Polymorphic Light Eruption Research Articles

A clinico-epidemiological study of hypopigmented and depigmented lesions in paediatric age group

Hypopigmentary and depigmentary lesions are very commonly encountered group of dermatosis in pediatric age group.: To evaluate the epidemiology and clinical characteristics of various hypopigmented and depigmented lesions in patient of paediatric age group. : A total number of 124 children between age group 0-18 years who presented to dermatology OPD with hypopigmented and depigmented lesions were assessed and evaluated.: In this study, most common causes of hypopigmented disorders among the children are Pityriasis Alba (25.7%) followed by Pityriasis versicolor(21.96), Polymorphous light eruption & vitiligo. Pigmentary disorders are very commonly encountered group of dermatoses in paediatric age group. Among pigmentary disorders, hypopigmented lesions are more common and are frequent cause of consultation. In this study most common causes of hypopigmented disorders among the children are Pityriasis Alba followed by Pityriasis versicolor, Polymorphous light eruption & vitiligo.

A Clinicopathological Study of Polymorphous Light Eruption

Background: Polymorphous light eruption (PLE) is the most common idiopathic photodermatoses, with a wide range of clinical presentations that tends to mimic a number of dermatoses. Objective: The aim was to study the clinicopathological profile in patients diagnosed with PLE. Materials and Methods: This was a cross-sectional, descriptive study of seventy clinically diagnosed cases of PLE over a period of 1 year, wherein following patient enrolment, they underwent a thorough clinical evaluation, followed by a skin biopsy that was studied categorically. Results: A male preponderance (62.8%) was observed. Majority of patients were in the 21-30 years’ age group (28.6%). Pruritus was witnessed in 98.5% of patients. The most common morphological type encountered was plaque PLE (35.7%), followed by lichen nitidus type (11.4%). Commonest site of involvement was sides and back of neck (75.7%), followed by dorsolateral aspect of both arms (31.4%). Hyperkeratosis was identified in 82.8%, spongiosis in 87.1%, liquefactive degeneration of basal cell layer in 82.8%, atrophy in 24.2%, and moderate-to-severe lymphocytic dermal infiltrates in 90% of our cohorts. Conclusion: PLE is a disorder with diverse clinical presentations, manifesting usually in the third decade of life that closely mimics a variety of other cutaneous disorders. Histological examination with certain specific criteria enables the clinician to arrive at a concrete conclusion in those cases where clinical findings alone pose diagnostic difficulties.

PD14 Audit of urgent phototherapy referrals

Abstract The British Association of Dermatologists’ (BAD) phototherapy guidelines state that patients referred urgently for phototherapy should start treatment within 3 weeks of referral and that if the patient is considered to require treatment urgently, then it should be started as soon as possible, to reduce patient discomfort and avoid the need for hospital admission. The prepandemic waiting time for urgent referrals, according to an audit in March 2021, was 6 weeks, but this time was even longer postpandemic. During the COVID-19 pandemic lockdown, the phototherapy service was suspended and then resumed in reduced capacity in our unit. The pandemic is also likely to have affected disease severity and patient’s concerns about treatment with systemic options. Our audit objective was to identify the time taken between referral to treatment start time for urgent referrals. Secondary objectives were to identify whether there was any prevalence of certain disease categories in deciding upon urgent referrals, and to identify if severity assessment scores were checked prior to urgent referrals by referring clinicians as per local guidelines. The audit was conducted retrospectively by including all urgent phototherapy referrals for 6 months between January and June 2022. Sixty-four urgent referral forms were analysed. The time taken between referral to treatment start time was 12 months. The majority of the urgent referrals (73%) were for eczema, 16% for psoriasis and 5% for mycosis fungoides. Other conditions such as polymorphic light eruptions, lichen planus and macular amyloidosis totalled 6% of referrals. Only 26% of referrals had documented disease severity scores. Thirty per cent of the referrals were < 18 years of age; young adults (19–25 years) accounted for 19% of referrals. Time taken between referral to treatment start time was 12 months, which significantly exceeded BAD standards. A number of factors affected this, including the impact of the COVID-19 lockdown on services and treatment capacity, patient choices and escalation of disease severity in lockdown, increased referrals with severe skin disease, preference in certain age groups such as children, and psychosocial factors. Patients with severe skin disease needing urgent treatment should be carefully triaged to receive treatment urgently, to avoid admission. Clinicians should assess this appropriately on a case-by-case basis and document disease severity scores and impact of skin disease in all urgent referrals.

