Polymorphic Light Eruption Research Articles

Polymorphous Light Eruption: a Review

To update readers on the current understandings of polymorphous light eruption (PMLE) in regard to epidemiology, clinical findings, pathophysiology, treatment, and prognosis. PMLE is known to be the most common photodermatosis seen in individuals with light skin types; however, recent evidence shows that it is also commonly observed in individuals with skin of color. Resistance to UV-induced immunosuppression is now known to be an essential part of pathogenesis; this could be secondary to unique cytokine or antimicrobial peptide expressions in these patients. Photohardening, done at the onset of sunny season for patients living in temperate climate, is a commonly used and effective management. PMLE is the most common photodermatosis. Lesions occur within hours after sun exposure, varying from urticarial papules, pinhead papules, to vesicles; they resolve in days to weeks without scarring. Resistance to UV-induced immunosuppression is thought to be an important contributor to the pathophysiology. Management includes photoprotection and photohardening. A 7–10-day course of oral corticosteroids is an appropriate prophylaxis for patients who plan to go to sunny locale for vacation. Though PMLE is chronic, many patients show improvement over years.

653 Identification of an inflammation-regulated gene TNFAIP3 in Chronic actinic dermatitis

Introduction: Chronic actinic dermatitis (CAD) is the common photosensitive dermatitis. Our previous study found that the transcription of TNFAIP3 (A20) was down-regulated in CAD. Although inflammation plays an important role in CAD, the underline molecular mechanisms remain unknown. Objective: The purpose of this study is to explore the expression and regulation of TNFAIP3 in the pathogenesis in inflammation of CAD. Materials and Methods: Quantitative real-time polymerase chain reaction (qRT-PCR) and western blotting were used to identify gene differentially expressed in HaCaT treated with UVB as well as in BALBC mice with chronic ultraviolet injury. To investigate the impact of TNFAIP3 on the inflammatory cytokines (IL-6, IL-10, IL-13, IL-19, IL-24 and TNF-α), both stable over-expression and knockdown TNFAIP3-expressed HaCaT cell lines were established. Western blotting was performed to test the expression of Phosphorylated p65. qRT-PCR and ELISA was used to detecte the changes in the release of the inflammatory cytokines in lipopolysaccharide (LPS) or ammonium pyrrolidinedithiocarbamate (PDTC) treated HaCaT cells. Results: The expression of TNFAIP3 was obviously down-regurated in HaCaT cells treated with UVB and skin in BALBC mice with chronic ultraviolet injury comparised to normal group. The expression and secretion of IL-6, IL-19 and IL-24 were markedly descend in TNFAIP3 up-regulated group and were elevated in the TNFAIP3 knockdown group. The expression of Phosphorylated p65 were remarkable increased in LPS-treated HaCaT cells but were decreased in PDTC-treated group. The expression of IL-6 was low in HaCaT cells without LPS-treated but rapidly increased and was maintained at a high level 2-4 h in LPS-treated cells. The secretion of IL-6 was gradually declined with increasing PDTC- treated HaCaT cells. Conclusion: These results indicate that TNFAIP3 plays an important role in the process of inflammation in CAD.

732 CD11b+ cells are a major source of IL31 in polymorphic light eruption

732 CD11b+ cells are a major source of IL31 in polymorphic light eruption

A clinicoepidemiological and histo-Pathological study of polymorphic light eruptions in malwa region

A clinicoepidemiological and histo-Pathological study of polymorphic light eruptions in malwa region - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/2581-4729.2019.0006, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

122 - Chronic actinic dermatitis or cutaneous T cell lymphoma: a case report

122 - Chronic actinic dermatitis or cutaneous T cell lymphoma: a case report

A Case of hansen's disease masquerading as polymorphous light eruption

Hansen's disease is a chronic, relapsing, infective granulomatous skin disease with protean manifestations imitating many benign dermatological conditions. This not only poses a diagnostic dilemma to the treating physician but also often delays the diagnosis and treatment. We report one such case of Hansen's disease imitating a polymorphous light reaction suspected and detected incidentally on the lack of response to treatment of the “apparently benign photodermatoses.”

Lichenoid pseudovesicular papular eruption on nose: A papular facial dermatosis probably related to actinic lichen nitidus or micropapular polymorphous light eruption.

