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Isaacs T, Lehloenya R. HIV-associated photodermatitis in African populations. FRONTIERS IN ALLERGY 2023; 4:1159387. [PMID: 37216149 PMCID: PMC10192905 DOI: 10.3389/falgy.2023.1159387] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/14/2023] [Indexed: 05/24/2023] Open
Abstract
Photosensitive dermatoses are seen in 5% of HIV-infected persons. These include drug- and chemical-induced photoallergic and phototoxic reactions, chronic actinic dermatitis of HIV, photo lichenoid drug eruptions, and porphyria. Data on photodermatitis in HIV are limited to case reports and series. The pathogenesis is not completely understood and includes a th2 phenotype in HIV which results in impaired barrier function and resultant allergen sensitisation as well as immune dysregulation. The objective of this manuscript is to review the literature on the clinical phenotype, pathogenesis, role of photo and patch testing, outcomes, and treatment of photodermatitis in HIV in an African population.
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Chimbetete T, Buck C, Choshi P, Selim R, Pedretti S, Divito SJ, Phillips EJ, Lehloenya R, Peter J. HIV-Associated Immune Dysregulation in the Skin: A Crucible for Exaggerated Inflammation and Hypersensitivity. J Invest Dermatol 2023; 143:362-373. [PMID: 36549954 PMCID: PMC9974923 DOI: 10.1016/j.jid.2022.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
Skin diseases are hallmarks of progressive HIV-related immunosuppression, with severe noninfectious inflammatory and hypersensitivity conditions as common as opportunistic infections. Conditions such as papular pruritic eruption are AIDS defining, whereas delayed immune-mediated adverse reactions, mostly cutaneous, occur up to 100-fold more during HIV infection. The skin, constantly in contact with the external environment, has a complex immunity. A dense, tightly junctioned barrier with basal keratinocytes and epidermal Langerhans cells with antimicrobial, innate-activating, and antigen-presenting functions form the frontline. Resident dermal dendritic, mast, macrophage, and innate lymphoid cells play pivotal roles in directing and polarizing appropriate adaptive immune responses and directing effector immune cell trafficking. Sustained viral replication leads to progressive declines in CD4 T cells, whereas Langerhans and dermal dendritic cells serve as viral reservoirs and points of first viral contact in the mucosa. Cutaneous cytokine responses and diminished lymphoid populations create a crucible for exaggerated inflammation and hypersensitivity. However, beyond histopathological description, these manifestations are poorly characterized. This review details normal skin immunology, changes associated with progressive HIV-related immunosuppression, and the characteristic conditions of immune dysregulation increased with HIV. We highlight the main research gaps and several novel tissue-directed strategies to define mechanisms that will provide targeted approaches to prevention or treatment.
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Affiliation(s)
- Tafadzwa Chimbetete
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Chloe Buck
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Phuti Choshi
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Rose Selim
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sarah Pedretti
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Sherrie Jill Divito
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rannakoe Lehloenya
- Division of Dermatology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Jonny Peter
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa; Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa.
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3
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Yang LH, Saeed U, Kuang YQ, Li YY. Clinical characteristics of patients with human immunodeficiency virus and immune-mediated photodermatoses: A retrospective study of 39 patients. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:140-146. [PMID: 36537697 DOI: 10.1111/phpp.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/27/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND HIV/AIDS patients are susceptible to various infectious and inflammatory dermatoses. No systemic work has been done on HIV/AIDS patients with immune-mediated photodermatoses in China. Here, we aim to determine the clinical features of immune-mediated photodermatoses in HIV/AIDS patients. METHODS A retrospective analysis of HIV/AIDS patients with immune-mediated photodermatoses was carried out with demographic data, clinical characteristics, laboratory data, and follow-up data at the First Affiliated Hospital of Kunming Medical University between 2012 and 2019. The data were subjected to statistical analysis. RESULTS A total of 39 HIV/AIDS patients with immune-mediated photodermatoses were enrolled, including 22 cases of polymorphic light eruption (PLE), 16 cases of chronic actinic dermatitis (CAD), and one actinic reticuloid. The CD4 count at the visit of the HIV-positive CAD group was lower than the PLE group (p = .049). The HIV-positive CAD group was more sensitive toward UVB than the PLE group (p = .020) and had a lower MED-UVB value (p = .044). There was no significant difference in UV tests among different categories of skin types. CONCLUSION Immune-mediated photodermatoses are a manifestation of the advanced symptom of HIV infection, and sometimes also the presenting feature of HIV infection. Compared with HIV-positive PLE patients, CAD patients showed higher sensitivity to UVB radiation and had a lower MED-UVB value. The primary treatment for immune-mediated photodermatoses in HIV/AIDS patients is HAART and sun avoidance.
