Polymorphic Light Eruption Research Articles

Actinic reticuloid. Diagnostics

This article is about the case of actinic reticuloid - the rare dermatosis which clinical presentation is similar to atopic dermatitis, T-cell lymphoma. Good treatment effect was obtained by long cycles (2 cycles for 3 months) of hydroxychloroquine and sun protective therapy included sunscreens SPF 50, nicotinic acid, sun-safe clothes which blocked ultraviolet radiation without any glucocorticosteroid drugs and cytostatic treatment.

Disorders characterized by predominant or exclusive dermal inflammation.

Some cutaneous inflammatory disorders are typified by a predominant or exclusive localization in the dermis. They can be further subdivided by the principal cell types into lymphocytic, neutrophilic, and eosinophilic infiltrates, and mixtures of them are also seen in a proportion of cases. This review considers such conditions. Included among the lymphoid lesions are viral exanthems, pigmented purpuras, gyrate erythemas, polymorphous light eruption, lupus tumidus, and cutaneous lymphoid hyperplasia. Neutrophilic infiltrates are represented by infections, Sweet syndrome, pyoderma gangrenosum, and hidradenitis suppurativa, as well as a group of so-called "autoinflammatory" dermatitides comprising polymorphonuclear leukocytes. Eosinophil-dominated lesions include arthropod bite reactions, cutaneous parasitic infestations, the urticarial phase of bullous pemphigoid, Wells syndrome (eosinophilic cellulitis), hypereosinophilic syndrome, and Churg-Strauss disease. In other conditions, eosinophils are admixed with neutrophils in the corium, with or without small-vessel vasculitis. Exemplary disorders with those patterns include drug eruptions, chronic idiopathic urticaria, urticarial vasculitis, granuloma faciale, and Schnitzler syndrome (chronic urticarial with a monoclonal gammopathy).

Desired response to phototherapy vs photoaggravation in psoriasis: what makes the difference?

Psoriasis commonly responds beneficially to UV radiation from natural sunlight or artificial sources. Therapeutic mechanisms include the proapoptotic and immunomodulating effects of UV, affecting many cells and involving a variety of pro- and anti-inflammatory cytokines, downregulating the Th17/IL-23 response with simultaneous induction of regulatory immune cells. However, exposure to UV radiation in a subset of psoriasis patients leads to exacerbation of the disease. We herein shed light on the predisposing factors of photosensitive psoriasis, including genetics (such as HLA-Cw*0602 or CARD14), gender and coexisting photodermatoses such as polymorphic light eruption (PLE) in the context of potential molecular mechanisms behind therapeutic photoresponsiveness or photoaggravation. UV-induced damage/pathogen-associated molecular patterns, damage to self-coding RNA (signalling through Toll-like receptors), certain antimicrobial peptides and/or inflammasome activation may induce innate immunity, leading to psoriasis at the site of UV exposure when there is concomitant, predisposing resistance against UV-induced suppression of the adaptive immune response (like in PLE) that otherwise would act to reduce psoriasis.

Photobiological responses in patients with chronic actinic dermatitis and their relationship with the melanocortin-1 receptor gene Arg163Gln variant: a preliminary study

Objective To explore differences in phototest and photopatch test results, and in skin color-related parameters between healthy subjects and patients with chronic actinic dermatitis (CAD), and to examine their relationship with the melanocortin-1 receptor gene (MC1R) Arg163Gln variant. Methods Phototests were performed by using a sun simulator SUN1000, and skin color was analyzed by using Hexameter MX18 in 25 patients with CAD and 25 healthy subjects. The MC1R genotype at position -163 was determined by PCR. Photopatch tests were performed on 25 patients with CAD and 5 healthy subjects using a standard series of photoallergens (RuiMin) and an ultraviolet (UV) phototherapy equipment, SS-03A. Results Regarding phototest results, both UVA-minimal persistent pigment darkening dose (MPPD) and UVB-minimal erythema dose (MED) were significantly lower in CAD patients compared with healthy controls (both P 0.05), but that of the CAA genotype differed significantly between the two groups (P < 0.01). UVA-MPPD and UVB-MED were both significantly lower in CAD patients with the CAA genotype at position-163 in the MC1R gene than in those without the genotype (P = 0.055, 0.325, respectively). Conclusions Skin photobiological testing plays a critical role in the diagnosis of CAD. Further studies are needed to clarify the role of the CAA genotype at position-163 in the MC1R gene in the diagnosis, prevention and treatment of CAD. Key words: Photosensitivity disorders; Pigmentation; Genes, Arg163Gln; Chronic actinic dermatitis; Photopatch tests

