Photoaggravated Dermatoses Research Articles

Phototoxicity and photoallergy – A brief review on pathogenesis, recent advances, and approach to a patient with photosensitivity

Photosensitivity can result in phototoxic or photoallergic reactions. Phototoxicity is the more frequent of the two and could be acute or chronic. Clinically, erythema and edema are the hallmarks of acute phototoxic reactions. There are two mechanisms by which phototoxic reactions can happen; photodynamic (which is oxygen dependent) and non-photodynamic (which is oxygen independent). Ultraviolet B (UVB) and less effectively UVA can cause phototoxic reactions. The main action spectrum for chronic phototoxicity falls in the UVB range, as compared to the UVA rays. Other phototoxic reactions include lichenoid or lichen planus such as reaction and photo-onycholysis. Photoallergic reactions usually are due to delayed hypersensitivity reaction that manifests with papular or eczematous eruptions. Topical medications are typically the most frequent provoking cause of photoallergic skin lesions. A thorough history with detailed clinical examination is necessary for the management of photosensitivity. Availability of newer diagnostic techniques and treatment modalities gives a promising approach to the management of photo-aggravated dermatoses.

Dupilumab for patients with photoaggravated dermatoses with skin nodules as main manifestations: A case series

Photoaggravated dermatoses (PD) are diseases that occur without ultraviolet (UV) radiation but are sometimes or frequently exacerbated by UV radiation. The clinical manifestations of PD are varied, some patients may present with pruritic nodular lesions at the site of light exposure, which possibly through a light-induced type 2 inflammatory response. Some cases may be difficult to treat, safe and effective treatment methods are constantly being explored. Here, we reported five patients with moderate to severe PD with skin nodules as main manifestations successfully treated with dupilumab, who were previously resistant to conventional treatment. After the 16-week treatment period, dupilumab showed good efficacy and safety in PD mainly characterized by nodules.

Prevalence and Trend of Photodermatoses in Thailand: A 16-year Retrospective Study at Siriraj Hospital

Objective: Photodermatoses are a group of cutaneous disorders with abnormal reactions triggered by exposure to sunlight. Previous studies reported varying photodermatoses prevalence in Caucasians and African-Americans; however, it was seldom reported in the Asian population. The aim of our study was to determine the prevalence, clinical characteristics and trend of photodermatoses in Thailand. Materials & Methods: A retrospective chart review was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University using diagnoses from the International Classification of Disease (ICD), Tenth Revisions codes, between January 2005 and September 2021. Results: A total of 561 patients with definite diagnosis of photodermatoses were identified. The prevalence of photodermatoses in the outpatient dermatology clinic was 3 cases per 1,000. The most common photodermatoses was chemical and drug-induced photosensitivity (39.4%), followed by immunologically-mediated photodermatoses (30.1%), photo-aggravated dermatoses (29.4%) and genophotodermatoses (1.1%). Overall phototesting was performed in 276 cases (49.2%). In our study, some photodermatoses had unique clinical characteristics including pinpoint popular variant of polymorphous like eruption and adult-onset actinic prurigo. Over 16 years, the trend of patients being diagnosed with photodermatoses has continued to rise gradually with an increment of 1.67 times. Conclusion: Photodermatoses are uncommon in Thailand. Some photodermatoses have distinctive clinical features in Asian populations. The trend of photodermatoses in Thailand is continually rising, reflecting an increase in physicians’ awareness and knowledge of these cutaneous conditions.

Photodermatoses in Children

Photodermatoses cover the skin’s abnormal reactions to sunlight, usually to its ultraviolet (UV) component or visible light. Etiologically, photodermatoses can be classified into 4 categories: (1) immunologically mediated photodermatoses (idiopathic photodermatoses); (2) drug- or chemical-induced photosensitivity; (3) hereditary photodermatoses; and (4) photoaggravated dermatoses. The incidence of photodermatoses in the pediatric population is much lower than in adults, Polymorphous light eruption (PMLE) is the most common form of photodermatoses in children, followed by erythropoietic protoporphyria. Early diagnosis and investigations should be performed to avoid long-term complications. Photoprotection is the mainstay of photodermatoses management, including use of physical protection and sunscreen. Keywords: children, photodermatoses, photoprotection, polymorphous light eruption.