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Affiliation(s)
- Lu-Hui Yang
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Ummair Saeed
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yu-Ye Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
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4
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Passeron T, Lim HW, Goh CL, Kang HY, Ly F, Morita A, Ocampo Candiani J, Puig S, Schalka S, Wei L, Dréno B, Krutmann J. Photoprotection according to skin phototype and dermatoses: practical recommendations from an expert panel. J Eur Acad Dermatol Venereol 2021; 35:1460-1469. [PMID: 33764577 PMCID: PMC8252523 DOI: 10.1111/jdv.17242] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Abstract
Increasing evidence on the impact of the different wavelengths of sunlight on the skin demonstrates the need for tailored recommendations of sunscreen according to skin phototype and dermatoses, which is now possible due to advances in the filters and formulations of sunscreens. A selective literature search was performed by an international expert panel, focusing on the type of sunscreen to recommend for photoaging, skin cancers, photodermatoses, pigmentary disorders and skin inflammatory disorders. Protection against ultraviolet (UV)B is especially important for light skin as there is a high risk of sunburn, DNA damage and skin cancers. Darker skin may be naturally better protected against UVB but is more prone to hyperpigmentation induced by visible light (VL) and UVA. Protection against UVA, VL and infrared A can be helpful for all skin phototypes as they penetrate deeply and cause photoaging. Long‐wave UVA1 plays a critical role in pigmentation, photoaging, skin cancer, DNA damage and photodermatoses. Adapting the formulation and texture of the sunscreen to the type of skin and dermatoses is also essential. Practical recommendations on the type of sunscreen to prescribe are provided to support the clinician in daily practice.
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Affiliation(s)
- T Passeron
- Department of Dermatology, Côte d'Azur University, Nice University Hospital Center, Nice, France.,INSERM U1065, C3M, Côte d'Azur University, Nice, France
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - C-L Goh
- National Skin Centre, Singapore, Singapore
| | - H Y Kang
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - F Ly
- Department of Dermatology, Cheikh Anta Diop Dakar University, EPS Institute of Social Hygiene, Dakar, Senegal
| | - A Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - J Ocampo Candiani
- Department of Dermatology, Medical Faculty University Hospital of Nuevo León, Monterrey, Mexico
| | - S Puig
- Melanoma Unit, Dermatology Department, Barcelona University Hospital Clinic, Barcelona, Spain
| | - S Schalka
- Medcin Skin Research Center and Biochemistry Department, Chemistry Institute of São Paulo University, São Paulo, Brazil
| | - L Wei
- Department of Dermatology, The General Hospital of Air Force PLA, Beijing, China
| | - B Dréno
- Department of Dermato-Oncology, CIC 1413, CRCINA, Nantes University Hospital Center, Nantes, France
| | - J Krutmann
- IUF Leibniz Research Institute for Environmental Medicine, Dusseldorf, Germany.,Medical Faculty, Heinrich-Heine-University, Dusseldorf, Germany
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Alrashidi A, Rhodes LE, Sharif JCH, Kreeshan FC, Farrar MD, Ahad T. Systemic drug photosensitivity-Culprits, impact and investigation in 122 patients. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:441-451. [PMID: 32564400 DOI: 10.1111/phpp.12583] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 05/19/2020] [Accepted: 06/13/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Systemic drugs are a potentially reversible cause of photosensitivity. We explore prevalence, impact, phototest findings and culprit drugs. METHODS Retrospective review of patients was diagnosed with drug-induced photosensitivity in a specialist photoinvestigation centre (2000-2016), using data recorded in standardized pro forma. Patients underwent detailed clinical evaluation. Monochromator phototesting was performed to 300 ± 5 nm, 320 ± 10 nm, 330 ± 10 nm, 350 ± 20 nm, 370 ± 20 nm, 400 ± 20 nm, 500 ± 20nm and 600 ± 20 nm. Broadband UVA and solar-simulated radiation (SSR) testing were performed, and