P13 A rare case of Sjögren syndrome in a White woman with Kikuchi–Fujimoto disease

Abstract A 36-year-old White woman was seen in May 2022 for a rash on her upper back, shoulders, cheeks, forehead and extensor surfaces of the upper limbs. It had developed following sun exposure on the beach despite regularly applying SPF50. Over time, the rash became sore but exhibited no signs of vesicles or oozing. Of note, the patient had been recently diagnosed with Kikuchi–Fujimoto disease (KFD) following a lymph node biopsy. She gave history of Raynaud phenomenon since childhood, and arthralgia primarily affecting the small joints of hands. She also experienced episodic dry eyes, dry mouth, peripheral oedema, dyspnoea, abdominal pain and constipation. For the previous month, she had felt fatigued with some undocumented weight loss. Clinical examination revealed an erythematous rash with discrete nonblanching macules and plaques of varying sizes, oval-to-circular in shape, on the involved areas. Lymph nodes were not palpable. Differential diagnosis included cutaneous lupus, other connective tissue disorders, and—less likely—polymorphic light eruption. Skin biopsy showed focal compact hyperkeratosis and parakeratosis with focal subtle spongiosis, intraepidermal neutrophils and lymphocyte exocytosis, with the presence of perivascular and periappendageal chronic inflammation. There was mild basement membrane thickening with focal deposition of fibrinogen at the basement membrane zone on direct immunofluorescence. She was positive for anti-Ro antibodies, with a titre of 84 kU L−1 (normal < 11 kU L−1). A diagnosis of Sjögren syndrome with KFD was made. The patient was advised on photoprotection with a high-potency topical steroid, and referred to rheumatology for review of her joint problems. After 4 weeks, the patient had only some improvement with topical therapy and was started on oral hydroxychloroquine. At the 12-week follow-up, there was significant improvement. Her skin was clear, with improvement in joint pain and fatigue. KFD, also known as necrotizing lymphadenitis, is a benign and self-limited disorder, characterized by regional cervical lymphadenopathy with tenderness, usually accompanied with mild fever and night sweats. Rarely, the skin and joints are involved. There is an established association between KFD and connective tissue disorders, especially Sjögren syndrome (Gates GA, Li Y, Magyar C, Sarantopoulos GP. Kikuchi–Fujimoto disease with unusual cutaneous findings. Am J Dermatopathol 2021; 43:e213–17). This is more prevalent among Asians and rarely reported in White people (Perry AM, Choi SM. Kikuchi-Fujimoto disease: a review. Arch Pathol Lab Med 2018; 142:1341–6), where it may cause diagnostic difficulties. This case highlights the importance of lateral thinking while formulating a differential diagnosis, despite the time pressures of a busy clinic. Although the reported prevalence of KFD among White people has been negligible (Perry et al.), it should not be dismissed solely based on a patient’s ethnicity. Timely and adequate management of rare conditions can reduce patient morbidity and improve their quality of life.

