Abstract
Polymorphous light eruption (PLE) is the commonest immuno-mediated photodermatosis. It occurs after solar or artificial UV-light exposure and affects only the sun-exposed areas with preference of the V-area of the chest, of arms and forearms, legs, upper part of the back, and rarely the face. The lesions are itching or burning, and vary morphologically from erythema to papules, vesico-papules and occasionally blisters, plaques, sometimes erythema multiforme-like, insect bite-like wheals and purpura. The clinical manifestations befall within a few hours to days from light exposure, last a few days, and subside in about a week without sequelae. Its diagnosis is based on history, morphology and phototests. PLE is considered as a delayed hypersensitivity response to newly UV induced, but still unidentified, antigen(s). Usually, MED is normal, but the provocative phototests with UVA or UVB reproduce the spontaneous lesions in about 50% of the patients. Broad spectrum sunscreens and antioxidants, photohardening with PUVA or narrow band UVB may be beneficial to prevent the disease. Therapy is based mainly on topical or systemic corticosteroids.
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References
Bateman D (1817) Delineations of cutaneous disease. Longman, London
Rasch C (1900) Om et polymorft [erythematost, vesikulost og ekzematoidt] lysudslet. Hospitalstid 43:478–480
Tutrone WD, Spann CT, Scheinfeld N et al (2003) Polymorphic light eruption. Dermatol Ther 16:28–39
Gruber-Wackernagel A, Byrne SN, Wolf P (2014) Polymorphous light eruption: clinic aspects and pathogenesis. Dermatol Clin 32:315–334
Honigsmann H (2008) Polymorphous light eruption. Photodermatol Photoimmunol Photomed 24:155–161
Morison WL, Stern RS (1982) Polymorphous light eruption: a common reaction uncommonly recognized. Acta Derm Venereol 62:237–240
Stratigos AJ, Antonoiu C, Katsambas AD (2002) Polymorphous light eruption. J Eur Acad Dermatol Venereol 16:193–206
Pao C, Norris PG, Corbett M et al (1994) Polymorphic light eruption: prevalence in Australia and England. Br J Dermatol 130:62–64
Sharma L, Basnet A (2008) A clinicoepidemiological study of polymorphic light eruption. Indian J Dermatol Venereol Leprol 74:15–17
Procaccini EM, Fabbrocini G, Affaticati V et al (2006) Epidemiologic data about polymorphous light eruption in Italy. G Ital Dermatol Venereol 141:215–219
Rhodes LE, Bock M, Janssens AS et al (2010) Polymorphic light eruption occurs in 18% of Europeans and does not show higher prevalence with increasing latitude: multicenter survey of 6,895 individuals residing from the Mediterranean to Scandinavia. J Invest Dermatol 130:626–628
Nakamura M, Henderson M, Jacobsen G et al (2014) Comparison of photodermatoses in African-Americans and Caucasians: a follow-up study. Photodermatol Photoimmunol Photomed 30:231–236
Kerr HA, Lim HW (2007) Photodermatoses in African Americans: a retrospective analysis of 135 patients over a 7-year period. J Am Acad Dermatol 57:638–643
Ros AM (1988) Solar purpura-an unusual manifestation of polymorphous light eruption. Photo-Dermatology 5:47–48
Hölzle E, Plewig G, von Kries R et al (1987) Polymorphous light eruption. J Invest Dermatol 88(3 Suppl):32s–38s
Hasan T, Ranki A, Jansen CT et al (1998) Disease associations in polymorphous light eruption. A long-term follow-up study of 94 patients. Arch Dermatol 134:1081–1085
Dover JS, Hawk JL (1988) Polymorphic light eruption sine eruption. Br J Dermatol 118:73–76
Kontos AP, Cusack CA, Chaffins M et al (2002) Polymorphous light eruption in African Americans: pinpoint papular variant. Photodermatol Photoimmunol Photomed 18:303–306
