Variant Of Polymorphous Light Eruption Research Articles

Summer and spring elbow rashes is a variant of polymorphous light eruption: confirmation by photoprovocation and histopathology in a series of five cases.

Summer and spring eruptions on the elbows are a variant of polymorphous light eruption described on clinical and histopathological grounds; however, to our knowledge, they have not been confirmed by photobiological studies. Based on photobiological studies, this study aimed to demonstrate the involvement of ultraviolet-A (UVA) radiation in this variant of polymorphous light eruption occurring exclusively on the elbows. A series of five patients with polymorphous light eruption lesions on the elbows were included in our study. All patients underwent phototesting and photoprovocation of the skin lesions after exposure to a UVA light source [Philips UVA HPA lamp (400 W)]. All patients underwent punch biopsy and histopathological and immunohistochemical studies with anti-CD123. In all the cases, UVA irradiation caused the appearance of skin lesions on the elbows with characteristic polymorphous light eruption. Histological data showed edema in the superficial dermis and a perivascular lymphocytic infiltrate compatible with polymorphous light eruption. Immunohistochemical staining for CD1-23 showed negative results. For the first time, photobiological photoprovocation studies demonstrated that repeated exposure to UVA radiation leads to the generation of skin lesions on the elbows, which are clinically and histologically consistent with summer and spring eruptions, confirming that elbow rash is a variant of polymorphous light eruption.

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

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

A facial micropapular variant of polymorphous light eruption: An infrequently reported entity

A facial micropapular variant of polymorphous light eruption: An infrequently reported entity

Polymorphic light eruption sine eruptione: A variant of polymorphous light eruption

Polymorphous light eruption (PMLE) is the most common immunologically-mediated photodermatosis; it usually presents as a pruritic, papular eruption in sun-exposed regions of the skin hours to days after sun exposure. Several variants of PMLE have been described, manifesting with varying morphologies but with photosensitivity as a common etiology. Polymorphic light eruption sine eruptione (PLESE), a rare variant presenting as sun-induced pruritus without cutaneous eruption, has been reported in a single cohort of seven patients in 1988. We report a case of a 62-year-old white female who developed PLESE.

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.

Photodermatoses in the Pigmented Skin.

Skin colour (specifically in relation to its melanin content and composition) has a marked influence on its interaction with ultraviolet light. Eumelanin has mainly photoprotective properties while pheomelanin has the ability to cause formation of reactive oxygen species. This difference is responsible for the difference in incidence and presentation of various idiopathic photodermatoses in dark skinned patients compared to those with lighter skin types. Certain conditions are peculiar to darker skins including pin point popular variant of polymorphous light eruption. These differences are discussed in this chapter while also highlighting the challenges faced in performing phototesting in patients with dark skin.

Juvenile spring eruption: an outbreak report and systematic review of the literature

Juvenile spring eruption of the helices of the ears is a distinctive sun-induced condition appearing on the light-exposed skin of the ears, typically in boys and young men in early spring. To determine clinical features and outcome of juvenile spring eruption of the ears. We report a new outbreak in 14 Swiss-Italian children. A systematic search of the literature was also performed. Five outbreaks in children involved a total of 203 cases (boys, 72%), and three outbreaks in young adults involved 223 male subjects. A further 54 sporadic cases were found: 41 among children (boys, 97%) and 13 among young adult males. The typical presentation included itching and diffuse erythema of both ears starting in the evening after exposure to bright sunlight during cold weather, followed within 24-48 h by papules or blisters. No other organ system was involved. The subjects recovered spontaneously without sequelae within 1-2 weeks. In New Zealand, among 162 school-aged boys, 20 developed the condition. A limitation is that the analysis was based upon the scanty available literature. Juvenile spring eruption is a self-limiting and generally easy recognizable variant of polymorphic light eruption. Outbreaks tend to appear on sunny and cold spring days. Paediatricians and general practitioners might rapidly develop the skills necessary to clinically appreciate this condition.