PD06 Efficacy of dupilumab in chronic actinic dermatitis

Abstract Chronic actinic dermatitis (CAD) is characterized by a photoexposed site dermatitis in association with objective evidence of photosensitivity, often arising on a background of atopic dermatitis (AD). Dupilumab is a monoclonal antibody that inhibits signalling of interleukin (IL)-4 and IL-13 and is licensed for the management of moderate-to-severe AD. To date, nine case reports have suggested that dupilumab can be clinically effective for CAD, yet only five cases had diagnostic baseline phototesting and only two cases could demonstrate objective improvement in photosensitivity on repeat testing. We report a retrospective case series from two UK photobiology units of 11 patients with concomitant AD and CAD treated with dupilumab. Inclusion criteria included baseline phototesting with an irradiation monochromator device confirming a diagnosis of CAD < 3 years prior to starting dupilumab, phototesting repeated after at least 16 weeks on dupilumab and all patients included were refractory or intolerant to at least one other systemic therapy prior to dupilumab. Eleven patients [82% male, median age 40 years (range 21–59) at diagnosis] of skin phototypes I–V were included. All patients had a pre-existing diagnosis of AD before the onset of CAD, and two patients also had a pre-existing diagnosis of allergic contact dermatitis. The average duration of dupilumab therapy prior to repeat phototesting was 15 months (range 4–44). Ten of 11 (91%) patients reported improvement in their AD in terms of both rash and pruritus. Five of 11 patients (45%) reported partial improvement in their subjective photosensitivity of whom two showed ultraviolet B monochromator improvement (3- to 6-fold). Six of 11 (55%) patients reported no clinical change in photosensitivity of whom two showed no improvement or worsening on phototesting; while four showed improvements, they remained in the severely photosensitive range on phototesting. While dupilumab is an effective therapy for moderate-to-severe AD, its potential benefit in managing CAD is more difficult to measure. In 91% of patients with CAD, dupilumab was associated with improvement in AD, while clinical or objective improvement in photosensitivity occurred in 82%, albeit sometimes only to a slight degree. However, these data suggest that, for patients with CAD and concomitant AD, reducing the eczematous response is beneficial and that dupilumab is a treatment worth exploring for this patient cohort for whom other treatment options are limited. Prospective studies of dupilumab in CAD are required to further evaluate its utility in this therapeutically challenging condition.

A convergent synthetic platform of hydrogels enclosing prednisolone-loaded nanoparticles for the treatment of chronic actinic dermatitis

ABSTRACT Recurrent eczematous lesions and acute itching describe chronic actinic dermatitis (CAD). Continuous use of corticosteroids might result in a dermal adverse effect. Chitosan (CS)-coated PLGA nanoparticles encapsulated prednisolone (PDS) and co-encapsulated to poloxamer hydrogel to enhance anti-inflammatory action and reduce side effects. The PDS@NPs were synthesized using the solvent-emulsification evaporation method, and their physical and chemical properties were analysed. Ex vivo drug absorption experiment was conducted utilizing the Franz diffusion cells in vitro. Toxic effects on human fibroblasts and keratinocytes were not observed in the nanoparticle formulations. Nanoparticles and hydrogels altered PDS’s release kinetics, but not by the non-encapsulated PDS (NE@PDS). Nanoparticles could not penetrate the stratum corneum of removed the skin, which shows the nano-encapsulation of PDS improved skin absorptions. Pseudoplastic and non-Newtonian behaviour was seen in all hydrogels. The nanoformulations appear to be a promising option for glucocorticoid delivery to individuals with chronic actinic dermatitis (CAD).

3D artificial sebocyte glands from inertial focusing effect for facile and flexible analysis of light damage and drug screening.

The sebaceous gland is a neuro-immuno-endocrine organ responsible for maintaining regular skin functions. Overdose exposure of UV and visible light (e.g., blue light) can cause sebocyte gland function disorders or even different diseases (e.g., chronic actinic dermatitis). Studying the mechanism of light-induced damage in sebaceous glands has been challenging, since ex vivo culture of sebaceous glands is difficult due to its short life in culture medium. To address this issue, a versatile 3D artificial sebocyte gland model was established using the inertial focusing effect for studying the impact of light damage and screening potential drugs. The artificial sebocyte gland exhibited specific biological function and structure similar to natural sebocyte glands. Using this artificial sebocyte gland, the interactions between the artificial organ and blue light or UV were studied. The results indicated that UV and blue light upregulated lipid secretion and downregulated cell viability within the sebocytes. Light damage intensified oxidative stress and promoted pro-inflammation cytokines (i.e., IL-1β and TNF-α) production in the artificial sebocytes. Additionally, the therapeutic effects of cannabidiol, a clinically tested drug for treating acne, was also indicated on restoring light damaged sebaceous gland functions. These results indicate that the 3D artificial sebocyte gland could be a versatile, fast, and low-cost platform for skincare studies or drug screening.