photopatch testing and laboratory tests examined for other causes of photosensitivity. DLQI was evaluated. RESULTS Prevalence of drug-induced photosensitivity was 5.4% (122/2243) patients presenting with photosensitivity. Patients with drug-induced photosensitivity were 52.5% female; median 62 years (range 11-86); phototype I (17.2%), II (39.3%), III (26.2%), IV (6.5%), V (4.1%). Fifty-five (45.1%) patients had reduced erythemal thresholds on monochromator phototesting: 83.6%% to UVA alone, 14.5% to both UVA and UVB, 1.8% to UVA and visible light; 61.4% (n = 75) showed abnormal response to broadband UVR. Drugs implicated: quinine (11.5%), diuretics (10.7%; thiazide 9.8%), antifungals (9.8%), proton-pump-inhibitors (9.8%), angiotensin-converting enzyme inhibitors (7.4%), anti-inflammatory drugs (6.6%), statins (5.7%), selective serotonin reuptake inhibitors (4.9%), calcium channel antagonists (3.3%), anti-epileptics (3.3%), tricyclic antidepressants (3.3%), beta-blockers (2.5%), antibiotics (2.5%), others (≤1.6% cases each). Emerging culprits included azathioprine (2.5%) and biologics (TNF-α inhibitors, denosumab; 2.5%). Median DLQI was 11 (range 2-27) for the past year. CONCLUSION Classically described photosensitizing drugs such as thiazides and quinine remain common offenders, while emerging culprits include biologics such as TNF-a inhibitors and proton-pump-inhibitors. There is very large impact on life quality; identification facilitates measures including drug cessation and implementation of appropriate photoprotection.
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Affiliation(s)
- Amirah Alrashidi
- Faculty of Biology, Medicine and Health, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, UK
| | - Lesley E Rhodes
- Faculty of Biology, Medicine and Health, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, UK
| | - Jennifer C H Sharif
- Faculty of Biology, Medicine and Health, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, UK
| | - Firas C Kreeshan
- Faculty of Biology, Medicine and Health, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, UK
| | - Mark D Farrar
- Faculty of Biology, Medicine and Health, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, UK
| | - Tashmeeta Ahad
- Faculty of Biology, Medicine and Health, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Centre for Dermatology Research, Manchester Academic Health Science Centre, University of Manchester and Salford Royal NHS Foundation Trust, Manchester, UK
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Hamel R, Mohammad TF, Chahine A, Joselow A, Vick G, Radosta S, Boh E, Alora‐Palli M, Mistur RL, Baron ED, Cooper KD, Lim HW. Comparison of racial distribution of photodermatoses in USA academic dermatology clinics: A multicenter retrospective analysis of 1080 patients over a 10‐year period. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:233-240. [DOI: 10.1111/phpp.12543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/21/2020] [Accepted: 02/23/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Remi Hamel
- Division of Dermatology Washington University School of Medicine in St. Louis St. Louis Missouri
| | | | - Adam Chahine
- Department of Dermatology Orange Park Medical Center Orange Park Florida
| | - Andrew Joselow
- Department of Dermatology Tulane University School of Medicine New Orleans Louisiana
| | - Garrett Vick
- Department of Dermatology Tulane University School of Medicine New Orleans Louisiana
| | - Stella Radosta
- Department of Dermatology Tulane University School of Medicine New Orleans Louisiana
| | - Erin Boh
- Department of Dermatology Tulane University School of Medicine New Orleans Louisiana
| | - Maria Alora‐Palli
- Department of Dermatology Massachusetts General Hospital/Harvard Medical School Boston Massachusetts
| | - Rachel L. Mistur
- Department of Dermatology Case Western Reserve University School of Medicine Cleveland Ohio
- Department of Dermatology University Hospitals Cleveland Medical Center Cleveland Ohio
| | - Elma D. Baron
- Department of Dermatology University Hospitals Cleveland Medical Center Cleveland Ohio
- Department of Dermatology Louis Stokes Cleveland VA Medical Center Cleveland Ohio
| | - Kevin D. Cooper
- Department of Dermatology Case Western Reserve University School of Medicine Cleveland Ohio
- Department of Dermatology University Hospitals Cleveland Medical Center Cleveland Ohio