Bansal I, Kerr H, Janiga JJ et al (2006) Pinpoint papular variant of polymorphous light eruption: clinical and pathological correlation. J Eur Acad Dermatol Venereol 20:406–410
Isedeh P, Lim HW (2013) Polymorphous light eruption presenting as pinhead papular eruption on the face. J Drugs Dermatol 12:1285–1286
AlJasser MI, Lui H, Ball NJ et al (2013) Persistent polymorphous light eruption after ultraviolet A1 phototherapy. Photodermatol Photoimmunol Photomed 29:52–54
Goitre M, Roncarolo G (1987) Unusual photodermatitis. Presentation of 2 cases. G Ital Dermatol Venereol 122:261
Molina-Ruiz AM, Sanmartin O, Santonja C et al (2013) Spring and summer eruption of the elbows: a peculiar localized variant of polymorphous light eruption. J Am Acad Dermatol 68:306–312
Knight TE (1994) Solar [ brachioradial] pruritus. Int J Dermatol 33:206–209
Shumway NK, Cole E, Fernandez KH (2016) Neurocutaneous disease: Neurocutaneous dysesthesias. J Am Acad Dermatol 74:215–228
Hawk J (1996) Juvenile spring eruption is a variant of polymorphic light eruption. N Z Med J 109:389
Lava SA, Simonetti GD, Ragazzi M et al (2013) Juvenile spring eruption: an outbreak report and systematic review of the literature. Br J Dermatol 168:1066–1072
Norris PG, Hawk JLM (1999) The idiopathic photodermatoses: polymorphic light eruption, actinic prurigo and hydroa vacciniforme. In: Hawk JLM (ed) Photodermatology. Arnold, London, pp 106–108
Ross G, Foley P, Baker C (2008) Actinic prurigo. Photodermatol Photoimmunol Photomed 24:272–275
Grabczynska SA, McGregor JM, Kondeatis et al (1999) E Actinic prurigo and polymorphic light eruption: common pathogenesis and the importance of HLA-DR4/DRB1*0407. Br J Dermatol 140:232–236
Norris PG, Hawk JLM (1999) The idiopathic photodermatoses: polymorphic light eruption, actinic prurigo and hydroa vacciniforme. In: Hawk JLM (ed) Photodermatology. Arnold, London, pp 108–109
Thomas P, Amblard P (1988) Lucite idiopathiques in Photodermatologie et Phototherapie, Paris, Masson, 49–53
Guarrera M, Cardo P, Rebora AE et al (2011) Polymorphous light eruption and benign summer light eruption in Italy. Photodermatol Photoimmunol Photomed 27:35–39
Leroy D, Dompmartin A, Verneuil L et al (2002) La lucite estivale bénigne existe-t-elle? Ann Dermatol Venereol 129:855–858
Hawk J (2004) Benign summer light eruption and polymorphic light eruption: genetic and functional studies suggest that a revised nomenclature is required. J Cosmet Dermatol 3:173–175
Farmer ER, Hood AF (2000) Pathology of the skin, 2nd edn. McGraw Hill, New York, p 331
Pincus LB, LeBoit PE, Goddard DS et al (2010) Marked papillary dermal edema–an unreliable discriminator between polymorphous light eruption and lupus erythematosus or dermatomyositis. J Cutan Pathol 37:416–425
Calzavara Pinton PG, Venturini M, Capezzera R, Zane C, Facchetti F (2003) Photosensitive erythema multiforme and erythema multiforme-like polymorphous light eruption. Photodermatol Photoimmunol Photomed 19:157–159
Tzaneva S, Voltc-Platzer B, Kittler H et al (2008) Antinuclear antibodies in patients with polymorphic light eruption: a long-term follow-up study. Br J Dermatol 158:1050–1054
Cahn M, Levy EJ, Shaffer B (1963) Polymorphous light eruption. A ten-year follow-up and evaluation. Arch Dermatol 88:756–758
Jansén CT, Karvonen J (1984) Polymorphous light eruption. A seven-year follow-up evaluation of 114 patients. Arch Dermatol 120:862–865
Mastalier U, Kerl H, Wolf P et al (1998) Clinical, laboratory, phototest and phototherapy findings in polymorphic light eruptions: a retrospective study of 133 patients. Eur J Dermatol 8:554–559