Eruption over both ears

A previously healthy six-year-old Swiss girl who had had an eruption over both ears for approximately 4 days was presented to the emergency service by her parents. Itching and diffuse redness were the initial manifestation, followed by the appearance of red blisters. The child was well and active and had enjoyed playing outside in spite of cold but sunny weather. Vital signs and physical examination were normal except for some small blisters without any honey-coloured crust on the helices of both ears (Figure). Q. What is the likely diagnosis? (Answer on page 252). In this girl with an eruption over both ears, the onset in the spring following sun exposure, the symmetric distribution of rash on both ear helices, its pruritic nature and its localisation, strongly argue for the diagnosis of juvenile spring eruption of the helices of the ears. The patients are typically children, adolescents or young adults with erythematous scaly papules or vesicles on the helices of the ears. Onset occurs in the spring during sunny and cold weather, and symptoms resolve within several weeks, not to recur until the following spring. Boys are more commonly affected than girls because shorter haircuts expose their ears. The diagnosis is typically made on a clinical basis. Juvenile spring eruption of the helices of the ears is likely a quite common and perhaps under-recognized photo-induced eruption, which is considered a localized variant of polymorphous light eruption, the most common idiopathic photodermatosis. Polymorphous light eruption, often called ‘sun poisoning’, usually presents as a pruritic rash in sun-exposed areas that appears hours after sun exposure and persists for days. Treatment of juvenile spring eruption of the helices of the ears is not always needed, because of the temporary nature of the disease. Topical corticosteroids may be helpful to reduce inflammation. It is critical to emphasise sun protection.

Spring and summer eruption of the elbows: A peculiar localized variant of polymorphous light eruption

Polymorphous light eruption (PLE) is the most common form of idiopathic photodermatosis. Several morphologic variants of PLE have been described, including a localized form of PLE primarily affecting the helices of the ears. To our knowledge, the presence of lesions on the elbows as the unique manifestation of PLE has not yet been reported. We have studied 9 patients presenting with a recurrent eruption on the elbows, with clinical and histopathologic features indistinguishable from PLE, occurring during springtime. Recently, a peculiar eruption of the elbows, with similar clinical features to our patients, has been proposed as a manifestation of cutaneous lupus erythematosus. We sought to describe the clinical, histopathological, and immunohistochemical features of this peculiar eruption of the elbows. Nine patients presenting a recurrent spring eruption on the elbows, collected from April 1989 to June 2012, were retrospectively analyzed. We studied their clinical and histopathological features, and the immunophenotype of the infiltrate. Five patients were men and 4 were women. The mean age was 44.7 years. The lesions consisted of pruriginous, erythematous-edematous papules and plaques, located on both elbows. The eruption appeared during the spring or early summer and recurred seasonally. No associated symptoms were present and the eruption regressed spontaneously or with topical corticosteroids after 7 to 15 days. Histopathologically, the lesions showed typical features of PLE, with variable degree of edema in the papillary dermis, and a papillary and reticular dermal perivascular infiltrate mostly composed of small lymphocytes. Immunohistochemical studies demonstrated strong immunoreactivity for CD2, CD4, and CD8, revealing the infiltrate was composed predominantly of T lymphocytes, with a predominance of T-helper over T-cytotoxic lymphocytes. Immunostaining for CD123 was negative, highlighting the absence of plasmacytoid dendritic cells. Other T- and B-cell markers, including CD30, PD-1, CXCL13, FoxP3, CD79a, and CD56 were also negative. Retrospective case series design is a limitation. Phototests were not performed. Results of antinuclear antibodies were only available in 1 patient. We believe this recurrent eruption of the elbows represents a distinctive and localized variant of PLE rather than a peculiar manifestation of cutaneous lupus erythematosus and suggest the term "spring and summer eruption of the elbows" for this peculiar condition. The mechanism of this localization on the elbows, with sparing of other photoexposed areas, remains unknown.

Clinicopathologic study of solar dermatitis, a pinpoint papular variant of polymorphous light eruption in Taiwan, and review of the literature

A mild, micropapular eruption previously coined as "solar dermatitis" on the extensor of the forearm is a common form of photodermatitis in Taiwan. This study aimed to investigate the clinicopathologic findings of "solar dermatitis", the micropapular type of photodermatitis. We characterized the features of this photodermatitis by retrospectively reviewing and analyzing all such cases in a medical center in Southern Taiwan diagnosed during October 1988 to November 2010. A total of 34 Taiwanese patients, all with Fitzpatrick skin type III-IV, were included (M:F = 1:1; mean age = 33.5 years; range = 9-62 years). Patients typically presented numerous, monomorphous, pinhead-sized micropapules on the extensor of the forearm after a recent, more intense sun exposure. The rash was often mildly pruritic and recurred in the summer, but usually resolved in a few days after sun protection and topical corticosteroid treatment. Reduced minimal erythema dose to UVB was noted in 2 of the 5 patients tested. Histopathologic examination (n = 10) revealed a mild spongiotic dermatitis. The clinicopathologic findings of the "solar dermatitis" closely resembled those of the pinpoint papular variant of polymorphous light eruption (PP-PMLE) affecting African Americans and Asians in Singapore. PP-PMLE, micropapular light eruption in Japanese, summertime actinic lichenoid eruption in Indians and the present photodermatitis might represent a common, micropapular variant of PMLE affecting darker skin populations.