| | - Henry W. Lim
- Department of Dermatology Henry Ford Hospital Detroit Michigan
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7
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Hofmann GA, Gradl G, Schulz M, Haidinger G, Tanew A, Weber B. The frequency of photosensitizing drug dispensings in Austria and Germany: a correlation with their photosensitizing potential based on published literature. J Eur Acad Dermatol Venereol 2019; 34:589-600. [PMID: 31520553 PMCID: PMC7065208 DOI: 10.1111/jdv.15952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/23/2019] [Indexed: 01/15/2023]
Abstract
Background Drug‐induced photosensitivity refers to the development of cutaneous adverse events due to interaction between a pharmaceutical compound and sunlight. Although photosensitivity is a very commonly listed side‐effect of systemic drugs, reliable data on its actual incidence are lacking so far. Objectives A possible approach to evaluate the real‐life extent of drug‐induced photosensitivity would be an analysis of the frequency of exposure to a given photosensitizing drug combined with an indicator of its photosensitizing potential. This could serve as a basis for developing a pharmaceutical ‘heatmap’ of photosensitivity. Methods The present study investigated the number of reimbursed dispensed packages of potentially photosensitizing drugs in Germany (DE) and Austria (AT) between 2010 and 2017 based on nationwide health insurance‐based databases. In addition, an indicator for the photosensitizing potential was established for each drug based on the number of reports on photosensitivity in the literature. Results This analysis includes means of 632 826 944 (+/−14 894 918) drug dispensings per year in DE and 113 270 754 (+/−1 964 690) in AT. Out of these, the mean percentage of drugs that enlist photosensitivity as a potential side‐effect was 49.5% (±0.7) in DE and 48.2% (±1.2) in AT. When plotting the number of reimbursed dispensed packages vs. the number of reports on photosensitivity, two categories of drugs show high numbers for both parameters, that is diuretics and non‐steroidal anti‐inflammatory drugs (NSAIDs). Conclusions Diuretics and NSAIDs appear to be responsible for the greatest part of exposure to photosensitizing drugs with potential implication on public health.
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Affiliation(s)
- G A Hofmann
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - G Gradl
- German Institute for Drug Use Evaluation (DAPI), Berlin, Germany
| | - M Schulz
- German Institute for Drug Use Evaluation (DAPI), Berlin, Germany.,Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.,Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - G Haidinger
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - A Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - B Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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8
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Nassan H, Dawe RS, Moseley H, Ibbotson SH. A review of photodiagnostic investigations over 26 years: experience of the National Scottish Photobiology Service (1989-2015). J R Coll Physicians Edinb 2019. [PMID: 29537405 DOI: 10.4997/jrcpe.2017.408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The Scottish Photobiology Service is the national referral pathway for patients with cutaneous photosensitivity diseases in Scotland. We reviewed the pattern of diagnosis of photosensitivity diseases and investigations performed between 1989 and 2015. Methods and Results Data were collected from the Photodiagnostic Database, annual reports and paper records. The total number of patients assessed each year was stable over the period studied (median 242 [range 231-266]), with most being new patients (median 69 [range 62-73]%). Monochromator phototesting was the most utilised investigation, although the use of provocation testing and photopatch testing has increased. The most common diagnosis was polymorphic light eruption, and there was a trend to increasing diagnosis of photoaggravated atopic eczema. Conclusions The pattern of diagnosis of photosensitivity diseases remains fairly stable in Scotland and we wish to emphasise the importance of this Scottish specialist service for patients with photosensitivity diseases and referrers.
