Photosensitive disorders are caused by exposure to ultraviolet radiation. As such, the distribution is striking as it follows the areas of the skin which are exposed. The following are some diseases that are associated with light exposure.
Lupus erythematosus (SLE, DLE, SCLE)
Polymorphous Light Eruption
Epidemiology Disease Associations Gross Appearance and Clinical Variants Differential Diagnosis Prognosis Treatment Commonly Used Terms Internet Links
Increase in sunburns and photosensitivity disorders at the edge of the Antarctic ozone hole, Southern Chile, 1986-2000
Jaime F. Abarca, MDa
Claudio C. Casiccia, PhDb
Felix D. Zamorano, MScb
Punta Arenas, Chile
J Am Acad Dermatol 2002;46:193-9 Abstract quote
Background: Over the past 15 years Punta Arenas, Chile, a medium-sized city located on the extreme southern tip of South America, has repeatedly been exposed to acute, sudden episodes of highly increased levels of ultraviolet B (UVB) 280-320 nm radiation because of the passage of the spring Antarctic “Ozone Hole” overhead, or nearby.
Objective: Our purpose was to observe the relationship between episodes of ozone depletion, increased UVB radiation, and sunburns and photosensitivity disorders in Punta Arenas, Chile, during spring.
Methods: Incidence of photosensitivity disorders and sunburns was registered by dermatologists during each of the past 15 springs. Local data of sudden, severe ozone depletions (<250 Dobson units) and the corresponding increase of UVB radiation were reviewed.
Results: Patients with sunburn increased significantly during the austral spring of 1999 (P < .01). This was especially noticeable (29/31 cases) on weekends with ozone depletion, and increased UVB radiation (P < .01) occurred on the Sundays Oct 31, Nov 21, and Dec 5, 1999. The incidence of photosensitivity disorders, although statistically not significant, increased 51% over the past 7 years.
Conclusions: An acute impact on human health (sunburn) occurred because of abrupt ozone depletion and the accompanying increase in UVB during the mid and late austral spring of 1999. Most sunburns (93.5%) occurred on weekends. Ozone levels as well as seasonal and recreational factors played a mayor role in the increase in sunburns. The increase in radiation at 300 nm, the most carcinogenic wavelength, on days under the Antarctic ozone hole is a matter of special concern.
DISEASE ASSOCIATIONS CHARACTERIZATION
Analysis of patients with suspected photosensitivity referred for investigation to an Australian photodermatology clinic.
Crouch RB, Foley PA, Baker CS.
University of Melbourne, Department of Medicine (Dermatology), and Department of Dermatology, St Vincent's Hospital Melbourne.
J Am Acad Dermatol 2003 May;48(5):714-20 Abstract quote
BACKGROUND: Australia's first dedicated photodermatology clinic was established at St Vincent's Hospital Melbourne in 1993.
OBJECTIVE: We sought to review clinical diagnoses and results of investigations performed on patients seen at this institution.
METHODS: A database was created to enable a retrospective and prospective analysis of all patients attending for evaluation of suspected photosensitivity from April 1993 to October 2000.
RESULTS: A total of 513 patients were seen, 289 (56.3%) female and 224 (43.7%) male, with a mean age of 45.2 years (range: 2.6-85.9). A photosensitive disorder was diagnosed in 397 patients (77.4%), with the acquired idiopathic photodermatoses accounting for diagnoses in 215 (41.9%) of all patients seen. The most common diagnosis was polymorphous light eruption. Reduced minimal erythema doses were seen in 25.3% of all patients light tested. In those photopatch tested, 23.3% had at least 1 photocontact reaction. Allergic contact dermatitis in a photosensitive distribution was diagnosed in 7.4% of the clinic population.
CONCLUSION: A large proportion of referrals to a photodermatology clinic comprise people with acquired idiopathic photodermatoses, with other common diagnoses that may mimic photosensitivity including allergic contact dermatitis, atopic dermatitis, and rosacea.