On the issue of diagnosis and treatment of skin pseudolymphoma on the example of a clinical case

Pseudolymphomas of the skin are a heterogeneous group of diseases manifested by benign lymphoid infiltrates that clinically and/or histologically mimic skin lymphoma.
 The group of pseudolymphomas of the skin includes actinic reticuloid, benign lymphocytoma of the skin, true pesvdolymphoma, postscabious lymphoplasia, lymphocytic reactions to insect bites, etc. The diagnosis of pseudolymphoma is based on anamnesis data (the presence of a provoking factor, with the exception of idiopathic pseudolymphomas), clinical picture (a single papule, less often a plaque localized in open areas of the upper half of the body ― the face: cheeks, nose, earlobes; scalp, upper extremities, chest), results histological, immunophenotypic studies, and with persistent persistence of rashes ― on the results of molecular biological studies.
 The similarity of clinical and pathomorphological signs of pseudolymph with malignant lymphoproliferative processes creates significant diagnostic difficulties and requires a thorough examination with the involvement of pathologists and oncologists. Diagnostic difficulties are often the cause of erroneous or late detection of skin lymphoma, which negatively affects the prognosis of the disease. Treatment tactics are determined by the morphological variant of lymphoid infiltration, as well as the presence and nature of the provoking factor. The majority of idiopathic psvdolymph is successfully treated with systemic glucocorticosteroids, however, in the case of resistance to systemic glucocorticoids, recommendations on treatment tactics have not yet been developed. Prolonged, often recurrent course, as well as the possibility of transformation of the process into malignant lymphoma of the skin, requires long-term clinical observation of patients.
 The case presented in the article confirms that the crucial importance for the successful diagnosis of pseudolymphoma lies in the analysis of anamnesis data, clinical picture, histological and immunohistochemical studies.

HIV-associated photodermatitis in African populations.

Photosensitive dermatoses are seen in 5% of HIV-infected persons. These include drug- and chemical-induced photoallergic and phototoxic reactions, chronic actinic dermatitis of HIV, photo lichenoid drug eruptions, and porphyria. Data on photodermatitis in HIV are limited to case reports and series. The pathogenesis is not completely understood and includes a th2 phenotype in HIV which results in impaired barrier function and resultant allergen sensitisation as well as immune dysregulation. The objective of this manuscript is to review the literature on the clinical phenotype, pathogenesis, role of photo and patch testing, outcomes, and treatment of photodermatitis in HIV in an African population.

1140 Skin microbiome affects cytokine regulation upon UV exposure in the skin of patients with polymorphic light eruption

1140 Skin microbiome affects cytokine regulation upon UV exposure in the skin of patients with polymorphic light eruption

784 XIst regulate nuclear factor-κb pathway to participate apoptosis imbalance in chronic actinic dermatitis

784 XIst regulate nuclear factor-κb pathway to participate apoptosis imbalance in chronic actinic dermatitis

Changing a Life in Medical Missions: Chronic Actinic Dermatitis

A 47-year-old male was seen in a rural Nicaraguan community for difficulty shaving his beard. The patient stated his face changed roughly 10 years ago and since has never looked the same. He presented at the clinic with an eczematous rash confined to the sun exposed surfaces on his skin. His face and posterior neck were covered in a confluent lichenified erythematous eruption sparing only the forehead and eyelids. The upper chest, forearms, and dorsal hands were hyperpigmented with various hypertrophic and hyperkeratotic lesions. The diagnosis of chronic actinic dermatitis was made due to the overall clinical picture along with limitations in further diagnostic capabilities. After initial therapy, the patient ecstatically returned to the clinic with greatly improved skin.