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Affiliation(s)
- H Nassan
- H Naasan, Dermatology Department, Ninewells Hospital and Medical School, Dundee, UK.
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10
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Ibbotson S. Drug and chemical induced photosensitivity from a clinical perspective. Photochem Photobiol Sci 2018; 17:1885-1903. [PMID: 30283959 DOI: 10.1039/c8pp00011e] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Drug photosensitivity is a relatively common occurrence and a range of mechanisms may be involved. Some of these mechanisms will be discussed, including the most common, that of drug phototoxicity. Different types of photosensitivity are addressed with respect to clinical presentation, mechanisms and additionally the contribution to our understanding through clinically directed investigations and regulatory requirements. Repeated controlled therapeutic use of drug phototoxicity, with psoralen-UVA (PUVA) photochemotherapy and photodynamic therapy (PDT) will also be discussed. Finally, the potential for drug-induced photocarcinogenesis will also be covered.
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Affiliation(s)
- Sally Ibbotson
- Photobiology Unit, Dermatology Department, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
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11
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Gutierrez D, Gaulding J, Motta Beltran A, Lim H, Pritchett E. Photodermatoses in skin of colour. J Eur Acad Dermatol Venereol 2018; 32:1879-1886. [DOI: 10.1111/jdv.15115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023]
Affiliation(s)
- D. Gutierrez
- The Ronald O. Perelman Department of Dermatology New York University New York NY USA
| | - J.V. Gaulding
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | | | - H.W. Lim
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - E.N. Pritchett
- Department of Dermatology Henry Ford Hospital Detroit MI USA
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12
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Kim HJ, Kim KH. Increased incidence of chronic actinic dermatitis in relation to climate changes and air pollution during the past 15 years in Korea. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 34:387-392. [DOI: 10.1111/phpp.12402] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Ho-Jin Kim
- Department of Dermatology; College of Medicine; Dong-A University; Busan Korea
| | - Ki-Ho Kim
- Department of Dermatology; College of Medicine; Dong-A University; Busan Korea
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13
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14
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Photodermatoses in the Pigmented Skin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:111-122. [DOI: 10.1007/978-3-319-56017-5_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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15
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Macfarlane L, Hawkey S, Naasan H, Ibbotson S. Characteristics of actinic prurigo in Scotland: 24 cases seen between 2001 and 2015. Br J Dermatol 2016; 174:1411-4. [PMID: 26847497 DOI: 10.1111/bjd.14444] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Macfarlane
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital & Medical School Dundee DD1 9SY U.K
| | - S. Hawkey
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital & Medical School Dundee DD1 9SY U.K
| | - H. Naasan
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital & Medical School Dundee DD1 9SY U.K
| | - S. Ibbotson
- Photobiology Unit Department of Dermatology University of Dundee Ninewells Hospital & Medical School Dundee DD1 9SY U.K
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16
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Chen Q, Shen M, Heng YK, Theng TSC, Tey HL, Ren EC, Chong WS. Actinic Prurigo in Singaporean Chinese: A Positive Association with HLA-DRB1*03:01. Photochem Photobiol 2016; 92:355-359. [PMID: 26787110 DOI: 10.1111/php.12569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 12/21/2015] [Indexed: 01/19/2023]
Abstract
Studies have reported the association of human leukocyte antigen (HLA) genes with susceptibility to develop actinic prurigo (AP) in Caucasians, but there were no studies in Asian populations, including the Chinese. Our study was performed to determine if AP is associated with susceptibility or protective HLA alleles or haplotypes in Singaporean Chinese. All Chinese patients diagnosed with AP at National Skin Center, Singapore, from January 2002 to April 2015 were invited to participate in the study. Clinical data and phototesting results were collated, and HLA typing was performed. Among 14 patients included, 11 were male and the mean age was 49.6 (37.9-61.3) years. All patients did not have a family history of AP and none had mucosal involvement, as such these clinical features differed from Caucasian AP patients. The frequency of DRB1*03:01 in AP patients was significantly higher compared to healthy controls (43% vs 16%, P = 0.022, odds ratio (OR) 3.89). Concurrently, the frequency of HLA-B*58:01-DRB1*03:01 haplotype was also significantly increased (25% vs 7%, P = 0.004, OR 4.23). In conclusion, HLA-DRB1*03:01 was associated with AP in Singaporean Chinese patients. This novel allelic association may possibly be utilized as a biological marker to aid in the diagnosis of AP in Chinese patients.
