thereby influencing subsequent immune responses. This intricate relationship remains underexplored in the context of PLE. Hence, we investigated the differential responses between disinfected and non-disinfected skin following both single and repetitive exposures to solar-simulated UV radiation in patients with PLE. An experimental, half-body pilot study was conducted involving six PLE patients and 15 healthy controls. Participants' skin was exposed to single and multiple doses of solar-simulated UV radiation, both in disinfected and in non-disinfected skin areas. The co-primary outcomes were PLE score and cytokine expression in blister fluid analysed through OLINK proteomic profiling. Secondary outcomes were erythema, pigmentation, induction of apoptotic cells in vacuum-generated suction blisters, and density of infiltrate in skin biopsies of PLE patients. Among the 71 cytokines analysed, baseline expression levels of 20 specific cytokines-integral to processes such as apoptosis, inflammation, immune cell recruitment, cellular growth, and differentiation-were significantly impaired in PLE patients compared with healthy controls. Notably, skin disinfection reversed the observed cytokine imbalances following a single UV exposure at the minimal erythema dose (MED) level and exhibited even more pronounced effects after multiple UV exposures. However, no significant differences were evident in PLE score, erythema, pigmentation, or rates of apoptotic cell induction upon UV radiation. These findings provide evidence for UV-driven cytokine regulation by the skin microbiota and imply microbiome involvement in the PLE immune response.

Tofacitinib: A Treatment Option for Recalcitrant Polymorphic Light Eruption and Its Mechanistic Rationale.

Background: Polymorphous light eruption is largely characterized by a delayed-type (type IV) hypersensitivity reaction to 1 or more undefined endogenous ultraviolet-induced skin antigens. Objectives: To evaluate the efficacy of tofacitinib in refractory cases of polymorphous light eruption. Methods: Seven patients who had failed multiple systemic treatments or relapsed within 2 weeks of existing systemic agents with concomitant photoprotection were offered tofacitinib after written consent. Results: Initiation of tofacitinib led to a marked reduction of itching (mean ± SD 3.1 ± 1.12 days) followed by clinical resolution (mean ± SD 2.6 ± 1.1 weeks). The duration of therapy ranged from 1 to 3 months (mean ± SD 2 ± 0.63 months), and 4 of 7 patients had a recurrence in 5.5 weeks and were again initiated on tofacitinib with a prompt response. Conclusion: Tofacitinib inhibits Janus kinase (JAK)1 and JAK3 thus it can abrogate the effects of the predominant cytokine milieu of polymorphic light eruption (PMLE) and thus reduce the expression of aberrant inflammatory T lymphocyte expression in PMLE.

Unveiling ferroptosis: a new frontier in skin disease research.

Ferroptosis, a form of regulated cell death distinct from apoptosis, necrosis, and autophagy, is increasingly recognized for its role in skin disease pathology. Characterized by iron accumulation and lipid peroxidation, ferroptosis has been implicated in the progression of various skin conditions, including psoriasis, photosensitive dermatitis, and melanoma. This review provides an in-depth analysis of the molecular mechanisms underlying ferroptosis and compares its cellular effects with other forms of cell death in the context of skin health and disease. We systematically examine the role of ferroptosis in five specific skin diseases, including ichthyosis, psoriasis, polymorphous light eruption (PMLE), vitiligo, and melanoma, detailing its influence on disease pathogenesis and progression. Moreover, we explore the current clinical landscape of ferroptosis-targeted therapies, discussing their potential in managing and treating skin diseases. Our aim is to shed light on the therapeutic potential of modulating ferroptosis in skin disease research and practice.

A case of allergic contact dermatitis presented with acquired vitiligo-like depigmentation developed persistent light reactivity: Unforeseen entity

Abstract Chemical leukoderma is an acquired depigmentary skin disorder, caused by repeated exposure to specific chemical compounds or secondarily to allergic contact dermatitis or through direct toxic effects, sharing similar clinical and histological features with vitiligo. We report a case of widespread allergic contact dermatitis with chemical leukoderma which later became a persistent light reactor.

Polymorphic light eruption-like lesions in association with cutaneous leishmaniasis – is it a unique leishmanid reaction in &lt;em&gt;Leishmania donovani&lt;/em&gt; cutaneous leishmaniasis in Sri Lanka?

