Polymorphic Light Eruption Research Articles

Efficacy of Methotrexate versus Azathioprine and Their Steroid Sparing Role in the Treatment of Chronic Actinic Dermatitis: A Randomized Control Trial

Efficacy of Methotrexate versus Azathioprine and Their Steroid Sparing Role in the Treatment of Chronic Actinic Dermatitis: A Randomized Control Trial

Atopic dermatitis and its association with serum immunoglobulin E levels: our experience in KVG medical college and hospital, Karnataka

<p><strong>Background:</strong> Eczema is an inflammatory skin reaction which presents as acute, subacute and chronic forms. Eczemas persisting for more than 6 weeks or characterized by thickening and discoloration of skin is typical of chronic eczema. Atopic dermatitis (AD) is a type of chronic or chronically relapsing eczematous skin disorder. To determine the percentage of AD in all forms of chronic eczema by using HRC. We also estimated serum immunoglobulin E (IgE) levels and determined its correlation with chronic eczemas and with various clinical parameters of HRC.</p><p><strong>Methods:</strong> A total of 50 patients with chronic eczema meeting defined inclusion and exclusion criteria were enrolled in this cross-sectional study after taking an informed consent and approval of institutional ethical committee. All patients were subjected to a detailed history based on a questionnaire. A thorough clinical examination was done to determine all major and minor clinical parameters of HRC for AD. Blood samples were collected and AEC and total serum IgE levels were determined.</p><p><strong>Results:</strong> Most of our study patients were females (64%). Majority of males (77.7%) were farmers and majority of females (56.2%) were housewives assisting in fieldwork activities. Various causes of chronic eczema were clinically diagnosed AD (34%), chronic actinic dermatitis (8%), polymorphic light eruption (4%), airborne contact dermatitis (10%), phyto-photodermatitis (10%), chronic hand and/or foot eczema (16%) and seborrheic dermatitis (2%). Thirty-two patients (64%) satisfied HRC. Among all clinical parameters of HRC, pruritus and xerosis were the commonest in AD patients. Serum IgE level was raised in 58% of chronic eczema and 68.7% of AD patients.</p><p><strong>Conclusions:</strong> Serum IgE levels showed significant association with typical morphology and distribution of lesions, early age of onset and perifollicular accentuation.</p><h2> </h2>

Methoxy-Monobenzoylmethane Protects Skin from UV-Induced Damages in a Randomized, Placebo Controlled, Double-Blinded Human In Vivo Study and Prevents Signs of Inflammation While Improving the Skin Barrier.

IntroductionSun protection is important in skin care and requires special attention as inefficient protection might trigger skin pathologies including polymorphic light eruption (PLE). The reduce-improve-protect (RIP) concept to avoid the onset of ultraviolet (UV) irradiation-induced diseases or damage to human skin is important. Methoxy-monobenzoylmethane (MeO-MBM), which is neither a UVB nor a UVA filter, converts to the UV filter avobenzone under UV irradiation and further acts as a photoantioxidant during its conversion process and initially as an antioxidant material. The aim of this study was to understand the mechanisms by which MeO-MBM improves the condition of UV-stressed skin through its photoantioxidant properties. The improvement of the skin condition by the activity of MeO-MBM as active ingredient was also investigated.MethodsPotential molecular targets were identified by in silico docking to numerous cellular membrane receptors on the cell surface or nuclear membrane, followed by microarray analysis of 164 genes after MeO-MBM treatment of normal human epidermal keratinocytes (NHEK). We conducted randomized, double-blinded, intra-individual comparison vs. placebo studies on ten volunteers, aged between 34 and 65 years, to assess the effect of MeO-MBM in vivo. The effect after UV-induced inflammation was assessed in a protective and curative set-up with 2% MeO-MBM vs. 1% hydrocortisone and placebo based on the change in blood flow. The barrier function of the skin was assessed by the change in transepidermal water loss (TEWL), skin scaling and skin thickness after the treatment with MeO-MBM. Additionally, the effect of MeO-MBM after UV-induced stress on the activation of ferritin in human explants was determined ex vivo.ResultsA docking simulation of MeO-MBM showed a potential interaction with the retinoic acid receptor gamma and further revealed downregulation of proteins related to inflammation. In the protective treatment set-up, after 24 h MeO-MBM significantly reduced the delta blood flow compared to placebo, while this reduction was more prominent with hydrocortisone. In the curative treatment set-up, a greater reduction in delta blood flow was also observed with MeO-MBM compared to placebo and similar to hydrocortisone. Treatment with MeO-MBM revealed an improvement in skin barrier function as a result of decreased TEWL, reduced skin scaling and increased skin thickness. Immunohistochemistry staining of ferritin on human skin explants further showed that the treatment with MeO-MBM reduced the ferritin expression.ConclusionBased on these results, MeO-MBM is capable of exerting an anti-aging activity via the retinoic acid receptor gamma. Its anti-inflammatory and anti-oxidative activity manifested via the downregulation of multiple anti-inflammatory genes as well as the reduction of ferritin in skin tissue. This study shows that the multidimensional functionality of MeO-MBM offers an effective approach to combat acute and chronic deleterious effects of oxidative UV damage while simultaneously enhancing the skin barrier function.