Photodermatoses: identifying abnormal skin reactions to ultraviolet radiation

This article aims to update aesthetic nurses' knowledge on a group of skin conditions associated with abnormal reactions to ultraviolet (UV) radiation (sunlight or artificial light sources), collectively referred to as photodermatoses. Photodermatoses are divided into five subgroups: immunological photodermatoses (immune-mediated skin conditions); drug or chemical photosensistive dermatoses (related to drugs, including photosensitising medications, or chemicals' reaction with light); genophotodermatoses (rare genetic skin disorders induced by light); metabolic photodermatoses (caused by a metabolic defect); and photoaggravated dermatoses (skin conditions made worse by UV radiation). This article will review and discuss three types of photodermatoses affecting adults, to aid aesthetic nurses in their assessment and diagnosis. Aesthetic nurses need to have knowledge of photodermatoses, sensitivity to UV radiation and skin typing. Medications should always be included in the patient's skin history, to ensure that photosensitivity is fully assessed before performing an aesthetic treatment. If a photodermatosis is suspected and treatment is unable to be offered, the patient should be referred back to their GP. As health educators, aesthetic nurses should also advise patients on photoprotection and prevention of skin cancer.

The Role of Polypodium leucotomos Extract in the Treatment of Porphyria Cutanea Tarda

The dermatologic manifestations of porphyrias result from localized cutaneous formation of reactive oxygen species. The significance of these inflammatory mediators may extend beyond the skin, as increased oxidative stress may play a role in the systemic manifestations of porphyrias. Polypodium leucotomos is a tropical fern that has demonstrated antioxidant, anti-inflammatory and photoprotective properties. Although it has proven effective in the treatment of various photoaggravated dermatoses, we are unaware of any prior reports citing Polypodium leucotomos as a beneficial treatment option in the setting of porphyria cutanea tarda. We describe a patient with refractory porphyria cutanea tarda, who demonstrated dramatic improvement in cutaneous lesions following the initiation of Polypodium leucotomos extract. Due to its low toxicity and demonstrated direct interference in the production of inflammatory mediators are central to cutaneous manifestations of porphyrias, we propose consideration of Polypodium leucotomos as a potential therapeutic option for patients with porphyria cutanea tarda.

Photodermatoses: Kids are not just little people

Photodermatoses are a group of skin disorders caused by abnormal reaction to ultraviolet radiation. Photodermatoses are divided into four groups: (1) immunologically mediated photodermatoses; (2) chemical- and drug-induced photodermatoses; (3) photoaggravated dermatoses; and (4) hereditary photodermatoses. This contribution discusses differences in the approach and diagnosis of pediatric and adult patients with suspected photodermatoses, focusing on immunologically mediated photodermatoses and chemical- and drug-induced photodermatoses.

Photosensitive disorders of the skin with ocular involvement

Patients with photosensitive disorders of the skin may present with ocular manifestations that are evident at birth or may be manifested later with progression of the disorder. Dermatologists should be able to recognize these and appropriately refer patients for further management. Ocular involvement associated with immunologically mediated photodermatoses, drug- and chemical-induced photosensitivity, photodermatoses associated with defective DNA repair/chromosome instability, and photoaggravated dermatoses are reviewed.Photodermatoses are commonly classified into four general groups: (1) immunologically mediated photodermatoses; (2) drug- and chemical-induced photosensitivity; (3) photodermatoses associated with defective DNA repair/chromosome instability; and (4) photoaggravated dermatoses. Photodermatoses in these groups with ocular involvement will be discussed. In addition, skin diseases associated with photophobia are also described.

Photosensitivity disorders in children

Photosensitivity disorders in children encompass a diverse group of diseases. Some inherited disorders manifest with photosensitivity early in life. Specific extracutaneous association may be the clue to diagnosis in this group of pediatric photodermatoses. Part II of this 2-part review covers hereditary photodermatoses caused by defects in nucleotide excision repair, double strand break repair, or localized or systemic biochemical abnormalities. Diagnosis and management of photoaggravated dermatoses are also discussed. Sun protection strategies are required in all patients with evidence of photosensitivity. Early recognition and prompt diagnosis is essential to minimize the long-term complications associated with inadequate photoprotection.