Cutaneous leishmaniasis (CL) in Sri Lanka is caused by Leishmania donovani species, which usually causes visceral leishmaniasis in neighboring countries. We report a case series of 54 patients with cutaneous leishmaniasis from Anuradhapura, Sri Lanka, with associated polymorphic light eruption (PMLE) like lesions. As these PMLE-like lesions show characteristic features of an id reaction, we propose that this could be a leishmanid reaction. To date, PMLE-like leishmanid reactions are not reported in association with other leishmania species. Therefore, we suspect that PMLE-like leishmanid reaction could be a unique association of Leishmania donovani CL that occur in Sri Lanka.

Improvement of Refractory Chronic Actinic Dermatitis During Tofacitinib Treatment.

Wang, Ying-Jun MM1,2; Hui, Hai-Zhen MM1,2; Cheng, Jia-Rong MM1,2; Mao, Han MM1,2; Diao, Qing-Chun MD1; Shi, Bing-Jun MD1 Author Information

Summer and spring elbow rashes is a variant of polymorphous light eruption: confirmation by photoprovocation and histopathology in a series of five cases.

Summer and spring eruptions on the elbows are a variant of polymorphous light eruption described on clinical and histopathological grounds; however, to our knowledge, they have not been confirmed by photobiological studies. Based on photobiological studies, this study aimed to demonstrate the involvement of ultraviolet-A (UVA) radiation in this variant of polymorphous light eruption occurring exclusively on the elbows. A series of five patients with polymorphous light eruption lesions on the elbows were included in our study. All patients underwent phototesting and photoprovocation of the skin lesions after exposure to a UVA light source [Philips UVA HPA lamp (400 W)]. All patients underwent punch biopsy and histopathological and immunohistochemical studies with anti-CD123. In all the cases, UVA irradiation caused the appearance of skin lesions on the elbows with characteristic polymorphous light eruption. Histological data showed edema in the superficial dermis and a perivascular lymphocytic infiltrate compatible with polymorphous light eruption. Immunohistochemical staining for CD1-23 showed negative results. For the first time, photobiological photoprovocation studies demonstrated that repeated exposure to UVA radiation leads to the generation of skin lesions on the elbows, which are clinically and histologically consistent with summer and spring eruptions, confirming that elbow rash is a variant of polymorphous light eruption.

Clinico-dermoscopic study of inflammatory dermatoses: a hospital based cross sectional study

Dermoscopy is a noninvasive, fast, and reliable diagnostic technique used to magnify and visualize structures on and beneath the skin surface which is difficult to observe by naked eyes, creating a link between macroscopic clinical dermatology and microscopic dermatopathology. The purpose of this study is to evaluate and compare the dermoscopic features of common inflammatory dermatological conditions of skin sharing similar clinical presentation according to the available literature data. All dermoscopic findings were studied using a handheld pocket dermoscopy (Dermlite DL1) with high magnification. Variables used for dermoscopic evaluation were divided into vascular and nonvascular features and specific clues. Descriptive analysis and Chi square test were used where appropriate and p &lt; 0.05 was considered statistically significant. There were a total of 205 patients enrolled in the study. The most common clinical diagnosis was psoriasis seen in 42.0%, lichen planus in 13.0%, contact dermatitis in 12.0%, polymorphic light eruption 7.0%, seborrheic dermatitis 4.0%, discoid lupus erythematosus 5.0%, pityriasia Rosea 5.0%, urticaria 5.0% and others 7.0%. Dermoscopic vascular changes were seen as regular in 52.0% and irregular in 46.0%. The most common type of vessels observed were dotted in 70.0%, linear in 7.0%, and coiled in 2.0%. Non-vascular changes were seen in 61.0%. The commonest type of scales were whitish scales seen in 63.0%. Pigmentary changes were seen in 19.0%. The commonest type of vessels observed were dotted vessels (p value 0.000) in most inflammatory diseases. Features like wickham striae were characteristic of lichen planus (p value 0.000). The characteristic dermoscopic features of various inflammatory disorders with the help of a dermoscope is easy to perform in outpatient without any invasive method and also helpful in guiding management of the patients with follow-up.

Deficiency of N6-Methyladenosine Demethylase ALKBH5 Alleviates Ultraviolet B Radiation-Induced Chronic Actinic Dermatitis via Regulating Pyroptosis.