A Prospective Observational Study on Clinico - Pathological Correlation in Polymorphous Light Eruption

A Prospective Observational Study on Clinico - Pathological Correlation in Polymorphous Light Eruption

Chronic actinic dermatitis: a retrospective analysis of 65 patients undergoing treatment in clinics of the Samara State Medical University

Chronic actinic dermatitis (HAD) - immunologically mediated photodermatosis characterized by pruritic eczematous lesions on areas of skin exposed to sunlight. Examined 65 patients with the purpose of the study and analysis of clinical, allergological and photobiological characteristics of HAD, the manifestations of which occur during the spring-summer-autumn period, mimic allergic contact dermatitis, eczema, diffuse variant of atopic dermatitis. In accordance with the results of fototest all patients marked change of photosensitivity: both UVA and UVB – from 77.1 per cent, only to UVA - 10,7%, only to UVB is 9.2%. Almost all patients were marked sensitization to vegetable allergens.

The Skin Microbiome: Is It Affected by UV-induced Immune Suppression?

Human skin apart from functioning as a physical barricade to stop the entry of pathogens, also hosts innumerable commensal organisms. The skin cells and the immune system constantly interact with microbes, to maintain cutaneous homeostasis, despite the challenges offered by various environmental factors. A major environmental factor affecting the skin is ultraviolet radiation (UV-R) from sunlight. UV-R is well known to modulate the immune system, which can be both beneficial and deleterious. By targeting the cells and molecules within skin, UV-R can trigger the production and release of antimicrobial peptides, affect the innate immune system and ultimately suppress the adaptive cellular immune response. This can contribute to skin carcinogenesis and the promotion of infectious agents such as herpes simplex virus and possibly others. On the other hand, a UV-established immunosuppressive environment may protect against the induction of immunologically mediated skin diseases including some of photodermatoses such as polymorphic light eruption. In this article, we share our perspective about the possibility that UV-induced immune suppression may alter the landscape of the skin’s microbiome and its components. Alternatively, or in concert with this, direct UV-induced DNA and membrane damage to the microbiome may result in pathogen associated molecular patterns (PAMPs) that interfere with UV-induced immune suppression.

The clinical severity score of chronic actinic dermatitis correlates with invivo photoallergic reactions and the immunologic parameters related to a shift towards Th2 immunity from the Th2/Th1 balanced status in patients with chronic actinic dermatitis.

Chronic actinic dermatitis (CAD) has a more complicated pathogenetic basis than others. The clinical grading system and its correlations with the clinical and immunological parameters still remained to be investigated to define the nature of CAD in a more detailed manner. We investigated correlations of the clinical severity score of CAD (CSS-CAD) with the clinical and immunological parameters. We evaluated 72 patients with CAD and classified them into three groups according to the CSS-CAD. We analysed total IgE level, peripheral blood (PB) eosinophil count, the ratio of Th2cell (CCR4+CD4+) percentage over Th1 cell (CXCR3+CD4+) percentage (Th2/Th1) and/or the sum of suppressor/cytotoxic T cells. The total IgE levels and the percentage of PB eosinophils were higher in the severer group than other groups. A shift towards Th2 from Th2/Th1 balanced status may be affected by total counts of suppressor T cells, and the patient with higher Th2/Th1 ratio than balanced status had the more proportion in the severer CSS-CAD group than other groups. The CSS-CAD correlates with total IgE level, PB eosinophil count and a shift towards Th2 immunity from Th2/Th1. So we suggest the Th1/Th2 dysbalance may be affected by the CSS-CAD.

Photo-patch and patch tests in patients with dermatitis over the photo-exposed areas: A study of 101 cases from a tertiary care centre in India.