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Affiliation(s)
| | - Meixin Shen
- Singapore Immunology Network, A*STAR, Singapore, Singapore
| | | | | | | | - Ee Chee Ren
- Singapore Immunology Network, A*STAR, Singapore, Singapore
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Abstract
Drug-induced photosensitivity is common. The principal mechanism of systemic drug photosensitivity is phototoxicity and the principal mechanism of topical drug photosensitivity is photoallergy. Photopatch testing is helpful to determine suspected topical agent photoallergies (eg, from ultraviolet filters in sunscreens) but generally not helpful in detecting systemic drug photosensitivity. Drug-induced photosensitivity is usually best managed by stopping the suspected drug. Other measures, including phototherapy using wavelengths that do not elicit the response, are sometimes necessary.
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Abstract
Chronic actinic dermatitis (CAD) is an immunologically mediated photodermatosis characterized by pruritic eczematous and lichenified plaques located predominantly on sun-exposed areas with notable sparing of eyelids, skin folds, and postauricular skin. CAD is thought to be due to secondary photosensitization of an endogenous antigen in the skin. Management of CAD should include strict photoprotection and topical agents, including corticosteroids and calcineurin inhibitors. Other treatments with noted efficacy include oral prednisone, cyclosporine, azathioprine, and mycophenolate mofetil. Photoprotection and avoidance of allergens, if identified, may lead to spontaneous resolution of CAD in 50% of patients over 15 years.
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Affiliation(s)
- So Yeon Paek
- Department of Dermatology, Henry Ford Hospital, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA.
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA
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Wadhwani AR, Sharma VK, Ramam M, Khaitan BK. A clinical study of the spectrum of photodermatoses in dark-skinned populations. Clin Exp Dermatol 2013; 38:823-9. [PMID: 23758593 DOI: 10.1111/ced.12098] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Photodermatoses are characterized by an abnormal cutaneous response to 'ordinary' light exposure. AIM To study the spectrum of photodermatoses in populations with dark skin (skin types IV-VI) at a tertiary referral centre. METHODS Consecutive patients with skin lesions confined to or predominantly located on photoexposed parts of the body and/or with photosensitivity were enrolled in the study, and their clinical details were recorded. Diagnosis was made on clinical grounds, and relevant investigations were carried out if required. Patch and photopatch testing were carried out in patients with chronic actinic dermatitis (CAD). Selected patients with CAD also underwent phototesting with UV (ultraviolet) A and broadband UVB light. RESULTS We enrolled 362 patients (146 men, 216 women; mean age 35.6 ± 13.6 years), with mean disease duration of 3.4 years. The Fitzpatrick skin types were IV and V (52.8% and 47.2% of patients, respectively). Polymorphic light eruption (PMLE) was the commonest photodermatosis seen, affecting 59.7% of patients, followed by CAD (13.8%), collagen vascular disorders (7.7%), photoaggravated atopic dermatitis (6.1%), actinic lichen planus (ALP; 2.2%) and lichen planus pigmentosus (LPP; 1.6%). The majority (84.5%) of patients were involved in indoor work. Papular PMLE (37%) was the most common variant of PMLE, followed by pinpoint (31%), eczematous (22.2%), lichenoid (5.5%) and plaque-type (4.1%) PMLE. CONCLUSIONS The spectrum of photodermatoses in Indian patients with dark skin phototypes (IV and V), is similar to that reported from other parts of the world. PMLE was the commonest photodermatosis seen, with the pinpoint and lichenoid variants accounting for over one-third of the PMLE cases. ALP and LPP were also not uncommon in our dark-skinned population.