Pyroptosis is an inflammatory programmed cell death (PCD) and is reported to be associated with N6-methyladenosine (m6A) modification. This study aimed to investigate the mechanism of m6A demethylase AlkB homolog 5 (ALKBH5) in pyroptosis in the process of chronic actinic dermatitis (CAD). Changes of m6A-related genes were evaluated between CAD and normal samples using quantitative reverse-transcription polymerase chain reaction (qRT-PCR). Human keratinocytes (HaCaT cells) exposed to ultraviolet B (UVB; 10, 20, and 30mJ/cm2), followed by evaluation of cell proliferation, cell apoptosis, inflammatory cytokines (interleukin (IL)-1β, IL-18, and tumor necrosis factor (TNF-α)), and pyroptosis-related proteins (gasdermin D (GSDMD), Caspase-1, and Caspase-4). Small interfering RNA (siRNA) targeting ALKBH5 was transfected into HaCaT cells to assess the effect of si-ALKBH5 on CAD. A CAD mice model was induced after exposure to UVB (250mJ/cm2 per day) to confirm the role of ALKBH5 in CAD. AKKBH5 was highly expressed in CAD patients. UVB also promoted ALKBH5 expression, increased cell apoptosis, and induced the release of inflammatory cytokines (IL-1β, IL-18, and TNF-α) as well as pyroptosis-related proteins (GSDMD, Caspase-1, and Caspase-4). Silencing ALKBH5 repressed cell apoptosis and suppressed UVB-induced pyroptosis and inflammatory response. Meanwhile, silencing ALKBH5 attenuated UVB-induced skin damage of CAD mice, accompanied with the reduction in expression of inflammatory cytokines and pyroptosis-related proteins. This study helps to further understand the mechanism of ALKBH5 in CAD-induced pyroptosis and provides novel ideas for the research and management of CAD.

Could red and near-infrared emitting fabric technology improve the severity of psoriasis, polymorphous light eruption, and alopecia areata?

AimLow-level light therapy (LLLT) may offer an adjunctive therapeutic tool for inflammatory skin conditions. This pilot study assessed the efficacy of a red/near-infrared (NIR)-emitting fabric for psoriasis, polymorphous light eruption (PMLE), and alopecia areata (AA).MethodsFourteen patients (five with psoriasis, five with PMLE, and four with AA) were instructed to wear a red/NIR-emitting (Lumiton®) garment during the 12-week study. Efficacy was assessed subjectively by patient-reported improvement and objectively by the redness, thickness, and scale of elbow psoriasis plaques, the frequency of PMLE flares, and the Severity of Alopecia Tool (SALT) score.ResultsThree patients with psoriasis completed the study while two self-discontinued. The three patients who completed the study noted improvement and two had improvements in lesion redness, thickness, or scale, while one was clinically stable. Three patients with PMLE completed the study, and none had a disease flare during the study period. Three patients with AA completed the study: two reported disease improvement and all three had an improved SALT score.ConclusionUse of a wellness apparel that emits red and NIR light may be associated with improved disease severity in patients with mild elbow psoriasis, PMLE, and limited AA. Limitations of this study include continuation on topical, intralesional, or systemic medications and small sample size.

Role of interleukin-36γ induced by ultraviolet radiation in chronic actinic dermatitis.

Chronic actinic dermatitis (CAD) is an immune-mediated photodermatosis characterized by a high eosinophil count and total immunoglobulin E (IgE) in the peripheral blood of patients. At present, however, the reasons for their elevation remain unclear. The current study aimed to detect changes in inflammatory cytokines in CAD and explore their role in this disease. Enzyme-linked immunosorbent assay and Luminex assay were conducted to measure inflammatory factor levels. Immunohistochemical analysis and quantitative real-time polymerase chain reaction were performed to evaluate the expression levels of interleukin-36γ (IL-36γ), IL-8, chemokine (C-C motif) ligand 17 (CCL17), and CCL18. CCK8 kits were used to assess cell proliferation. Immunofluorescence was used to detect nuclear factor κB (NF-κB) p65 nuclear translocation. Western blot analysis was performed to detect the protein expression level of phosphorylated NF-κB (p-NF-κB) p65. Hematoxylin and eosin and Masson trichrome staining were applied to observe histological changes in a chronic photo-damaged mouse model. Eosinophils, total IgE, IL-36γ, IL-8, tumor necrosis factor α, CCL17, and CCL18 were elevated in CAD. Of note, IL-36γ promoted the proliferation of eosinophilic cells (EOL-1) and the production of IgE in peripheral blood mononuclear cells. IL-36γ also promoted the production of IL-8 and CCL18 in immortalized human keratinocytes (HaCaT cells), while ultraviolet radiation (UVR)-induced IL-36γ via activation of the NF-κB signaling pathway. IL-36γ was involved in the pathogenesis of CAD and UVR contributed to the production of IL-36γ, which may provide a novel therapeutic target for CAD.