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photosensitivity

Etiology: 1) idiopathic - actinic prurigo - chronic actinic dermatitis - hydroa vacciniforme - polymorphous light eruption - solar urticaria - hydroa aestivale - actinic reticuloid 2) metabolic a) porphyrias - hereditary coproporphyria - porphyria cutanea tarda - variegate porphyria - congenital erythropoietic porphyria - erythropoietic protoporphyria (EP) - almost all cases present in childhood - case of late life-onset EP reported [5] b) Bloom's syndrome c) Cockayne's syndrome d) Rothmand-Thompson syndrome e) Xeroderma pigmentosum f) phenylketonuria g) albinism h) Hartnup disease i) kwashiorkor j) pellagra k) carcinoid syndrome l) pseudoporphyria 3) neoplastic - basal cell carcinoma - actinic keratosis 4) degenerative - photoaging 5) photoaggravated a) lupus erythematosus - systemic lupus erythematosus - subacute cutaneous lupus erythematosus b) dermatomyositis, amyopathic dermatomyositis c) pemphigus foliaceus d) Herpes simplex e) lichen planus actinicus f) acne vulgaris (aestivale) g) transient acantholytic dermatosis 6) drug induced photosensitivity Pathology: - phototoxic or photoallergic abrnormal skin response to ultraviolet radiation [4] Laboratory: 1) complete blood count (CBC) 2) serum chemistries a) liver function tests b) renal function tests 3) serology a) antinuclear antibody (ANA) b) anti-SSA c) anti-SSB 4) erythrocyte chemistries a) uroporphyrin b) coproporphyrin c) protoporphyrin 5) urine a) uroporphyrin b) coproporphyrin c) aminolevulinic acid d) porphobilinogen 6) feces a) uroporphyrin b) coproporphyrin c) protoporphyrin 7) skin biopsy a) light microscopy b) direct immunofluorescence microscopy Special laboratory: 1) Phototesting 2) patch & photopatch testing 3) assessment of DNA repair Management: 1) avoid sunlight 2) sunblock (Mexoryl may help) 3) antihistamines for pruritus 4) topical glucocorticoids [4] - methylprednisolone 0.1% [6]

Related

photosensitizing agent (photosensitizer) phototherapy

Specific

drug-induced photosensitivity polymorphous light eruption (PMLE)

General

sign/symptom

References

  1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 983-89
  2. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 331
  3. Prescriber's Letter 12(8): 2005 Drug-Induced Photosensitivity Detail-Document#: 200509 (subscription needed) http://www.prescribersletter.com
  4. Medical Knowledge Self Assessment Program (MKSAP) 15, 19 American College of Physicians, Philadelphia 2009, 2022
  5. Livideanu CB et al. Late-onset x-linked dominant protoporphyria: An etiology of photosensitivity in the elderly. J Invest Dermatol 2013 Jun; 133:1688 PMID: 23223129 - Frank J et al. Photosensitivity in the elderly - think of late-onset protoporphyria. J Invest Dermatol 2013 Jun; 133:1467 PMID: 23673504
  6. Zink A and Ring J Phototoxic Dermatitis N Engl J Med 2014; 371:559. August 7, 2014 PMID: 25099580 http://www.nejm.org/doi/full/10.1056/NEJMicm1315566