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Ashley Feneran, DO
Jenifer Lloyd, DO
University Hospitals Regional Hospitals
AMERICAN OSTEOPATHIC COLLEGE OF DERMATOLOGY
Review key points of several photodermatoses
Update knowledge and treatment of photodermatoses
Discuss vitamin D levels in photodermatoses
Objectives
Types of photodermatoses
Immunologically mediated disorders
Defective DNA repair disorders
Photoaggravated dermatoses
Chemical- and drug-induced photosensitivity
Types of photodermatoses
Immunologically mediated disorders
Polymorphous light eruption
Actinic prurigo
Hydroa vacciniforme
Chronic actinic dermatitis
Solar urticaria
Polymorphous light eruption (PMLE)
Most common form of idiopathic
photodermatitis
Possibly due to delayed-type
hypersensitivity reaction to an
endogenous cutaneous photo-
induced antigen
Presents within minutes to
hours of UV exposure and lasts
several days
Superficial and deep lymphocytic infiltrate
Marked papillary dermal edema
Pathology
PMLE Treatment
Topical or oral corticosteroids
High SPF
Restriction of UV exposure
Hardening – natural, NBUVB,
PUVA
Antimalarial
PMLE updates
Study suggests topical vitamin D analogue
used prophylactically may provide
therapeutic benefit in PMLE
Gruber-Wackernagel A, Bambach FJ, Legat A, et al. Br J Dermatol, 2011.
PMLE updates
Study seeks to further elucidate the
pathogenesis of PMLE
Found a decrease in Langerhans cells and an
increase in mast cell density in lesional skin
Wolf P, Gruber-Wackernagel A, Bambach I, et al. Exp Dermatol, 2014.
Actinic prurigo
Similar to PMLE
Common in native American
children
Strong association with HLA
DR4 subtype DRB1*0407
Heals with scarring
Shallow ulcer, neutrophils, & fibrin deposits
Acanthosis, spongiosis, & superficial vessel
telangiectasias
Follicular chelitis
Pathology
Actinic prurigo treatment
Photoprotection
UV protective film on windows
Topical and oral steroids
NBUVB
Thalidomide
Pentoxifylline
Cyclosporine
Azathioprine
TNF-a inhibitors
Actinic prurigo updates
Study describes successful use of thalidomide
in 6 total adult and pediatric patients with
actinic prurigo
Regular nerve conduction studies performed
Crouch R, Foley P, Ng J, et al. Australas J Dermatol, 2002.
Hydroa vacciniforme (HV)
Rare, scarring photodermatosis
seen in early childhood
Some cases are associated
with latent EBV infection
Hemorrhagic bullae heal with
varioliform scars
Spongiosis & epidermal vesicles
Epidermal and upper dermis necrosis
Lymphocytic infiltrate of dermis
Pathology
Hydroa vacciniforme treatment
Refractory to treatment
Close monitoring for atypical
features
Photoprotection
NBUVB
Oral antimalarials
Azathioprine
Thalidomide
Cyclosporine
Beta carotene
Fish oil supplements
Hydroa vacciniforme updates
Recent case report illustrates adult-
onset HV with T-cell monoclonality with
a favorable course
Nomura H, Suzuki H, Egami S, et al. Br J Dermatol, 2015.
Chronic actinic dermatitis
Chronic eczema caused by UV
radiation and visible light
Tends to affect older men
Likely a delayed-type
hypersensitivity reaction
Often a pre-existing allergic or
photoallergic contact dermatitis
Spongiosis, acanthosis, superficial perivascular
infiltrate
Occasional apoptotic keratinocytes
Exocytosis of inflammatory cells
Pathology
Chronic actinic dermatitis treatment
Photoprotection
Topical steroids
Topical calcineurin inhibitors
NBUVB
PUVA
Azathioprine
Cyclosporine
Mycophenolate mofetil
Chronic actinic dermatitis updates
This study disproved the hypothesis that
the filaggrin gene plays a strong role in
the pathogenesis of chronic actinic
dermatitis
Harkins C, Waters A, Kerr A, et al. J Invest Dermatol, 2015.
Solar urticaria
Urticaria induced by sun
exposure
Appears within 5-10 minutes of
sun exposure & resolve over
1-2 hours
Most cases do not resolve
Risk of anaphylactic-type
response
Mild perivascular lymphocytic, mast cell, &
eosinophilic infiltrate
Mild dermal edema
Can see intraluminal neutrophils and
eosinophils
Pathology
Solar urticaria treatment
Photoprotection
Sunscreen is not particularly helpful
for those sensitive to visible light
Anti-histamines
Topical steroids
Graduated UV exposure
IVIG
Omalizumab
Plasmapheresis
Solar urticaria updates
This study showed promising results
with IVIG to treat solar urticaria,
however the duration of response was
not prolonged and adverse effects were
frequent
Aubin F, Porcher R, Jeanmougin M. J Am Acad Dermatol, 2014.
Solar urticaria updates
Case studies are conflicting on efficacy of
omalizumab in solar urticariaBaliu-Piqué C, Aquilera Peiró P. J Eur Acad Dermatol Venereol, 2015.
Müller S, Schempp C, Jakob T. J Eur Acad Dermatol Venereol, 2014.
Vitamin D levels
All of the discussed photodermatoses have the
recommendation for photoprotection, but what effect, if
any, does this have on vitamin D levels?
This prospective, longitudinal study
compared sunlight exposure,
photoprotective behavior, and vitamin D
levels in patients with photosensitivity
vs. healthy adults
Rhodes L, Webb A, Berry J, et al. Br J Dermatol, 2014.
Compared to healthy adults,
photosensitive patients had:
Lower weekend UVB doses
Smaller skin area exposure
Greater sunscreen use
Rhodes L, Webb A, Berry J, et al. Br J Dermatol, 2014.
Compared to healthy adults,
photosensitive patients had:
Lower vitamin D levels year-round
Year-round lows
Rhodes L, Webb A, Berry J, et al. Br J Dermatol, 2014.
Recommendation is to educate patients
on potential for year-round decreased
vitamin D levels and supplementation of
400IU daily
Program Director: Jenifer Lloyd, DO
PGY-3
Rosanne Paul, DO
Madeline Tarrillion, DO
PGY-2
Mathew Loesch, DO, PhD
Miesha Merati, DO
PGY-4
Aziza Wahby, DO
AMERICAN OSTEOPATHIC COLLEGE OF DERMATOLOGY
AMERICAN OSTEOPATHIC COLLEGE OF DERMATOLOGY
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