Skip to Main Content

Chapter 90: Polymorphous Light Eruption

Vijay Balakrishnan; Craig A. Elmets

POLYMORPHOUS LIGHT ERUPTION

Therapeutic Approach

Polymorphous light eruption (PMLE), sometimes called sun poisoning, is an idiopathic photodermatosis that classically presents as a persistent pruritic rash favoring sun-exposed areas of skin hours to days after prolonged sun exposure. As its name implies, PMLE can present with a variety of morphologies in sun-exposed areas including skin-colored to erythematous papules or plaques, vesicles, and erythema multiforme-like lesions. In patients with darker skin types, PMLE may present as pinpoint papules. The cornerstone of preventative measures for PMLE is rigorous sun protection. Other therapies utilizing the concept of photohardening are useful prophylactically. Asymptomatic patients may forgo treatment entirely and are unlikely to present to a dermatologist. Therapy for symptomatic patients should be based on clinical severity. See Table 90-1.

Table 90-1Polymorphous Light Eruption Treatment Table
View Table||Download (.pdf)
Table 90-1 Polymorphous Light Eruption Treatment Table
MEDICATION NAME INDICATION MECHANISM OF ACTION DOSING ADVERSE EFFECTS SUGGESTED MONITORING LEVEL OF EVIDENCE (REFERENCE)
Topical Therapy
Broad spectrum sunscreen with sun protective factor of at least 30 Prevention Photoprotective Topically with reapplication every 2-3 h Skin irritation None IB1,2
Calcipitriol cream Prevention with pretreatment Cutaneous immunosuppression Twice daily 7 d prior to photoexposure Skin irritation None IB3
Topical corticosteroids Treatment of mild to moderate PMLE Anti-inflammatory Potent topical corticosteroids once to twice daily to affected areas for 5-7 d; use lower potency for affected areas of face Atrophy, striae, acneiform lesions None IV4
Systemic Therapy
Oral corticosteroids Treatment of severe PMLE Anti-inflammatory Prednisolone 25 mg for 4-5 d Gastrointestinal disturbance; mood disturbance None IB5
Polypodium leucotomos Prevention Photoprotective According to body weight: less than or equal to 55 kg, 720 mg every day; 56-70 kg, 960 mg every day; and more than 70 kg, 1200 mg every day None reported None IIB6
Hydroxychloroquine Treatment of severe PMLE Immunomodulatory 400 mg daily for the first month and then 200 mg daily thereafter GI disturbance

Baseline CBC w/diff, CMP, at 3-4 wk and every 3 mo thereafter.

Baseline dilated eye exam and regular eye exams thereafter.

 IIA7,8
Cyclosporine Treatment of severe PMLE Immunosuppressive Starting dose of 3.3 mg/kg; dose reduced with clinical improvement Elevated blood pressure, hirsutism, gingival hyperplasia, hyperuricemia, hypomagnesemia CBC w/diff, CMP, urinalysis, baseline blood pressure, uric acid, magnesium.Repeat laboratories at mo 1, mo 2, and every 3 mo thereafter. Not recommended for longer than 1 y. III9
Azathioprine Treatment of severe PMLE Immunosuppressive Initial dose of 0.8 mg/kg/d; increase to 1.2 mg/kg/d after 6 wk Gastrointestinal disturbance, fatigue, pancytopenia CBC w/diff, CMP, TPMT. Consider repeating CBC w/diff and LFTs every 2 wk for the first 2 mo, then repeating every 3 mo thereafter. III10
Procedural Therapy
Psoralen plus UVA Photoprophylaxis Photohardening 2 to 3 times per week for an average of 5 wk in the early spring Exacerbations of PMLE None IB...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close