Clinicopathologic study of solar dermatitis, a pinpoint papular variant of polymorphous light eruption in Taiwan, and review of the literature

Clinicopathologic study of solar dermatitis, a pinpoint papular variant of polymorphous light eruption in Taiwan, and review of the literature

‘Lambing ears’: a blistering disorder affecting farmers at lambing time

At lambing time some farmers experience blistering and crusting of the pinnae. This occupational disease, termed 'lambing ears', does not feature in the medical literature. To define the condition and explore its pathogenesis. We obtained five biopsies from affected individuals and sent questionnaires to 69 farmers in the U.K. Farming communities abroad were also contacted. The eruption lasts for the duration of the lambing practice. The histological features are dominated by a pandermal perivascular and diffuse, predominantly T-cell lymphocytic infiltrate. Only the pinnae are affected and its incidence is related to the degree of involvement a farmer has with the animals around parturition. The condition also occurs, but less frequently, in farmers who are calving. This occupational disease occurs with close contact to lambing ewes or calving cows. The histology and distribution are comparable with the juvenile spring eruption variant of polymorphic light eruption, but its demographics are unique.

Pinpoint papular variant of polymorphous light eruption: clinical and pathological correlation

Polymorphous light eruption (PMLE) is the most common chronic idiopathic photodermatosis usually manifesting as a papular eruption along with several other morphological variants including a pinpoint papular variant. Between June 1998 and August 2003, 10 PMLE patients presented to the Department of Dermatology at Henry Ford Hospital with complaints of a pruritic pinpoint papular eruption associated with sun exposure. In six patients skin biopsies were performed along with a detailed history and complete skin examination. We correlated the histology with the clinical course of disease corresponding to acute and subacute disease presentation. We also performed immunohistochemistry on three cases to study the immunophenotype in PMLE. The clinical, histologic and immunostain findings are summarized. Acute: Clinically pinpoint papules and vesicles, some with erythematous base, were seen. Histology showed focal vesicle formation, spongiosis, oedema, red blood cells extravasation, and superficial and deep perivascular and interstitial lymphocytic infiltrate with occasional eosinophils. Subacute: Clinically pinpoint papules with or without erythema were seen. Histology of the pinpoint lesion showed a nodular collection of lymphocytes and histiocytes with claw-like extension of epidermal rete ridges at the lateral boundaries of the lesion. Overlying epidermal atrophy with adjacent spongiosis, exocytosis, oedema and a superficial perivascular lymphocytic infiltrate and parakeratosis was also observed. The histologic differential diagnosis included lichen nitidus. Immunohistochemical stains revealed the following results: CD8, CD68 positive, CD4 variable (strongly positive to negative) and S-100 negative. (i) Pinpoint papular variant of PMLE is a distinct entity, which shows characteristic histology corresponding to the clinical course of the disease (acute and subacute). (ii) The histologic and immunophenotypic differential diagnosis of this variant during the subacute phase includes lichen nitidus.

Juvenile spring eruption: clinicopathologic features and phototesting results in 4 cases

Juvenile spring eruption is a distinct photodermatosis characterized by the development of papules and vesicles on light-exposed areas of the ears usually in the early springtime. It primarily affects boys and young men, and has a tendency to occur in the form of small epidemics. We report a similar outbreak in separate groups of soldiers who were performing military exercises during cold and sunny weather of a midwinter season. The clinicopathologic features and phototesting results are described in 4 of these cases. All patients showed normal erythemal responses to monochromator phototesting with UV and visible wave bands. Photoprovative testing with repeated daily exposures of the ears to a broadband UVA source provoked diffuse erythema and itching in 1 case, whereas similar photoprovocation of a nonaffected area, ie, the flexor surface of the forearm, in 2 patients did not yield a skin reaction. Although the cause of juvenile spring eruption is not known, our observations further strengthen the hypothesis that the disorder is a localized variant of polymorphous light eruption.