Drug triggered pruritus, rash, papules, and blisters \u2013 is AGEP a clash of an altered sphingolipid-metabolism and lysosomotropism of drugs accumulating in the skin?

Rash, photosensitivity, erythema multiforme, and the acute generalized exanthematous pustulosis (AGEP) are relatively uncommon adverse reactions of drugs. To date, the etiology is not well understood and individual susceptibility still remains unknown. Amiodarone, chlorpromazine, amitriptyline, and trimipramine are classified lysosomotropic as well as photosensitizing, however, they fail to trigger rash and pruritic papules in all individuals. Lysosomotropism is a common charcteristic of various drugs, but independent of individuals. There is evidence that the individual ability to respond to external oxidative stress is crosslinked with the elongation of long-chain fatty acids to very long-chain fatty acids by ELOVLs. ELOVL6 and ELOVL7 are sensitive to ROS induced depletion of cellular NADPH and insufficient regeneration via the pentose phosphate pathway and mitochondrial fatty acid oxidation. Deficiency of NADPH in presence of lysosomotropic drugs promotes the synthesis of C16-ceramide in lysosomes and may contribute to emerging pruritic papules of AGEP. However, independently from a lysosomomotropic drug, severe depletion of ATP and NAD(P)H, e.g., by UV radiation or a potent photosensitizer can trigger likewise the collapse of the lysosomal transmembrane proton gradient resulting in lysosomal C16-ceramide synthesis and pruritic papules. This kind of papules are equally present in polymorphous light eruption (PMLE/PLE) and acne aestivalis (Mallorca acne). The suggested model of a compartmentalized ceramide metabolism provides a more sophisticated explanation of cutaneous drug adverse effects and the individual sensitivity to UV radiation. Parameters such as pKa and ClogP of the triggering drug, cutaneous fatty acid profile, and ceramide profile enables new concepts in risk assessment and scoring of AGEP as well as prophylaxis outcome.

Immunopathogenesis and management of polymorphic light eruption.

Polymorphic light eruption (PLE) is the most common immunologically mediated photodermatosis, demonstrating many abnormalities caused by critical failure of ultraviolet (UV)-induced immunosuppression. The unique expression of antimicrobial peptides in PLE, which is most likely determined by alteration of microbiome components upon UV exposure, implicates their possible triggering role and pathogenic significance in the eruption. The review aims to clarify current knowledge regarding the immunological disturbances correlated with PLE that serve a base for better understanding of molecular pathogenesis of the disease and the development of new therapeutic strategies. Preventive treatment with broad-spectrum suncreens and sunscreens containing DNA repair enzymes, as well as natural photohardening with graduate exposure to sunlight in early spring could be sufficient in milder cases. Antioxidants and topical calcipotriol are promising approach for adjuvant prevention. Phototherapy, mainly with narrow band UVB rays, is more appropriate method in severe cases of the disease. The established treatment options for PLE include local and systemic glucocorticoids, systemic nonsedative antihistamines for itch relief, and rarely, immunosuppressive drugs in the refractory cases. Like medical photohardening, afamelanotide has the potential of photoprotection by inducing a melanization of the skin. Afamelanotide is believed to be a possible new treatment option for very severe and refractory cases of PLE. Targeting the main pruritogenic cytokine, IL-31, opens a new road for the development of novel therapeutic approaches to combat moderate and severe itching in cases of PLE with intense pruritus.