Photodermatoses in India

Photodermatoses are a group of disorders resulting from abnormal cutaneous reactions to solar radiation. They include idiopathic photosensitive disorders, drug or chemical induced photosensitivity reactions, DNA repair-deficiency photodermatoses and photoaggravated dermatoses. The pathophysiology differs in these disorders but photoprotection is the most integral part of their management. Photoprotection includes wearing photoprotective clothing, applying broad spectrum sunscreens and avoiding photosensitizing drugs and chemicals.

Delayed diagnosis and diminished quality of life in erythropoietic protoporphyria: results of a cross-sectional study in Sweden

Delayed diagnosis and diminished quality of life in erythropoietic protoporphyria: results of a cross-sectional study in Sweden

P96 Hydration potential of a new UVA/UVB protection cream

Aim A new UVA/UVB protection cream SPF50+ (C) has been specially formulated for dermatologists and can be used as an adjunct to the treatment of photo-aggravated dermatoses and photo-induced dermatoses. The moisturizing properties of a protection cream provide additional comfort and therefore can contribute to maximizing patient adherence. A study was performed to assess the moisturizing properties of this new product. Methods This was an intra-individual, single blind, single centre, randomized study. Subjects having dry skin on the legs were recruited for this study. Moisturizing properties of C were compared to those of 2 other products (A, S). A non treated zone served as control. A single application of 2 mg/cm2 of each product on a zone of 5 cm×5 cm (50 μl on the entire zone) was performed. The moisturizing effect of each tested product was measured using a Corneometer(r) CM 825 before products’ application (t0) and at each of the following kinetic times: t1 h, t2 h, t4 h, t8 h, t12 h and t24 h after products’ application. Results Twenty one subjects were recruited. Mean age was 35.6 years and all subjects were female. The Corneometer(r) measurements showed that C had a hydration rate significantly higher than the one measured on the non treated zone from one hour to 12 hours after its application. On the contrary, A and S never significantly differed from the non treated zone, whatever the timepoint. C also had a better moisturizing effect than all other products up to 12 hours after its application (P<0.05). When the sum of hydration gains over 24 hours was considered, C was significantly better than A, and S (P<0.001). Conclusion These study results demonstrate the superior moisturizing properties of the new UVA/UVB protection cream.

Epidermal Platelet‐activating Factor Receptor Activation and Ultraviolet B Radiation Result in Synergistic Tumor Necrosis Factor‐alpha Production

Ultraviolet B radiation (UVB) is a potent stimulator of epidermal cytokine production which has been implicated in photoaggravated dermatoses. In addition to cytokines such as tumor necrosis factor-alpha (TNF-alpha), UVB generates bioactive lipids including platelet-activating factor (PAF). Our previous studies have demonstrated that UVB-mediated production of keratinocyte TNF-alpha is in part due to PAF. The current studies use a human PAF-receptor (PAF-R) negative epithelial cell line transduced with PAF-Rs and PAF-R-deficient mice to demonstrate that activation of the epidermal PAF-R along with UVB irradiation results in a synergistic production of TNF-alpha. It should be noted that PAF-R effects are mimicked by the protein kinase C (PKC) agonist phorbol myristic acetate, and are inhibited by pharmacological antagonists of the PKC gamma isoenzyme. These studies suggest that concomitant PAF-R activation and UVB irradiation results in a synergistic production of the cytokine TNF-alpha which is mediated in part via PKC. These studies provide a novel potential mechanism for photosensitivity responses.

Photodermatoses: classification, evaluation and management

Photodermatoses are skin disorders induced or exacerbated by light. They can be broadly classified into four groups: (i) immunologically mediated photodermatoses (idioapathic); (ii) drug- and chemical-induced photosensitivity; (iii) defective DNA repair disorders; and (iv) photoaggravated dermatoses. The exact pathomechanism of those diverse skin reactions to light radiation remains unclear. Immunologically mediated photodermatoses are the most common dermatoses among all photosesnsitive disorders. The management of photodermatoses starts with clinical recognition of characteristic lesions localized predominantly in light exposed skin. Detailed history-taking, phototesting and photopatch testing are required to establish a correct diagnosis, especially if patients present in disease-free intervals. Classification and short description of distinctive clinical features of most common photodermatoses, several practical aspects of evaluation and management of the patient with photosensitivity will be outlined.

