Polymorphous Light Eruption

Aka: Polymorphous Light Eruption, Polymorphic photodermatitis, Polymorphic Light Eruption, Actinic Prurigo, PMLE

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II. Epidemiology

  1. Most common Photodermatitis
    1. Prevalence may be as high as 10-20% in adults (esp. in Fitzpatrick Skin Type 1-3)
  2. Gender: Female predominance
  3. Age onset 23 years

III. Pathophysiology

  1. Primarily triggered by UVA exposure
  2. May be a Type 4 Hypersensitivity (Delayed-Type Hypersensitivity) reaction

IV. Types

  1. Papular (most common)
  2. Papulovesicular (common)
  3. Actinic Prurigo (Hutchinson Summer Eruption)
    1. Hereditary form of Polymorphous Light Eruption seen in Native Americans

V. Symptoms

  1. Onset
    1. Intensely pruritic rash within hours of Sun Exposure
    2. Rash is painful when scratched
  2. Timing
    1. Most common after Sun Exposure (even through car windows) in spring and early summer
    2. Persists 7 to 10 days

VI. Findings

  1. Pink to red lesions
    1. Primarily papular or papulovesicular
    2. Rarely Plaques or Urticaria
  2. Distribution
    1. Lesions may affect face (but typically spares other areas of the head and neck)
    2. Most commonly affected regions
      1. V-Neck region
      2. Forearms and upper arms
      3. Chest

VII. Differential Diagnosis

  1. See Photodermatitis

VIII. Course

  1. Chronic and recurrent after Sun Exposure by early summer
  2. Reactions become less significant with tolerance by late summer (only to recur in the following year)
  3. May spontaneously resolve over the course of years

IX. Management

  1. Sunscreen
    1. First-line measure, but not uniformly effective
    2. Apply SPF 50 Sunscreens every 2 hours to exposed skin
  2. Prophylaxis
    1. Beta Carotene
      1. Take 60 mg orally three times daily for 2 weeks before Sun Exposure
    2. PUVA and Narrow Band UVB at 311 nm
      1. Given in early spring (before sunny season) to induce tolerance
      2. Annual treatment with 2-3 sessions per week for 4 to 6 weeks (for 3-4 years)
    3. Corticosteroids
      1. Prednisone 20 mg/day starting 2 days before and continuing for 2 days after start of Sun Exposure OR
      2. Triamcinolone Acetonide 40 mg IM given 2 days prior to travel to sunny region

X. References

  1. Wolff et. al. (2017) Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, McGraw-Hill, Chicago, p. 202-3
  2. Oakley (2023) Polymorphic Light Eruption, StatPearls, Treasure Island
    1. https://www.ncbi.nlm.nih.gov/books/NBK430886/

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Related Studies

Ontology: Polymorphous light eruption (C0031736)

Definition (NCI) A red, edematous rash that occurs on areas of the skin with recent exposure to sunlight.
Concepts Disease or Syndrome (T047)
ICD10 L56.4
SnomedCT 367484009, 200860003, 61064008, 238525001
English PLE - Polymorphic light eruptn, polymorphic photodermatitis, polymorphous light eruption, polymorphous light eruption (diagnosis), eruptions light polymorphous, eruptions light polymorphic, polymorphic light eruption, Polymorphous light eruption (disorder), Polymorphic light eruption, Polymorphous light eruption, Polymorphous Light Eruption, Polymorphic photodermatitis, PLE - Polymorphic light eruption, Polymorphic light eruption (disorder), eruption; polymorphous light, polymorphous light; eruption, Polymorphous light eruption, NOS, Polymorphous light eruption (disorder) [Ambiguous]
Italian Eruzione polimorfica da esposizione alla luce
Japanese 多形日光疹, ﾀｹｲﾆｯｺｳｼﾝ
German Polymorphe Lichtdermatose, polymorphe Lichtdermatosen
Czech Polymorfní světelná erupce
Korean 다형 광발진
Hungarian Polymorph fény-exanthema
Spanish dermatitis polimorfa por luz solar (trastorno), dermatitis polimorfa por luz solar, erupción polimorfa por luz solar, erupción solar polimorfa, erupción polimorfa por luz solar (trastorno), dermatitis polimorfa por luz solar (concepto no activo), erupción polimorfa lumínica, fotodermatitis polimorfa (trastorno), fotodermatitis polimorfa, Erupción polimorfa por la luz solar
Dutch eruptie; polymorf door licht, polymorf door licht; eruptie, Polymorfe lichteruptie, polymorfische lichteruptie
Portuguese Erupção polimorfa à luz
French Lucite polymorphe
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Actinic prurigo (C0406217)

Concepts Disease or Syndrome (T047)
MSH C566780
SnomedCT 27687007, 201015007
English Actinic prurigo, POLYMORPHIC LIGHT ERUPTION, HEREDITARY, ACTINIC PRURIGO, HPLE, hutchinson summer prurigo, actinic prurigo, Polymorphic Light Eruption, Hereditary, Actinic Prurigo, Summer prurigo of Hutchinson, Hutchinson's summer prurigo, Actinic prurigo (disorder)
Czech Aktinické prurigo, Hutchinsonovo letní prurigo
Dutch actinische prurigo, zomer prurigo van Hutchinson
French Prurigo estival de Hutchinson, Prurigo actinique
German Hutchinson Sommerprurigo, aktinische Prurigo
Hungarian Hutchinson-féle nyári prurigo, Actinicus prurigo
Italian Prurigo attinica, Prurito estivo di Hutchinson
Japanese ｺｳｾﾝﾖｳｼﾝ, ﾊｯﾁﾝｿﾝｶｷﾖｳｼﾝ, 光線痒疹, ハッチンソン夏季痒疹
Portuguese Prurido actínico, Prurigo estival de Hutchinson
Spanish Prurigo actínico, Prurigo estival de Hutchinson, prurigo estival de Hutchinson, prurigo actínico (trastorno), prurigo actínico, prurigo solar
Derived from the NIH UMLS (Unified Medical Language System)

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