POLYMORPHOUS LIGHT ERUPTION AND ITS ASSOCIATION WITH HYPOTHYROIDISM AND AUTOIMMUNE THYROIDITIS – A COMPARATIVE CROSS-SECTIONAL STUDY

BACKGROUND In many parts of the world, polymorphous light eruption (PLE) is the commonest cause of photosensitivity. Previous studies have suggested the association of PLE with multiple autoimmune diseases. Few studies are available suggesting the association of PLE with autoimmune thyroiditis. We have undertaken this study to conrm such an association and to predict which cases of PLE are likely to have hypothyroidism and autoimmune thyroiditis. METHODS This was a cross-sectional study with comparative group with 75 PLE cases and 75 controls. Thyroid function test (TFT) was done for all subjects and, if found abnormal, anti-thyroid peroxidase (TPO) antibodies were tested. The studied parameters were compared using Pearson's chi-squared test for signicance. RESULTS The male to female ratio was 1:2.1. Hypothyroidism and autoimmune thyroiditis were signicantly present in PLE cases. PLE lesions with papular morphology, persistent and recurrent PLE, positive family history and associated other autoimmune diseases were signicantly associated with autoimmune thyroiditis. CONCLUSION PLE is signicantly associated with hypothyroidism and autoimmune thyroiditis. Hence we suggest screening of PLE patients for hypothyroidism and, if required, for autoimmune thyroiditis for early diagnosis and treatment.

Trichoscopy may enhance the differential diagnosis of erythroderma.

There is a paucity of data concerning the usefulness of trichoscopy in patients with erythroderma. The aim of the study was to compare the trichoscopic features in erythroderma of various aetiologies. In total, 49 patients with a determined cause of erythroderma [including atopic dermatitis (AD), mycosis fungoides (MF), allergic contact eczema (ACE), psoriasis (Pso), Sézary syndrome (SS), drug reaction, pityriasis rubra pilaris (PRP), dermatomyositis (DM), actinic reticuloid (AR), crusted scabies (CS) and pemphigus foliaceus (PF)] were included in the study. Dotted vessels were present in patients with AD, PRP, MF, SS and Pso, and absent in DM, CS and PF (χ², P < 0.02). Spermatozoon-like vessels were observed only in MF and SS (P = 0.001). Whitish-pinkish structureless areas were described in all patients with DM, AR and CS (P < 0.03). The type of vessel and the presence of whitish-pinkish structureless areas under trichoscopy may indicate the cause of erythroderma.

313 Photoprotective effects of liposomal DNA repair enzymes are independent of its effect on the microbiome

Solar ultraviolet radiation (UVR) is a mutagenic agent causing damage to the DNA and resulting in photoageing and carcinogenesis. Polymorphic light eruption (PLE) is a frequent skin disorder characterized by the appearance of itchy polymorphic skin lesions (photodermatosis) which is triggered by natural sunlight. In our previous study, PLE patients treated with liposomal DNA repair enzymes diminished induction of PLE symptoms, however the underlying mechanisms remained unraveled. We now investigated whether the therapeutic potential of topical DNA repair enzymes is due to its effect on the skin resident microbes, which are also impacted by UV exposure. To test this hypothesis, we investigated the effect of DNA repair enzymes (photolyase from Anacystis nidulans and Micrococcus luteus extract with endonuclease activity) on the survival of commensal skin microbes subjected to UVB radiation. Briefly, strains of microbes (Staphylococcus aureus or S. epidermidis) were cultured and exposed to varying doses of UVB. DNA repair enzymes incorporated in liposomes or vehicle (liposomes alone) were added to the culture medium/plate either before or after UVB exposure, followed by photoactivating visible (blue) light exposure or not in the case of photolyase administration. The colony forming units of the cultures was quantified throughout the protocol. The results showed no significant difference in the survival of either the pathogenic or the commensal bacterial strain treated with liposomal DNA repair enzymes following exposure to UVB radiation. Taken together, this data suggests that photoprotective effect of DNA repair enzymes is independent of its direct activity on the skin microbiome.