Many patients with dermatitis over photo-exposed body areas are positive to many contact allergens and have a pre-existing allergic contact dermatitis. This study included patients who presented to a tertiary centre in India with dermatitis on photo-exposed body areas suspected of chronic actinic dermatitis. Their detailed histories were recorded and cutaneous and systemic examinations were performed. Patch testing was done in all the patients and photo-patch testing was carried out in 86 patients. Altogether 101 patients were included (69 males, 32 females). The most common presentation was lichenified hyperpigmented plaques on the photo-exposed sites. Photosensitivity was recorded in 64 (63%) patients and summer exacerbation in 52 (52%). Exposure to the Parthenium hysterophorus weed was recorded in 70 (69%) patients, 27 (26.7%) had a history of hair dye application and 20 (20%) had a history of atopy. Photo-patch test was positive in 11 (12.8%) patients and patch testing was positive in 71 (70%). Parthenium hysterophorus was the most common allergen implicated and was positive in three (4%) photo-patch and 52 (52%) patch tests. Other positive photo-patch test allergens were perfume mix, balsam of Peru, thiuram mix, Compositae mix and promethazine hydrochloride. Other common patch test allergens were parthenolide, colophony, fragrance mix and p-phenylenediamine (PPD) base. In the Indian population parthenium and perfume mix are the most common photoallergens in patients with dermatitis over photo-exposed areas, while parthenium, colophony, fragrance mix and PPD are the common positive allergens.

Phototherapy and vitamin D

The skin is the site for the photosynthesis of vitamin D and is a target tissue for the active metabolite of vitamin D. An increasing body of evidence indicates that vitamin D produced during phototherapy may be responsible for the positive effects observed during treatment of some skin diseases. Topical or oral application of vitamin D derivatives are used alone or with phototherapy. This paper reviews what is known about the use of phototherapy to enhance vitamin D levels, the use of vitamin D analogues with phototherapy, the efficacy of combination therapies, and controversies regarding some of the outcomes. Vitamin D can play a beneficial role in treating psoriasis, even though the exact role of vitamin D in the pathogenesis and severity of psoriasis remains unclear. The role of vitamin D in vitiligo, atopic dermatitis, polymorphic light eruption, and mycosis fungoides must be further investigated.

Polymorphous light eruption under the Mediterranean sun: a clinico-epidemiological and photobiological study.

Polymorphous light eruption (PLE) affects one in five Europeans, being the most common photodermatosis [1]. A large-scale cross-sectional European study recently showed that inhabitants of southern countries, such as Greece, are almost three times more likely to develop PLE, than northern Europeans [1]. However, data on PLE in Mediterranean climates are scarce. Exposure to bright sunlight throughout the year could theoretically constitute a strong trigger for the induction and persistence of PLE [...]

Actinic reticuloid in the setting of HIV

Actinic reticuloid in the setting of HIV

Patch and photo patch test in suspected chronic actinic dermatitis patients

Patch and photo patch test in suspected chronic actinic dermatitis patients

Secondary syphilis manifesting as annular lichenoid plaques

Background: Syphilis continues to be a diagnostic challenge as the myriad manifestations of secondary syphilis can mimic a lot many dermatological disorders. Annular Lichenoid syphilis is an uncommon entity, reported only occasionally in the penicillin era. We present the case of a 24-year-old man presenting with annular lichenoid lesions over face Methods & Materials: A 24-year-old male with multiple pink to brown coloured lesions over face since 1 month. At the same time he was being treated for acne vulgaris with tretinoin 0.025% cream and clindamycin 0.05% cream from private practioner. Lesion initially appeared as reddish coloured gradually spreading peripherally to become annular with central hyperpigmentation. Past history revealed homosexual unprotected sexual exposure with multiple partners, last passive exposure 1 month prior to onset of skin lesions. General and systemic examination was normal. On cutaneous examination there was evidence of multiple annular plaque over face with central hyperpigmentation. Also hyperpigmented macules over bilateral palms and soles, neck, chest, forearms, hands was present. Deep dermal tenderness was positive. Differential Diagnosis kept was Lichen Planus, Secondary Syphilis, Polymorphic light eruption disorderand Erythema Multiforme. Serological investigation showed Venereal disease research laboratory assay came out to be positive in the titres for the patient: 1:32, and Treponema pallidum haemagglutination for syphilis was Positive. Serology for Hepatitis B, and HIV was negative. Results: Biopsy from annular plaque showed interface dermatitis, perivascular and perieccrine plasma cell infiltrate and granuloma. Diagnosis kept was Secondary syphilis presenting as unusual annular lichenoid lesions was favoured. Three doses of Intramuscular Injection of Benzathine penicillin 2.4 million units was given. After 3 months all skin lesions subsided with persistence of post inflammatory hyperpigmentation over face. Conclusion: The presentations of syphilis, often described as “the great imitator,” can be varied and atypical. Thus prompt diagnosis and treatment is necessary.