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Affiliation(s)
- A R Wadhwani
- Department of Dermatology and Venereology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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20
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Abstract
Photodermatoses are a group of skin diseases primarily caused by, or exacerbated by exposure to ultraviolet and or visible radiation. The effect of sunlight on skin depends on a number of factors including skin colour, skin phototype and the content and type of melanin in the skin. There are only a few studies describing photodermatoses in populations with dark skin. A PubMed search was conducted to summarize currently available information on differences in biology of melanin in dark and light skin and photodermatoses in dark skin. Dark skin is characterised by higher content of melanin, higher eumelanin to pheomelanin ratio, lower tyrosinase activity, and more effective distribution of melanin for protection against ultraviolet light. Photodermatoses are common in dark skinned patients with some variation in the spectrum of photodermatoses. Polymorphous light eruption (PMLE) is the commonest, followed by chronic actinic dermatitis. Pin-point papular and lichenoid variants of PMLE and actinic lichen planus are more frequent in dark skin whereas actinic prurigo, solar urticaria and hydroa vacciniforme are uncommon. Photodermatoses are common in dark skinned patients despite better natural photoprotection. It is proposed that lichenoid photodermatoses may be added to the classification of photodermatoses in dark skin.
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Affiliation(s)
- Vinod Kumar Sharma
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India.
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21
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Que SKT, Brauer JA, Soter NA, Cohen DE. Normal minimal erythema dose responses in patients with suspected photosensitivity disorders. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2012; 28:320-1. [DOI: 10.1111/phpp.12005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Syril Keena T. Que
- Photomedicine Section; New York University School of Medicine; New York; NY; USA
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22
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Tan AWM, Lim KS, Theng C, Chong WS. Chronic actinic dermatitis in Asian skin: a Singaporean experience. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2011; 27:172-5. [DOI: 10.1111/j.1600-0781.2011.00589.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Chao Y, Xue-min W, Yi-mei T, Li-jie Y, Yin-fen L, Pei-lan W. Effects of sunscreen on human skin’s ultraviolet radiation tolerance. J Cosmet Dermatol 2010; 9:297-301. [DOI: 10.1111/j.1473-2165.2010.00525.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bylaite M, Grigaitiene J, Lapinskaite GS. Photodermatoses: classification, evaluation and management. Br J Dermatol 2010; 161 Suppl 3:61-8. [PMID: 19775359 DOI: 10.1111/j.1365-2133.2009.09451.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Photodermatoses are skin disorders induced or exacerbated by light. They can be broadly classified into four groups: (i) immunologically mediated photodermatoses (idioapathic); (ii) drug- and chemical-induced photosensitivity; (iii) defective DNA repair disorders; and (iv) photoaggravated dermatoses. The exact pathomechanism of those diverse skin reactions to light radiation remains unclear. Immunologically mediated photodermatoses are the most common dermatoses among all photosesnsitive disorders. The management of photodermatoses starts with clinical recognition of characteristic lesions localized predominantly in light exposed skin. Detailed history-taking, phototesting and photopatch testing are required to establish a correct diagnosis, especially if patients present in disease-free intervals. Classification and short description of distinctive clinical features of most common photodermatoses, several practical aspects of evaluation and management of the patient with photosensitivity will be outlined.