Personalized Medical Photoprotection: Determining Optimal Measures for Susceptible Patient Groups

Background: Increasing knowledge regarding the deleterious effects of sun exposure and the mechanisms of photodamage has enabled the development of tailored photoprotection strategies based on skin type and the existence of underlying conditions. Dermatologists play an essential role as they identify the specific skin photoprotection needs of their patients. This translates into specific recommendations of suitable protection measures, both in terms of the length and time of the day these patients can be exposed to the sun and the use of sun protection products. Purpose: Our purpose was to overview optimal photoprotection strategies for patients with dermatological pathologies or alterations. Methods: Increasing evidence supports the use of sunscreens containing not only organic and inorganic filters but also non-filtering biological ingredients that can enhance sunscreen protection efficacy. Examples of these biologicals are DNA repair enzymes, antioxidants including vitamins and other biological agents, including those of botanical origin. Results: Oral photoprotection is also an area of increasing interest that contributes to an integral protection against sun-related alterations. Conclusion: This article provides the skin care specialist with a simple, easy-to-use guide to identify appropriate measures for patients presenting pathologies or conditions requiring specific sun protection needs, including (but not limited to) photodermatoses (polymorphic light eruption, porphyrias); inflammatory dermatoses (atopic dermatitis, rosacea, psoriasis); pigmentation disorders (hyperpigmentation, vitiligo), photoaging, skin pre-cancerous lesions and cancers, and photosensitive or sensitized skin (patients undergoing specific drugs treatments or skin-related procedures), ensuring the choice of personalized protection for susceptible groups within the general population.

Demographics and clinical presentations of 844 patients with light and dark skin types with polymorphous light eruption and chronic actinic dermatitis evaluated over 23 years.

Polymorphous light eruption (PMLE) and chronic actinic dermatitis (CAD) have been classically described in White individuals, although recent studies have reported higher prevalence in patients with dark skin types, particularly African Americans. To evaluate for differences in demographic, and clinical features between persons with light and dark skin types who have PMLE and CAD. Retrospective review of patients with PMLE and CAD who were diagnosed from January 1, 1998, through November 31, 2021, at a single academic dermatology center. A total of 844 patients (725 [85.9%] female; mean [SD] age of onset: 41.7 [16.9] years) were diagnosed with PMLE, and 60 patients (22 [36.6%] female; mean age, [SD]: 60.6 [10.6] years) of age at presentation, disease duration of 8.2 [7.3] years were diagnosed with CAD. Although just over 50% of the general clinic population was White, the prevalence of PMLE and CAD was significantly higher in dark-skinned individuals compared to light-skinned individuals (PMLE: 625 [74.0%] vs. 219 [25.9%], p value < .001; CAD: 43 [71.6%] vs. 17 [28.3%], p value=.003) respectively. The pinpoint papular variant of PMLE (PP-PMLE) was predominantly seen in dark-skinned individuals. A substantial proportion of PMLE and CAD cases are present in dark-skinned individuals. PP-PMLE can be mistaken for lichen nitidus. As such, recognition of this entity is important for adequate evaluation and management of patients with PMLE.

Malignancy-associated generalised exfoliative dermatitis: A retrospective study in a single-centre Asian cohort.

Erythroderma is an inflammatory skin condition that causes extensive erythema and skin scaling amounting ≥90% of the body surface area. This retrospective cohort study describes the prevalence of malignancy-associated erythroderma in a single centre where there was concerted effort to systematically offer malignancy screens to all adult erythroderma patients above the age of 65 years. Clinical charts were reviewed for all adult inpatients and outpatients with erythroderma who attended the National University Hospital (NUH) from 1 July 2019 to 31 December 2021. Data collected included patient demographics, clinical findings, laboratory investigations, disease-specific investigations such as endoscopic procedures and biopsies, follow-up duration and mortality data. Seventy-four patients were analysed. The median age of the patients was 73 years old (interquartile range: 59-81 years old). An underlying dermatosis was the most common cause of erythroderma-63 patients having atopic dermatitis/asteatotic eczema or psoriasis. Three patients had erythroderma from drug eruptions, and 1 patient had chronic actinic dermatitis. Four patients had associated malignancies (5.4%). Half of our patients completed further evaluation for malignancy (52.7%). The rest had either declined or were eventually unable to complete the investigations. There was a higher prevalence of associated malignancy (7.8%) in elderly patients above 65 years old. When compared to existing literature, our cohort reflects a higher observed occurrence of malignancy in association with erythroderma. As delays in evaluation for underlying malignancy could result in potentially deleterious outcomes, it is prudent to consider systematic screening for malignancy in high-risk populations such as elderly erythroderma patients.