The quality of life of 790 patients with photodermatoses

Polymorphic light eruption and erythropoietic protoporphyria (EPP) have been demonstrated to have a moderate and large impact on the quality of life (QoL) of patients, respectively. However, there is little information available about the impact of other photodermatoses on QoL. To assess and compare the impact of all forms of photodermatoses on patients' QoL using the standard 1-week Dermatology Life Quality Index (DLQI) questionnaire and a modified questionnaire to assess the impact over the previous year. All patients with photodermatoses seen between 2001 and 2005 at five U.K. photobiology centres were contacted by post on the same day during a forecasted sunny week across the U.K. and asked to complete DLQI questionnaires. A total of 1877 patients were contacted. Seven hundred and ninety-seven (42%) patients replied, with a range from 30% to 48% for the five individual centres. Nearly two-thirds of patients with actinic prurigo (AP) and more than one-third of patients with photoaggravated dermatoses (PAD), chronic actinic dermatitis, EPP and solar urticaria had a DLQI of > 10, confirming a very large effect of the disorders on QoL. Of the cutaneous porphyrias, both variegate porphyria (median DLQI 3) and porphyria cutanea tarda (median DLQI 1.5) had a much lower impact on QoL than EPP. This is the first large-scale study to attempt to measure the impact of a range of photodermatoses on QoL. Photodermatoses have a major impact on QoL. This impact is highest in AP and PAD.

Polymorphous light eruption, chronic actinic dermatitis, solar urticaria and porphyria cutanea tarda

Photodermatoses can be divided into four general categories: immunologically mediated photodermatoses, drug- and chemical-induced photosensitivity, DNA repaired deficient photodermatoses and photoaggravated dermatoses. In this review, selected photodermomatoses will be discussed: polymorphous light eruption, chronic actinic dermatitis, solar urticaria and porphyria cutanea tarda. The frequency of photodermatoses has been reported from studies assessing patients in photodermatology referral centers in different parts of the world. All studies consistently showed that polymorphous light eruption is the most common primary photodermatosis, ranging in frequency from 23 to 65% of the patients referred to those centers for evaluation. Other commonly seen primary photodermatoses include solar urticaria and chronic actinic dermatitis. In studies reported from Singapore and Melbourne, Australia, photoaggravation of skin diseases was also seen commonly, probably owing to the high level of sun exposure experienced b...

Ultraviolet B Radiation Generates Platelet-activating Factor-like Phospholipids underlying Cutaneous Damage

Ultraviolet B light (UVB) causes cutaneous inflammation and cell death, but the agents responsible are not defined. These studies examined the role of the platelet-activating factor (PAF) signaling system in UVB-mediated effects. Expression of the PAF receptor in the PAF receptor-negative epidermoid cell line KB augmented apoptosis in response to UVB irradiation. Overexpression of the PAF receptor in primary human keratinocytes also enhanced UVB-mediated apoptosis in vitro, and it enhanced apoptosis in an in vivo model of human keratinocytes grafted onto severe combined immune-deficient (SCID) mice. To define the mechanism by which UVB activates the PAF receptor, we used mass spectrometry to demonstrate significant amounts of the C4 PAF analogs 1-alkyl-2-(butanoyl and butenoyl)-sn-glycero-3-phosphocholine, as well as native PAF in an epidermal cell line after UVB irradiation. Supplementing the cells with the precursor phospholipid 1-hexadecyl-2-arachidonoyl-sn-glycero-3-phosphocholine (HAPC) increased the amount of C4 PAF analogs recovered after UVB exposure. We irradiated HAPC directly and found, even in the absence of a photosensitizer, fragmentation to C4-PAF receptor ligands. We conclude UVB photo-oxidizes cellular phospholipids, creating PAF analogs that stimulate the PAF receptor to induce further PAF synthesis and apoptosis. PAF signaling may participate in the cutaneous inflammation that occurs during photo-aggravated dermatoses.