Facial papules are a feature of several clinical conditions and may present both diagnostic and therapeutic challenges. To describe a grouped papular eruption on the nose and adjoining cheeks that has not been well characterized previously. A series of consecutive patients with a papular eruption predominantly involving nose and cheeks were evaluated, treated and followed up prospectively at tertiary care centers. Demographic details, clinical features, histopathology and response to treatment were recorded. There were five men and six women (mean age 29.9 ± 6.9 years) who had disease for a mean duration of 17.3 ± 11.1 months. All patients presented with a predominantly asymptomatic eruption of monomorphic, pseudovesicular, grouped, skin colored to slightly erythematous papules prominently involving the tip of nose, nasal alae, philtrum and the adjoining cheeks. A total of 15 biopsies from 11 patients were analyzed and the predominant finding was a dense, focal lymphoid infiltrate restricted to the upper dermis with basal cell damage and atrophy of the overlying epidermis. The eruption ran a chronic course from several months to years. Direct immunofluorescence could not be performed except in one case. Immunohistochemical stains for CD4 and CD8 could not be done owing to nonavailability. Phototesting was undertaken in one patient only. Small grouped papules on the nose and adjoining skin with a lichenoid histopathology appear to represent a distinct clinicopathological entity. It may be related to actinic lichen nitidus/micropapular variant of polymorphous light eruption.

Photodermatosis and Photo protection in Metropolitan Traffic Police in Kathmandu city

Background: Police officer serves a vital role in maintaining safety and serve are role model for discipline throughout the world, they are non–intentional type sun exposure(NISE).The objective of our present study was to evaluate photo protector practice, knowledge in response to Ultra violet Radiation ,Sunscreens and sun related photodermatosis.
 Methodology: A cross sectional study was conducted in traffic police officer at different locations at Kathmandu. Data was collected by using self-administered questionnaires and interviewed by Dermatologist to establish their knowledge and behaviour and practice in relation to ultra violet radiation and photo-protection.
 Result: Out of 265 participants, mean age was 27.1 years. Respondent with graduation and master degrees had knowledge and practice toward UVR, follow by higher secondary education. Regarding the practice for photo protection only 59.6% had knowledge about sunscreen, 39.6% knowledge about Ultraviolet Radiation and 24.9% had knowledge about Ultra Violet Index .Skin problem like melasma, premature wrinkles, and hardening of skin, polymorphic light eruption, burning foot syndrome, dermatophytes, and varicose vein.
 Conclusion: Traffic police officers showed good practices in term of wearing hat, clothes that cover most of the body parts but poor practice over sunscreen, UVR, UVI. Lectures & seminar regarding the awareness and photo protection practice should be recommended.
 With lack of awareness among police officers and providing sunscreen for free should be considered by Police authorities. Similarly lectures & seminar on sun protection should be provided in regularly.

Coexistence of chronic actinic dermatitis with bullous pemphigoid: a rare case report

Coexistence of chronic actinic dermatitis with bullous pemphigoid: a rare case report

Application of Calahuala (Phlebodium spp) fern complex for the formulation of diverse medicinal and cosmetic products

Extracts of the tropical fern Phlebodium complex of Polypodiaceae family, appear to possess beneficial properties for the skin, attributed to the presence of numerous compounds within the extract that have antioxidant and photoprotective properties. Orally administered Phlebodium complex may provide protection against the detrimental photoaging effects of sunlight, can help reduce the frequency and severity of polymorphous light eruption, and is beneficial for the prevention and potential treatment of several aesthetically relevant conditions. The purpose of this review is to describe beneficial role of Phlebodium complex as an adjunct treatment for vitiligo, melasma, and post-inflammatory hyper-pigmentation. Various extracts applied topically or taken orally have shown several beneficial antioxidant, photo-protectant, anti-mutagenic, and immunoregulatory effects. Modern studies have evaluated the efficacy of Phlebodium extracts as a photoprotective agent and for use in several photo-aggravated dermatologic disorders such as polymorphous light eruption, photodermatoses, vitiligo, melasma, psoriasis, atopic dermatitis, and more recently, in minimizing infections in high-performance athletes. It is these multiple mechanisms of action, in combination with a favorable side effect profile, which make Phlebodium complex a promising adjunctive treatment for several dermatologic disorders. Aerial part has proved to exert antioxidant, photo-protective and immunomodulatory activities; extract of fronds is a natural mixture of phytochemicals endowed with powerful antioxidant properties as flavonoids compared to rhizome. Phlebodium fern extract of fronds and rhizome blocked the deleterious effect of UV irradiation in vitro and in vivo as a natural photoprotectant and potential adjuvant to phototherapy of various skin diseases.

Actinic reticuloid: case report

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.