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Affiliation(s)
- M Bylaite
- Department of Infectious diseases, Centre of Dermatovenereology, Vilnius University Santariskiu klinikos, Vilnius, Lithuania.
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25
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Abstract
In diagnosing actinic prurigo (AP), the patients' ethnic background is very helpful as this condition is associated with very specific ethnic groups. We discuss a patient with an unknown family history who presented with a rash that initially seemed like lupus, but was subsequently diagnosed as AP upon further evaluations.
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Affiliation(s)
- Gene Kitamura
- Loma Linda University School of Medicine, Loma Linda University, Loma Linda, California, USA
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26
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Horkay I, Emri G, Varga V, Simics E, Remenyik E. Environmental dermatology in childhood: photosensitivity. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17455111.2.6.749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recently, sunlight-induced damage of healthy human skin, including skin malignancies and a large scale of photodermatoses representing a diverse group of diseases, have increased in childhood as a result of unfavorable environmental changes. This article yields an overview of the diagnosis, the clinical features and the treatment of these conditions and disorders and also reveals perspectives. Some diseases are more frequent in the pediatric population than in adulthood, whereas others heal spontaneously during adolescence and vice versa. The majority of cases are idiopathic photodermatoses, mainly polymorphic light eruption. Photosensitivity may be an early symptom of genetic disorders, such as porphyria, or very rare genophotodermatoses. Photosensitivity, secondary to topical or systemic external agents as well as photoexacerbated dermatoses, is not so frequent in childhood. Effective photoprotection is crucial.
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Affiliation(s)
- Irene Horkay
- Department of Dermatology, University of Debrecen, Nagyerdei krt. 98, H-4032 Debrecen, Hungary
| | - Gabriella Emri
- Department of Dermatology, University of Debrecen, Hungary
| | - Viktoria Varga
- Department of Dermatology, University of Debrecen, Hungary
| | - Eniko Simics
- Department of Dermatology, University of Debrecen, Hungary
| | - Eva Remenyik
- Department of Dermatology, University of Debrecen, Hungary
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Kerr HA, Lim HW. Photodermatoses in African Americans: A retrospective analysis of 135 patients over a 7-year period. J Am Acad Dermatol 2007; 57:638-43. [PMID: 17630044 DOI: 10.1016/j.jaad.2007.05.043] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 04/24/2007] [Accepted: 05/29/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND The frequency of photodermatoses in African Americans has not been well characterized. OBJECTIVE To evaluate the frequency of photodermatoses in African Americans in an academic medical center during a 7-year period. This was compared with that observed in Caucasians seen during the same period. METHODS A retrospective chart review of 2200 dermatology clinic charts from August 1997 to September 2004 was performed. Charts of patients with International Classification of Diseases, Ninth Revision diagnostic codes related to photodermatoses were included. RESULTS Two hundred eighty patients with photodermatoses were identified: 135 (48%) African Americans, 110 (40%) Caucasians, and 35 (12%) patients of other races. In African Americans and Caucasians, the frequency of diagnoses was as follows: polymorphous light eruption (PMLE) (67.4% and 41.1%, respectively), systemic phototoxicity (13.3%, 10.7%), chronic actinic dermatitis (11.1%, 7.1%), porphyrias (0.7%, 21.4%), solar urticaria (2.2%, 8%), and other (5.2%, 10%). There was a statistically significantly higher proportion of African Americans with PMLE (P < .0001) compared with Caucasians. There was a statistically significantly higher proportion of Caucasians with porphyrias and solar urticaria (P < .001 and = .03, respectively) compared with African Americans. LIMITATIONS This study was a retrospective analysis. CONCLUSION Photodermatoses occur regularly in African Americans. With the notable exceptions of PMLE, porphyrias, and solar urticaria, the frequency of photodermatoses in African Americans was similar to that in Caucasians.
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Affiliation(s)
- Holly A Kerr
- Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 48202, USA
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