Actinic prurigo and polymorphic light eruption: common pathogenesis and the importance of HLA-DR4/DRB1*0407.

Actinic prurigo (AP) and polymorphic light eruption (PLE) both belong to the group of idiopathic photodermatoses, but it remains controversial whether AP is a distinct photodermatosis or a variant of PLE. The aim of this study, by collecting data from 119 patients with features of these disorders, was to establish whether specific criteria could be used to distinguish AP from PLE prospectively. We found that presence of the eruption on both exposed and covered sites, its occurrence in winter, persistence of lesions beyond 4 weeks, mucosal and conjunctival involvement, excoriation and scarring of the skin were important features of AP which were not typical of PLE. On this basis, confident clinical diagnoses could be reached in 103 of 119 patients (87%), 57 with AP and 46 with PLE, supported by phototesting and negative lupus serology. HLA typing subsequently confirmed the strong association (90%) between AP and the DR4 allele, in particular with the rare subtype DRB1*0407 which was present in 60% of these patients. No HLA association was found in PLE. In the 16 remaining cases, however, clinical overlap meant that no definite diagnosis could be made; these patients were notionally described as having persistent PLE (PPLE). Demographic and HLA data in this group suggested that PPLE was perhaps most appropriately grouped with PLE. In addition to those patients who were difficult to classify, 35% of our typical AP patients also described clinical progression from PLE to AP, AP to PLE or coexistence of both AP and PLE. In conclusion, our study suggests that while AP and PLE are clinically distinct conditions in most cases, they may perhaps share a common pathophysiological basis. The AP phenotype may be determined by HLA and perhaps other factors in patients otherwise predisposed to PLE.

Juvenile spring eruption of the ears: a probable variant of polymorphic light eruption

We report 18 cases in which a pruritic, erythematous, papular and vesicular eruption developed on the ears following sun exposure. Four of these patients had, on other occasions, suffered from typical polymorphic light eruption. The clinical features, histological changes, and results of phototesting suggest that juvenile spring eruption of the ears is a localized form of polymorphic light eruption.

HLA typing in actinic prurigo

Thirty-two actinic prurigo patients of Cree ancestry underwent human lymphocyte antigen (HLA) typing and were compared with 32 control subjects of Cree ancestry. We found a significantly increased frequency of HLA-A24 and Cw4 antigens and a significant decrease in the frequency of the A3 antigen in actinic prurigo patients. These HLA associations may be helpful in determining whether actinic prurigo is a distinct disease or a variant of polymorphous light eruption.

Polymorphic light eruption sine eruption.

We describe seven patients, four female and three male, who developed intense pruritus on sun-exposed skin without visible change. The clinical features resembled those of polymorphic light eruption (PLE) without rash. Four patients also occasionally developed typical PLE upon sun exposure, but sun-induced pruritus alone occurred most frequently. No patient was taking any drug therapy. One patient developed similar pruritus following solar simulated irradiation, and one following PUVA therapy. All other laboratory investigations were negative. Treatment with low dose UVB phototherapy or PUVA therapy was effective. The condition, which we have called polymorphic light eruption sine eruptione (PLESE), appears to be a variant of PLE not previously reported.

Polymorphic light eruption sine eruptione

Seven patients, four female and three male, who develop intense pruritus without visible skin changes in light‐exposed areas after sun exposure are reviewed. Onset in all cases has been in childhood or adolescence and the condition has persisted indefinitely except in one patient who has been in remission‐for I year and one who was in remission for 5 years before relapse. Itching occurs on sun‐exposed areas within 45 min to 24 h and lasts for 1–5 days. No patient has taken photosensitizing medications or suffered from any significant systemic illness. There is a positive family history of polymorphic light eruption (PLE) in one, and of sunlight‐induced pruritus in another. Porphyrin studies and antinuclear factor titres are normal. Cutaneous phototesting of the back by monochromator is normal in the UV‐B, UV‐A and visible light ranges. Irradiation from a xenon arc solar simulator in one patient induced intense pruritus with no visible skin changes on the tested sites of the anterior forearm and back in a time course mimicking that of sun‐induced symptoms. Treatment by sun avoidance, topical sunscreens and antihistamines has been only partially effective. Two patients have subsequently developed occasional typical PLE upon sun exposure, but sun‐induced pruritus alone occurs most frequently. This suggests that polymorphic light eruption sine eruptione is a variant of PLE and, to our knowledge, is the first report of this condition.