Turn the light on photosensitivity

Photosensitivity plays a role in a variety of skin diseases but most of the causative mechanisms are still not completely resolved. Ultraviolet (UV) radiation can have both immunosuppressive and inflammatory effects as well as influence antimicrobial peptides, produce reactive oxygen species and induce DNA damage. This review discusses the multitude of these mechanisms and the current knowledge on their role in diseases such as cutaneous lupus erythematosus (CLE), phototoxic/photoallergic reactions and polymorphic light eruption (PLE).Currently, photosensitization can only be prevented by either avoiding known sensitizing compounds or by avoiding UV-exposure itself. Therefore, it is important to better understand the underlying mechanisms with the aim to develop strategies to counteract the deleterious effects of photosensitization in the diseases above.

Contribution of phototesting in the diagnosis of photodermatoses: Retrospective study of 100 cases.

Photodermatoses are sun-related inflammatory skin diseases. They usually require phototesting in diagnosis. However, fewer and fewer medical centers in France are equipped with photobiological equipment. The main purpose was to evaluate the relevance of phototesting in photodermatosis diagnosis. The second goal was to study the proportions of the different kinds of photodermatosis found in this particular study. This study was descriptive, retrospective, and mono-centric. It was based on 100 consecutive patients, who have been phototested in a French University Hospital from 2014 to 2018. Phototesting included determination of the minimal erythematous dose (MED), UVA and UVB phototests, and photopatch testing. The use of phototesting led to 60% of photodermatosis diagnosis and formally eliminated the latter in 13% of the cases. The diagnosis remained undetermined in 27% of the cases. Nineteen cases of polymorphous light eruption (PLE), 14 cases of photocontact dermatitis (PCD), 10 cases of solar urticaria, 8 cases of photo-aggravated atopic eczema, 5 cases of chronic actinic dermatitis, and 2 cases of systemic photosensitization were diagnosed. The allergens involved in PCD were topical non-steroidal anti-inflammatory drug (NSAID) in 9 cases, sunscreens in 3 cases, and fragrance in 2 cases. The average amount of time between the first symptoms and actual phototesting was about 7,5years. This study confirms phototesting is truly useful. PLE was the most common form of photodermatosis, followed by PCD and solar urticaria. As photodermatosis could imply severe diseases sometimes requiring hospitalization, it is critical to maintain this expertise.

La hidroxicloroquina como fármaco fundamental en dermatología y su papel controvertido en la COVID-19

Hydroxychloroquine is an antimalarial drug with immunomodulatory, anti-inflammatory, antibacterial, and antiviral properties. It has a good safety profile, can be used in children and in pregnant and breastfeeding women, and does not suppress the immune system. Regular screening for retinopathy, one of the drug's most feared adverse effects, is necessary. Hydroxychloroquine is a widely used, essential drug in dermatology. Clinical response rates are good in lupus erythematous, where it is a first-line therapy, as well in numerous autoimmune/inflammatory diseases, including lichen planus, polymorphic light eruption, porphyria cutanea tarda, granuloma annulare, and sarcoidosis. In 2020, it was widely prescribed both to prevent and to treat COVID-19 caused by SARS-CoV-2. Its increased use led to serious supply shortages and in some cases stocks were entirely depleted. Recent meta-analyses have concluded that hydroxychloroquine is ineffective against COVID-19 and have advised against its use.

S2k guideline: Diagnosis and management of cutaneous lupus erythematosus - Part1: Classification, diagnosis, prevention, activity scores.