Serum 25-Hydroxy Vitamin D Levels in Patients with Polymorphic Light Eruptions: A Case-control Study

Introduction: Polymorphic Light Eruptions (PMLE) are immune mediated dermal maculopapular eruptions that occurs after sun exposure. Vitamin D deficiency has been gaining attention in many dermatological diseases of varied pathologies. Research studies on vitamin D levels in PMLE are lacking despite it being an immuno modulator. Aim: To estimate the levels of serum 25-OH Vitamin D among patients with PMLE disease and also to compare its level with healthy controls Materials and Methods: A case-control study was conducted during January 2022 to June 2022 in Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research Hospital, Tamil Nadu, India. Total 80 participants (40 patients with PMLE eruptions and 40 normal healthy volunteers), of both sexes aged between 40-60 years were included. Serum 25-OH Vitamin D levels were estimated for participants and the data obtained were analysed by using Student’s t-test and Chi-square test as tests for significance and Odds ratio by logistic regression as test for outcome association. Results: Amongst the total 80 participants, 40 in each case and control group, mean age in case group was 50.08±5.21 years and in control group was 49.80±5.68 years. The results of the study showed significantly reduced serum 25-OH vitamin D levels (30.13±7.39 ng/mL) among cases compared to controls (34.50±6.05 ng/mL) (p=0.005). It further showed significant positive B (0.160) slope for sunlight exposure and significant negative B (-0.556) slope for serum vitamin D levels with odds of occurrence to PMLE disease state increases by 17.4% for every unit increase in sunlight Ultraviolet (UV) exposure {Odds ratio: 1.174 (C.I: 1.088-1.266)} and decreases by 42.6% for every unit increase in Vitamin D levels {Odds ratio: 0.574 (C.I: 0.446-0.738)}. Conclusion: Most PMLE patients were found to have significantly lower Vitamin D levels with majority in the pre- deficient zones. These findings suggest Vitamin D could be a cost effective alternative prospect in both PMLE diagnostics and therapeutics in future after thorough trial validations.

Clinical Characteristics of Photodermatoses in Indian Patients and their Phototesting Findings: A Cross-sectional Study

Introduction: Phototesting helps to confirm photosensitivity, identify the action spectra, reproduce lesions by photo provocation for biopsy, calculate starting dose of desensitisation therapy, assess the severity of the photodermatoses, and monitor response to treatment. The effect of sunlight on darker skin has only been sparingly studied and hence, this study was undertaken in our population. Aim: To identify the spectrum of photodermatoses, with their clinical characteristics and phototesting findings. Materials and Methods: A cross-sectional study was conducted in Outpatient Department (OPD) of the Department of Dermatology, Pushpagiri Medical College, Tiruvalla, Kerala, India from January to December 2015. A total of 30 patients clinically diagnosed as photodermatoses were subjected to phototesting using the whole body phototherapy unit with Ultraviolet A (UVA) and UVB exposure. After 24 hours the UV-exposed areas were examined for the Minimal Erythema Dose (MED), and for the reoccurrence of skin lesions to determine the action spectra for the disorder, and the values were expressed in mean, frequency, and percentage. Results: Polymorphic Light Eruption (PLE) remains the most common photodermatosis (n=25) with a definite female preponderance (n=19). The mean MED-UVB for type IV skin with photodermatoses was found to be 766 mj/cm2 and for type V skin was found to be 900 mj/cm2 . MED-UVA was not observed in the majority of patients (n=24). Among the 25 patients with PLE, 16 patients had normal MED values to both UVA and UVB, four had reduced MED-UVB alone, one patient to UVA alone, and three patients had reduced MED to both. MED-UVB was not observed in one patient. MED-UVA was not observed in 21 patients (normal). Of the three patients with photoallergic dermatitis, one patient had reduced MED-UVB and MED-UVA. The other two patients had normal MEDs. The chronic actinic dermatitis patient had reduced MED to UVB and UVA and the actinic lichen planus patient had normal MEDs. Conclusion: Phototesting remains a very useful tool in the evaluation and management of photodermatoses and PLE was the most common photodermatoses in studied population.