The role of antihistamines in chronic actinic dermatitis treatment

Inveterate actinic dermatitis is an immunologically mediated photodermatosis characterized by itchy eczematous dermhelminthiasis exposed to sunlight. The disease proceeds in the same way as the atopic eczema or atopic dermatitis. The treatment of patients with inveterate actinic dermatitis is similar to the treatment of patients with atopic dermatitis and eczema. Administration of the modern antihistaminic preparation desloratadine (Aerius) in the treatment has a positive effect on the skin process relief and on some cellular and humoral immunity factors.

Unilateraler ungewöhnlicher Lupus tumidus: pathogenetische Mysterie und diagnostisches Problem

Lupus tumidus is a rare immunological disorder whose pathogenesis is not fully understood. Although on the one hand there are some differences in (1) the clinical morphology of lesions, (2) the histopathology picture, as well as in (3) serological profile of lupus tumidus patients at the current moment, the disease is regarded as a subform of chronic cutaneous lupus erythematosus. Differential diagnosis requires the exclusion of many diseases such as Jessner Kanoff lymphocytic infiltration, polymorphous light eruption, and reticular erythematous mucinosis. Differentiation between them is not always easy. The standard treatment regimen of patients with lupus tumidus is based on local and systemic application of corticosteroids, azathioprin, dapsone, mepacrine, chloroquine, and hydroxychloroquine. Modern treatment options include the use of pulsed dye laser, tacrolimus 0.1 % ointment and photophoresis. We present a 42-year-old patient with unilateral atypical form of lupus tumidus who was successfully treated with systematically administration of hydroxychloroquine in combination with sunscreen SPF 50. After a 2-month course of treatment with hydroxychloroquine dosage of 200mg per day and a break of 3 months between courses, we observed a complete remission.

Narrowband UVB-induced iatrogenic polymorphous light eruption: a case and suggestions to overcome this rare complication

Polymorphous light eruption (PMLE) is the most common photodermatosis characterized by pruritic papules and papulovesicles, which appear hours to days following ultraviolet (UV) exposure. Herein, the authors report successful treatment of generalized plaque psoriasis with Goeckerman regimen in a patient despite new onset iatrogenic PMLE following narrowband (NB) UVB therapy. Although further studies are necessary, this case suggests that the co-existence of psoriasis and PMLE should not prevent the use of phototherapy; phototherapy, especially as part of the Goeckerman regimen, remains a valuable treatment option for psoriasis in patients with PMLE.

Correction: Patients with polymorphic light eruption have decreased serum levels of 25-hydroxyvitamin-D(3) that increase upon 311 nm UVB photohardening

Correction for 'Patients with polymorphic light eruption have decreased serum levels of 25-hydroxyvitamin-D(3) that increase upon 311 nm UVB photohardening' by Peter Wolf et al., Photochem. Photobiol. Sci., 2012, 11, 1831-1836.

Solar urticaria.

Solar urticaria is a rare IgE-mediated and chromophore-dependent photodermatosis. In some cases, these chromophores, designated as "serum factor", may be detected in serum or plasma. To date, the exact pathogenesis of solar urticaria has, however, not been elucidated. Typical clinical features include the onset of urticarial lesions within a few minutes after light exposure, which already raises diagnostic suspicion. The most common triggers are UVA and visible light. Determination of the action spectrum as well as the minimal urticarial dose (MDU) is diagnostically crucial. Other photodermatoses such as polymorphic light eruption or porphyrias (especially erythropoietic protoporphyria) have to be ruled out. Apart from sunlight avoidance, which is always required, further therapeutic options used include nonsedating antihistamines as well as light hardening. Newer treatment modalities such as plasmapheresis or the anti-IgE antibody omalizumab are reserved for severe, recalcitrant forms of solar urticaria.

T regulatory cells in polymorphic light eruption.

T regulatory cells in polymorphic light eruption.