S2k guideline: Diagnosis and management of cutaneous lupus erythematosus - Part1: Classification, diagnosis, prevention, activity scores.

Long-Term Course of Polymorphic Light Eruption: A Registry Analysis.

Background: Little is known about the long-term course of polymorphic light eruption (PLE).Objective: To predict disease course, a questionnaire was sent to patients whose PLE had been diagnosed between March 1990 and December 2018 and documented in the Austrian Cooperative Registry for Photodermatoses.Methods: In January 2019, 205 PLE patients were contacted by mail and asked to complete a questionnaire on their disease course, including whether the skin's sun sensitivity had normalized (i.e., PLE symptoms had disappeared), improved, stayed the same, or worsened over time. Patients who reported normalization of sun sensitivity were asked to report when it had occurred.Results: Ninety-seven patients (79 females, 18 males) returned a completed questionnaire. The mean (range) duration of follow-up from PLE onset was 29.6 (17–54) years for females and 29.4 (16–47) years for males. The disease disappeared in 32 (41%) females after 17.4 (2–41) years and in 4 (24%) males after 11.8 (5–26) years. Twenty-nine (37%) females and 6 (35%) males reported improvement of symptoms over time; 15 females (19%) and 7 males (41%) reported no change; and 3 females (4%) and no males reported worsening of symptoms. Kaplan-Meier analysis revealed that after 20 years 74% (95%CI, 64–82%) of patients still suffered from PLE. PLE lesion persistence (>1 week) tended to predict a prolonged course of PLE.Conclusions: PLE usually takes a long-term course over many years though in most patients its symptoms improve or disappear over time. How improvement relates to the pathophysiology of the disease remains to be determined.

Senescent Progenitor Cells in the Skin of Patients with Cutaneous Lupus Erythematosus

Senescent Progenitor Cells in the Skin of Patients with Cutaneous Lupus Erythematosus

A study of the pattern of dermatoses in adolescent patients in South India.

Adolescence describes the age group between 10 and 19 years. This is the transitional stage of physical and physiological human development generally occurring between puberty and adulthood. Hormonal changes occurring during puberty result in various physical and psychological changes, affecting their social relationship. At this stage, external appearance is of immense concern to them. As such, any dermatological condition can extremely affect their psychological status. This study was conducted to give an insight on the various dermatological conditions of the adolescent age groups and their incidence. Study design: Descriptive study - Cross-sectional study. Three hundred patients between the ages of 10 and 19 years, attending the tertiary care center in South India, were included in the study. A detailed history, clinical examination, and appropriate laboratory investigations were carried out. Out of 300 patients, females (52.7%) more commonly presented with dermatoses than males (47.3%). Most of the 300 patients belonged to the age group of 17-19 years (50.33%). Infections/infestations (39%) were the most predominant dermatoses followed by acne (17.67%), eczema (9.67%), insect bite reactions (IBRs) (7%), keratinization disorders (6.67%), polymorphic light eruptions (PLEs) (4.33%), urticaria (4.33%), and pigmentary disorders (4.33%). This study gives an insight of various dermatological conditions among the adolescent age groups. Females more commonly presented with dermatoses. The most common dermatoses were infections. Since very few studies regarding dermatoses in adolescents are available in the literature, this study is distinctive in this regard.

Clinical Role of Oral Vitamin C and E Therapy in Skin and Hair Disorders

Clinical Role of Oral Vitamin C and E Therapy in Skin and Hair Disorders

Tyrosine kinase Inhibitors in Dermatology: A Systemic Review

The inhibition of enzyme subgroups of tyrosine kinases can block the ability of various cytokines at the same time. Tyrosine kinase inhibitors are a class of drugs that can be used either primarily as oral medicines or in dermatological definitions locally. In several skin problems, restraint of tyrosine kinases has been demonstrated to be advantageous. Aim of this article is to explore the role of tyrosine kinase inhibitors in various skin diseases. Tyrosine inhibitors have demonstrated a guaranteed response in psoriasis, alopecia areata, Vitiligo, while the variable response in other skin disorders, including atopic dermatitis, chronic actinic dermatitis, dermatomyositis, erythema multiforme, graft-versus-host disease, hypereosinophillic syndrome, STING vasculopathy, palmoplantar pustulosis and lupus. The approach of Tyrosine inhibitors in dermatology has been met with incredible interest. This class of prescriptions can generously propel the treatment of inflammatory and immune mediated dermatoses. It is still too early to make a strong inference regarding these medicines' place in dermatological treatment, even though the evidence provides promising results.