Analysis of photodermatoses seen in a predominantly Asian population at a photodermatology clinic in Singapore

The idiopathic photodermatoses have been reported to be rarer in tropical Singapore than in countries of higher latitude, with photoaggravated dermatoses and systemic phototoxicity making up most of the photodermatoses seen here. This study aims to reassess the spectrum of photodermatoses seen at the National Skin Centre, Singapore, compared with almost a decade ago, and analyse the clinical and photobiological characteristics, as compared with other countries. We reviewed the clinical data of 141 patients phototested from January 2000 to December 2001, and analysed the epidemiological, clinical and photobiological features. Photosensitive dermatoses were diagnosed in 88% (124/141) of patients phototested. In those diagnosed with photodermatoses, polymorphic light eruption (PMLE) (28%) was the most common diagnosis, followed by photoaggravated dermatoses (26%), chronic actinic dermatitis (CAD) (15%), systemic phototoxicity (15%), solar urticaria (SU) (7%), actinic prurigo (AP) (5%) and photoallergic contact dermatitis (4%). Ethnic Indians appeared to be more predisposed to PMLE; AP was diagnosed only in ethnic Chinese. The other photodermatoses occurred proportionally in all racial groups. AP differed from that found in Caucasians, being of adult onset and persistent. Abnormal phototest results were obtained in all patients with CAD, SU and AP, but only in 56% and 49% of systemic phototoxicity and PMLE, respectively. Idiopathic photodermatoses are more commonly diagnosed in Singapore than a decade ago, while the incidence of systemic phototoxicity has remained stable. The spectrum of photodermatoses in our Asian population now approximates that seen in Caucasian cohorts.

Contact and photocontact sensitivity to sunscreens. Review of a 15-year experience and of the literature.

This review summarizes published and unpublished data of our 15-year experience with sunscreen allergy and photoallergy. From 1981-1996, 402 patients with suspected clinical photosensitivity were patch and photopatch tested with the commercial sunscreens and facial cosmetics that they had used and with chemical UV absorbers, fragrance materials, preservatives, and emollients. 80 patients (20%) (28 men, 52 women) demonstrated allergic and/or photoallergic contact dermatitis to 1 or more UV absorber(s). In 47 patients with photodermatoses or photo-aggravated dermatoses and in 33 subjects with normal photosensitivity, 91 allergic and 84 photoallergic reactions to UV filters were observed. Over the years sunscreens were added to the test series, which since 1989 comprised the following 10 UV absorbers and which induced allergic (a) and photoallergic (pa) reactions (number, type of reaction): 4 UVA absorbers--isopropyldibenzoylmethane (30a/32pa); butyl methoxydibenzoyl-methane (15a/13pa); benzophenone-3 (3a/9pa); benzophenone-4 (0a/0pa); and 6 UVB absorbers--PABA (2a/2pa); octyl dimethyl PABA (1a/2pa); methylbenzylidene camphor (32a/5pa); octyl methoxycinnamate (3a/4pa); isoamyl p-methoxycinnamate (4a/10pa); and phenylbenzimidazole sulfonic acid (1a/7pa). The frequent (photo)sensitization to isopropyldibenzoylmethane was the reason that its production was discontinued in 1993. 47 patients reacted to fragrance materials, 11 to preservatives and 2 to lanolin alcohol. These constituents were contained in the commercial sunscreens and cosmetics that they had used. Continuous revision of the UV absorber photopatch test series was necessary to be closer to the real frequency of exposure and of reported (photo)allergy to newer sunscreens. Clinicians should consider contact and photocontact allergy, especially in patients with photodermatoses and photo-aggravated dermatoses, and they should perform photopatch testing. Once the culprit has been identified, its INCI (International Nomenclature Cosmetic Ingredients) designation should be given to the patient, who must be warned to avoid products containing the (photo)allergen.

Solar urticaria in an infant

A 2-year-old girl presented with a history of an erythematous rash which occurred immediately after exposure to sunlight and had been a problem since birth. Extensive laboratory investigations to exclude genophotodermatoses, photosensitivity secondary to metabolic disorders and photoaggravated dermatoses were negative. Monochromator irradiation phototesting demonstrated immediate erythematous flares to all ultraviolet B (UVB), UVA and visible wavelengths up to 500 nm. A diagnosis of solar urticaria was made and she responded to loratidine 10 mg daily. We believe this is the first report of solar urticaria, confirmed by phototesting with a monochromator so early in life.