Dermoscopic Features of Lichenoid Pseudovesicular Papular Eruption of the Nose (LiPEN): A Rare Entity.

Dermoscopic Features of Lichenoid Pseudovesicular Papular Eruption of the Nose (LiPEN): A Rare Entity.

A spectrum of dermatological manifestations associated with hypothyroid condition – A pilot study

BACKGROUND: Hypothyroidism, a major health problem, is associated with a wide range of diseases. One of the organs affected by hypothyroidism, which shows a wide range of clinical signs, is the skin. OBJECTIVES: The objective of this study was to determine various cutaneous manifestations of hypothyroidism that can be used as a diagnostic marker and may help in the early diagnosis and treatment of hypothyroidism. METHODOLOGY: A cross-sectional observational study was carried out on 100 consecutive diagnosed cases of hypothyroidism patients in the dermatology department of a tertiary care hospital in Bengaluru during June 2021–September 2021. A pretested standard pro forma was used to collect and maintain the details of the patients. The study was ethically approved by the institution. RESULTS: The majority were female (84%) and patients' age ranged from 16 to 65 years, covering all groups with 31% having comorbidities. Seventy-one percent had pruritus and 14% with urticaria, 13% with palmar and sole hyperkeratosis, 3% with burning skin symptoms, and 5% with cold skin symptoms. The majority (38%) had pruritus as an early symptom. Pruritus symptom patients were categorized into mild pruritus (25%) and moderate pruritus (75%). A significant number of patients presented with hair changes in the form of dry brittle hair in 50 patients and with other associated skin conditions which included 20 patients with melasma, 10 patients with seborrheic dermatitis, eight patients had acrochordons, four patients had vitiligo, five had polymorphic light eruptions like lesions, three patients had lichen planus, and two each had psoriasis and acne vulgaris. CONCLUSION: The present study was undertaken to know the spectrum of dermatological manifestations associated with a hypothyroid condition. It was observed the female sex, pruritis, and hair changes were common in these patients. Recognition of hypothyroidism is important to ensure that appropriate treatment is provided at the earliest, thus preventing complications.

Clinical characteristics of patients with human immunodeficiency virus and immune-mediated photodermatoses: A retrospective study of 39 patients.

HIV/AIDS patients are susceptible to various infectious and inflammatory dermatoses. No systemic work has been done on HIV/AIDS patients with immune-mediated photodermatoses in China. Here, we aim to determine the clinical features of immune-mediated photodermatoses in HIV/AIDS patients. A retrospective analysis of HIV/AIDS patients with immune-mediated photodermatoses was carried out with demographic data, clinical characteristics, laboratory data, and follow-up data at the First Affiliated Hospital of Kunming Medical University between 2012 and 2019. The data were subjected to statistical analysis. A total of 39 HIV/AIDS patients with immune-mediated photodermatoses were enrolled, including 22 cases of polymorphic light eruption (PLE), 16 cases of chronic actinic dermatitis (CAD), and one actinic reticuloid. The CD4 count at the visit of the HIV-positive CAD group was lower than the PLE group (p=.049). The HIV-positive CAD group was more sensitive toward UVB than the PLE group (p=.020) and had a lower MED-UVB value (p=.044). There was no significant difference in UV tests among different categories of skin types. Immune-mediated photodermatoses are a manifestation of the advanced symptom of HIV infection, and sometimes also the presenting feature of HIV infection. Compared with HIV-positive PLE patients, CAD patients showed higher sensitivity to UVB radiation and had a lower MED-UVB value. The primary treatment for immune-mediated photodermatoses in HIV/AIDS patients is HAART and sun avoidance.