Case Report on Chronic Actinic Dermatitis

Abstract: Chronic Actinic Dermatitis (CAD) or Chronic Photosensitivity Dermatitis is an immunologically mediated photodermatosis which is characterized by pruritic eczematous lesions, severely itchy, red, inflamed and thickened dry skin of sun exposed areas. The other term of chronic actinic dermatitis is Actinic reticuloid. It is usually seen in patients older than 50 years of age. The etiology of chronic actinic dermatitis is not identified until now. The diagnosis of chronic actinic dermatitis is based on patient history, cutaneous findings and histological features (biopsy). Photo protection measures are a central management of chronic actinic dermatitis. Other therapeutic remedies include immunosuppressive agents and antihistamines. Here we reported a case of chronic actinic dermatitis presenting with long history of itching and reddish lesions, multiple hyper pigmented and erythematous papules and plaques present over the body. On the scalp there is multiple well defined de-pigmented and erythematous plaques were present. The patient condition improved with the use of steroids, antihistamines and sunscreens. Key words: Chronic actinic dermatitis, Photodermatosis, Photoprotection, Photopatch, Photosensitive.

HPLC methods for choloroquine determination in biological samples and pharmaceutical products.

Review and assess pharmaceutical and clinical characteristics of chloroquine including high-performance liquid chromatography (HPLC)-based methods used to quantify the drug in pharmaceutical products and biological samples. A literature review was undertaken on the PubMed, Science Direct, and Scielo databases using the following keywords related to the investigated subject: 'chloroquine', 'analytical methods', and 'HPLC'. For more than seven decades, chloroquine has been used to treat malaria and some autoimmune diseases, such as lupus erythematosus and rheumatoid arthritis. There is growing interest in chloroquine as a therapeutic alternative in the treatment of HIV, Q fever, Whipple's disease, fungal, Zika, Chikungunya infections, Sjogren's syndrome, porphyria, chronic ulcerative stomatitis, polymorphic light eruption, and different types of cancer. HPLC coupled to UV detectors is the most employed method to quantify chloroquine in pharmaceutical products and biological samples. The main chromatographic conditions used to identify and quantify chloroquine from tablets and injections, degradation products, and metabolites are presented and discussed. Research findings reported in this article may facilitate the repositioning, quality control, and biological monitoring of chloroquine in modern pharmaceutical dosage forms and treatments.

Photopatch testing in Chinese patients: A 5-year experience.

In 2015, a Chinese expert consensus on photopatch testing (PPT) was established, based on European consensus methodology. To update current information on the prevalence of photoallergic contact dermatitis (PACD) to 20 photoallergens and their clinical relevance in the Chinese context. A retrospective analysis of 2372 patients who performed PPT in a tertiary referral center in China between 2015 and 2019 was completed. A total of 1208 PACD reactions were observed in 897 (37.8%) patients, and 413 reactions were of current or past relevance. The proportion of reactions of current or past relevance was 34.2%. The most frequent photoallergens were chlorpromazine, thimerosal, potassium dichromate, and formaldehyde. The ultraviolet absorbers, benzophenone and Para-aminobenzoic acid, showed opposite gender distribution to PACD. Twenty-five patients (1.9%) developed PACD reactions to a newly added photoallergen preparation - fragrance mix I. Patients with chronic actinic dermatitis, widespread exposed-site or generalized dermatitis, and older age were more likely to have PACD. This study is the first to profile PACD reactions with clinical relevance in China. The prevalence of PACD to culprit photoallergens was affected by regional peculiarities. Attention needs to be paid to the age, body-site distribution, and known diagnoses of patients for the identification of PACD.