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Chapter 208: Photosensitivity

E.J. Mayeaux, Jr.

PATIENT STORY

A 50-year-old woman presented to the clinic with an abrupt onset of an intensely pruritic rash that extended over the dorsal aspect of both arms (Figure 208-1). The patient noted no new medicines and no recent exposures to any new chemicals. She acknowledged recent time spent outside in the sun. The plaques were photodistributed, with sparing of her watch area. A clinical diagnosis of polymorphous light eruption (PMLE) was made, and the patient was started on oral antihistamines and topical steroids. It was recommended that she minimize her sun exposure.

FIGURE 208-1

Polymorphous light eruption noted over dorsum of left forearm. Note absence of the lesion where the patient had been wearing her watch. (Reproduced with permission from Wenner C, Lee A. A bright red pruritic rash on the forearms, J Fam Pract. 2007;56(8):627-629. Frontline Medical Communications. Inc.)

A photo shows bright red rash extending over the back of hand and forearm. A band of clearing is seen over the wrist.
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INTRODUCTION

Photosensitivity is an abnormal skin response to ultraviolet light that occurs on sun-exposed areas of the skin. There are three common types of photodermatitis:

FIGURE 208-2

Polymorphous light eruption on the arm of a young man. Note the sparing of the skin under his watchband. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows faint red rashes in the forearm, excluding a band in the wrist.
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FIGURE 208-3

Severe phototoxic drug reaction secondary to hydrochlorothiazide use. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows dark red to purplish patches in the forearm and upper chest of a man.
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FIGURE 208-4

Phototoxic drug reaction secondary to ibuprofen. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows a homogenous pale red rash in the cheek and nose of a woman.
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FIGURE 208-5

Phototoxic drug reaction secondary to treatment of vitiligo with oral psoralen and ultraviolet light (phytophotodermatitis). Note the bullae. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows inflammatory patches and bullae in the back of both hands. Also seen are small hypopigmented patches in the fingers.
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FIGURE 208-6

Phytophotodermatitis in a woman, caused by lime juice and sun exposure on the beach. Note the hand print of her fiancé who had been squeezing limes into their tropical drinks. This contact occurred when they posed for a photograph. (Reproduced with permission from Darby-Stewart AL, Edwards FD, Perry KJ. Hyperpigmentation and vesicles after beach vacation. Phytophotodermatitis, J Fam Pract. 2006;55(12):1050-1053. Frontline Medical Communications. Inc.)

A photo shows reddish pink patches in the waist of a woman. One of the patch is shaped as a handprint.
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FIGURE 208-7

Phytophotodermatitis visible on the arm, trunk, and leg caused by lime juice and sun exposure on the beach. Note the hyperpigmentation that ...

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