Chronic actinic dermatitis developing after remission of malignant lymphoma

Chronic actinic dermatitis developing after remission of malignant lymphoma

Once-Weekly Hypofractionated Radiation Therapy in Breast Cancer: A Phase 2 Trial

Hypofractionated radiotherapy in 15 or 16 daily fractions is well established as an alternative in early breast cancer after breast-conserving surgery. The evidences for a whole-breast treatment even shorter in 5-10 fractions are still scarce. The objective of the presenting study is to analyse the effects of adjuvant breast cancer radiation using a once-weekly schedule, in 5 fractions. Women 50 years or older, with early breast tumor with negative lymph nodes (pT1-2N0), after breast-conserving surgery with negative margins were eligible to enter in this phase II trial and received whole breast once-weekly hypofractionated radiotherapy to a total dose of 30 Gy, in 5 weekly fractions of 6 Gy. During the treatment and in post treatment follow-up the toxicity was assessed and graduated according the “Common Terminology Criteria for Adverse Events ” (CTCAE), v3.0. The quality of life was evaluated by the EORTC QLQ-30 e QLQ-BR23 questionnaires, that were applied before radiation, immediately after and 1 month after treatment. Breast pictures for aesthetic evaluation were taken in 5 moments and two breast surgeons independently graduated the cosmetics changes. From October 2013 to November 2015, 44 patients were enrolled in the trial and treated according to the protocol of once-weekly radiation. The median age was 70.5 years (51-88 years), and the median follow-up was 22 months (9-33 months). Actinic dermatitis was the most common acute adverse event. At the end of radiation, 30 patients (68,2%) had any grade of radiation dermatitis. Breast pain and hyperpigmentation were the most frequent late events. By the end of the first year of follow-up 53,8% and 51,3% developed breast pain and hyperpigmentation, respectively. Concerning the aesthetic evaluation, for only one of the two observers there was breast appearance alteration over time. For this observer, 63,6% and 13,6% of cases were classified as good or excellent in the evaluations before and after radiotherapy, respectively. After 6 months of treatment completion, 59,1% and 61,4% were aesthetic evaluated as good or excellent by each of the observers. The domain for “social function” was the only one that changed overtime in the quality of life analysis. One month after radiotherapy the median score for “social function” was greater compared to before treatment. The 2-year overall survival and disease-free survival were, respectively 96,8% and 97,7%. There was only one distant recurrence and no local or regional recurrences. Once-weekly hypofractionated radiotherapy is a feasible alternative in early breast cancer management with acceptable acute toxicity and aesthetic alterations and no meaningful quality of life impairment.

Polymorphous light eruption with complication of solar urticaria revealed by phototesting

Polymorphous light eruption with complication of solar urticaria revealed by phototesting

Cutaneous Changes During Pregnancy

Background:There are several changes which affect females’ skin that occur during pregnancy. These changes, although considered, physiological are quite distressing to many women. Discussion with the pregnant woman about the nature of her skin condition and the possible fetal risks associated with it is imperative. Aim of the work: This study aimed to evaluate the pattern of dermatological manifestations which affect pregnant women in our environment with different socio-economic levels. Patients and Methods: This study was a cross- sectional design. It included 600 pregnant women who attended Dermatology, Venereology, Andrology and Antenatal care clinics. Local examination included morphology of skin changes (monomorphic or polymorphic), type of lesion (primary or secondary), distribution of skin disease (localized or generalized, unilateral or bilateral) and site of the lesion. Results: The most common physiological skin changes were pigmentary changes (98%) followed by striae distensae (76%), vascular changes (27.3%), hair changes (20.2%), glandular changes (19%) and nail changes (2%). As regarding pigmentary changes; lineanigra (86.6%), secondary areola (74.3%) and melasma (44%) were most common pigmentary changes in pregnant women.Scabies was the most common associated dermatological disorder (2.7%) of pregnant women followed by acute urticaria (1.3%), polymorphic light eruption (1.3%) and molluscum contagiosum (0.3%) of patients.Pregnancy-induced dermatoses were found in 67 (11.3%) of pregnant women. Atopic eruption of pregnancy (44.8%) was the most common condition [i.e. includes eczema (23.9%), prurigo (14.9%) and pruritis folliculitis (6%)]; polymorphic eruptions (44.8%), intrahepatic cholestasis of pregnancy (6%) and pemphigoid gestationis (4.5%) of pregnant women. Conclusion: Pregnancy is a unique physio-logical state characterized by metabolic, immunologic, and hormonal readjustments. These make a pregnant woman vulnerable to all dermatoses occurring in the non-pregnant state and also to certain eruptions related to the physiologic burden of gestation.