GROSS APPEARANCE/CLINICAL VARIANTS CHARACTERIZATION General VARIANTS INFANCY WITHOUT TELANGIECTASIA Xeroderma pigmentosum
INFANCY WITH TELANGIECTASIA Bloom's syndrome
ADULTS-HERITABLE/METABOLIC DISEASES Xeroderma pigmentosum
Porphyria cutanea tarda
IN COLLAGEN VASCULAR DISEASES Systemic lupus erythematosus
Subacute cutaneous lupus erythematosus
DRUG INDUCED PHOTOTOXIC Tetracyclines
Diltiazem-Associated Photodistributed Hyperpigmentation A Review of 4 Cases Arch Dermatol. 2001;137:179-182 PHOTOALLERGIC Thiazides
PHOTOCONTACT MISCELLANEOUS Actinic reticuloid
HISTOPATHOLOGY CHARACTERIZATION VARIANTS
- Photodermatitis with Minimal Inflammatory Infiltrate: Clinical Inflammatory Conditions with Discordant Histologic Findings.
From the *Department of Pathology, Upstate Medical Center, Syracuse, New York; and the daggerDepartment of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
- Am J Dermatopathol. 2006 Dec;28(6):482-485. Abstract quote
Dermatoses associated with cutaneous photosensitivity are a group of photodistributed skin eruptions caused or exacerbated by light. Multiple clinical variants of photosensitive dermatoses have been characterized including polymorphous light eruption, chronic actinic dermatitis, solar urticaria, phototoxic and photoallergic dermatitis, reticular erythematous mucinosis, acute cutaneous lupus erythematosus, and dermatomyositis. As there may be significant overlap among the clinical presentation of these conditions, the specific diagnosis of individual photodermatosis relies heavily on characteristic histopathologic features.
We present here 5 cases of photodistributed eruptions with virtual absence of histologic epidermal changes and dermal inflammation, yet all were described clinically as being "inflammatory" and erythematous. All cases of this "pauci-inflammatory photodermatitis" presented with photodistributed bright red macular erythema or slightly indurated plaques that developed over a period of weeks to months and clinically resembled photoallergic or phototoxic drug reactions or polymorphous light eruption.
Microscopically, however, only very sparse dermal lymphocytic infiltrate was noted with no or minimal epidermal changes.
To our knowledge, the observation of clinically evident photodistributed dermatoses that demonstrate such minimal histopathologic findings has not been reported. Clinicians and histologists should be aware of the disparity that may be encountered in this setting, as the clinical features are usually far more impressive than those seen histologically.
DIFFERENTIAL DIAGNOSIS CATEGORIES
CHARACTERISTIC PHOTOTOXIC PHOTALLERGIC Incidence Usually relatively high Usually relatively low Clinical Resemble sunburn Varied Possibility of reaction on first exposure Yes No Incubation period after first exposure No Yes Development of persistent light reaction No Yes Possibility of flares at distant previously involved sites No No Cross reactions to structurally related agents No Frequent Broadening of cross reactions following repeated photopatch testing No Possible Concentration of drug necessary for reaction High Low Chemical alteration of photosensitizer Sometimes Yes Covelent binding with carrier protein No Yes Langerhans cell required No Yes Cellular passive transfer No Yes Lymphocyte stimulation test No Yes Macrophage migration inhibition test No Yes
Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 6th Edition. McGraw-Hill. 2003.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.
Basic Principles of Disease
Learn the basic disease classifications of cancers, infections, and inflammation
Commonly Used Terms
This is a glossary of terms often found in a pathology report.
Learn how a pathologist makes a diagnosis using a microscope
Surgical Pathology Report
Examine an actual biopsy report to understand what each section means
Understand the tools the pathologist utilizes to aid in the diagnosis
How Accurate is My Report?
Pathologists actively oversee every area of the laboratory to ensure your report is accurate
Recent teaching cases and lectures presented in conferences
Last Updated December 1, 2006
mail to The Doctor's Doctor with
questions or comments about this web site.
Read the Medical Disclaimer.
Copyright © The Doctor's Doctor