EFFICACY AND SAFETY OF METHOTREXATE IN CHRONIC ACTINIC DERMATITIS: A PILOT STUDY

ABSTRACTOBJECTIVE: To evaluate the efficacy and safety of methotrexate in chronic actinic dermatitis.METHODS: Clinically and biopsy proven cases of chronic actinic dermatitis were included in study after fulfilling the inclusion criteria. Patients were given methotrexate according to protocol and efficacy was noted according to improvement in Psoriasis Area and Severity Index (PASI) score. Side effects were noted for safety evaluation.RESULTS: A total of thirty patients, 27 male and 3 females, with a mean age of 57.5±9.91 years, were included in study. Duration of disease was 10 years in 6 patients.Twenty seven patients received 10mg and 3 patients received dose of 15mg.Twenty nine patients completed 6 months of methotrexate therapy. One patient stopped treatment because of mild gastrointestinal side effects and deranged Liver Function Tests (LFTs). SGPT was 3 time above normal when treatment was stopped. Patients were evaluated at 1st week, 4th week and monthly for 6 months. Six patients (20%) showed complete recovery, 13(43%) showed 50-75% recovery, 7 (23%) showed 25-49% recovery while rest showed no improvement. Means of initial and final PASI score showed significant results with P<0.0001. The clinical response to treatment was observed at 4-6 weeks which reached to maximum in 4-6 months.CONCLUSION:We found methotrexate to be a potentially efficacious and safe drug in the treatment and asteroid sparing drug in chronic actinic dermatitis. KEY WORDS: Photosensitivity Disorders (MeSH); Chronic Actinic Dermatitis (MeSH); Efficacy (Non-MeSH); Methotrexate (MeSH); Safety (MeSH).

Polymorphic Light Eruption: What's New in Pathogenesis and Management.

Polymorphic light eruption is the commonest photosensitive disorder, characterized by an intermittent eruption of non-scarring erythematous papules, vesicles or plaques that develop within hours of ultraviolet radiation exposure of patient skin. Together with the lesions, a terrible itch starts and increases with the spreading of the disease, sometimes aggravated by a sort of burning sensation. Clinical picture and symptoms can improve during the rest of the summer with further solar exposures. In the last years many advances have been performed in the knowledge of its pathogenesis and some news have been proposed as preventive, as well as therapeutic options. All this has been discussed in the current mini review.

Exposure to Ultraviolet Radiation in the Modulation of Human Diseases.

This review focuses primarily on the beneficial effects for human health of exposure to ultraviolet radiation (UVR). UVR stimulates anti-inflammatory and immunosuppressive pathways in skin that modulate psoriasis, atopic dermatitis, and vitiligo; suppresses cutaneous lesions of graft-versus-host disease; and regulates some infection and vaccination outcomes. While polymorphic light eruption and the cutaneous photosensitivity of systemic lupus erythematosus are triggered by UVR, polymorphic light eruption also frequently benefits from UVR-induced immunomodulation. For systemic diseases such as multiple sclerosis, type 1 diabetes, asthma, schizophrenia, autism, and cardiovascular disease, any positive consequences of UVR exposure are more speculative, but could occur through the actions of UVR-induced regulatory cells and mediators, including 1,25-dihydroxy vitamin D3, interleukin-10, and nitric oxide. Reduced UVR exposure is a risk factor for the development of several inflammatory, allergic, and autoimmune conditions, including diseases initiated in early life. This suggests that UVR-induced molecules can regulate cell maturation in developing organs.

Study of Thyroid Function Tests in Cases of Polymorphic Light Eruption in Tertiary Care Institute

Background: Polymorphic Light Eruption (PLE) has been found to be associated with thyroid function abnormalities. Aim: To study and compare thyroid function tests in cases of polymorphic light eruption. Methods: The study included 35 cases of PLE and age- and sex-matched controls attending a skin outpatient department. Both cases and controls were tested for Thyroid-Stimulating Hormone (TSH). In case of abnormality in TSH, Triiodothyronine (T3) and Tetraiodothyronine (T4) levels were estimated. Results: TSH was elevated in 6 cases and 1 control. T3 and T4 were decreased in 4 cases and normal in 1 each in case and control. Hypothyroidism was seen among 6 cases and 1 control. Conclusion: Cases of PLE should be examined clinically for thyroid disorder and also tested for TSH to find any association and prevent serious consequences.

Photocontact Dermatitis and Its Clinical Mimics: an Overview for the Allergist.

Photo-contact dermatitis (PCD) describes the adverse cutaneous reaction that occurs in some patients as a result of simultaneous exposure to a contactant and to light. PCD can be subdivided into photo-allergic and photo-irritant dermatitis depending on whether the contactant respectively invokes an allergic or irritant reaction. Photo-irritant reactions are commonly caused by plants, psoralens, and medications taken internally, whereas photo-allergic reactions are commonly caused by sunscreens and topical nonsteroidal anti-inflammatory medications. The work-up of photo-contact dermatitis includes a thorough history and physical exam augmented by patch and/or photopatch testing, as the cornerstone of treatment for PCD is identification and avoidance of the irritating or allergenic chemical. Photo-contact dermatitis has the potential to significantly impact quality of life, so an informed approach to diagnosis and management is critical. Clinical mimics of PCD include polymorphic light eruption, solar urticaria, actinic prurigo, hydroa vacciniforme, cutaneous porphyrias, and systemic disorders with photosensitivity such as lupus and dermatomyositis. Herein, we review the clinical presentation, differential diagnosis (including the clinical mimics mentioned above), pathogenic mechanisms, diagnostic testing, and therapeutic considerations for PCD.