Murphy GM, Hauk JL (1991) The prevalence of antinuclear antibodies in patients with apparent polymorphic light eruption. Br J Dermatol 125:448–451
Nyberg F, Hasan T, Puska P et al (1997) Occurrence of polymorphous light eruption in lupus erythematosus. Br J Dermatol 136:217–221
Arbuckle MR, McClain MT, Rubertone MV et al (2003) Development of autoantibodies before the clinical onset of systemic lupus erythematosus. N Engl J Med 349:1526–1533
Millard TP, Lewis CM, Khamashta MA et al (2001) Familial clustering of polymorphic light eruption in relatives of patients with lupus erythematosus: evidence of a shared pathogenesis. Br J Dermatol 144:334–338
Epstein S (1942) studies in abnormal human sensitivity to light. IV. Photoallergic concept of prurigo aestivalis. J Invest Dermatol 5:289–298
Wolf P, Byrne SN, Gruber-Wackernagel A (2009) New insights into the mechanisms of polymorphic light eruption: resistance to ultraviolet radiation-induced immune suppression as an aetiological factor. Exp Dermatol 18:350–356
van de Pas CB, Kelly DA et al (2004) Ultraviolet-radiation-induced erythema and suppression of contact hypersensitivity responses in patients with polymorphic light eruption. J Invest Dermatol 122:295–299
Kölgen W, van Meurs M, Jongsma M et al (2004) Differential expression of cytokines in UV-B-exposed skin of patients with polymorphous light eruption: correlation with Langerhans cell migration and immunosuppression. Arch Dermatol 140:295–302
Damian DL, Patterson CR et al (2008) UV radiation-induced immunosuppression is greater in men and prevented by topical nicotinamide. J Invest Dermatol 128:447–454
Aubin F (2004) Why is polymorphous light eruption so common in young women? Arch Dermatol Res 296:240–241
Widyarini S, Domanski D et al (2006) Estrogen receptor signaling protects against immune suppression by UV radiation exposure. Proc Natl Acad Sci U S A 103:12837–12842
Boonstra H, Boer J (1989) Polymorphic light eruption induced by oral contraceptives and pregnancy? Photo-Dermatol 6:56–57
Millard TP, Bataille V, Snieder H et al (2000) The heritability of polymorphic light eruption. J Invest Dermatol 115:467–470
McGregor JM, Grabczynska S, Vaughan R et al (2000) Genetic modeling of abnormal photosensitivity in families with polymorphic light eruption and actinic prurigo. J Invest Dermatol 115:471–476
Millard TP, Fryer AA, McGregor JM (2008) A protective effect of glutathione-AS-transferas GSTP1*Val 105 against polymorphic light eruption. J Invest Dermatol 128:1901–1905
Zirbs M, Pϋmer C, Buters JTM et al (2013) GSTM1,GSTT1 and GSTP1 gene polymorphism in polymorphous light eruption. J Eur Acad Dermatol Venereol 27:157–162
McFadden JP, Norris PG, Cerio R et al (1994) Heat shock protein 65 immunoreactivity in experimentally induced polymorphic light eruption. Acta Derm Venereol 74:283–285
Guarrera M, Ferrari P, Rebora A (1998) Catalase in the stratum corneum of patients with polymorphic light eruption. Acta Derm Venereol 78:335–336
Briganti S, Cristaudo A (1998) Guarrera M et al Alteration of systemic antioxidant levels is correlated with the manifestation of polymorphohic light eruption? Exp Dermatol 7:423
Guarrera M, Rebora A (2007) Serum antioxidant capacity in polymorphic light eruption. Acta Derm Venereol 87:228–230
Giardini R, Cardo PP (2008) Decreased hydrosoluble antioxidant capacity in women: comment on the paper by Guarrera & Rebora on polymorphic light eruption. Acta Derm Venereol 88:204
Gruber-Wackernagel A, Obermayer-Pietsch B, Byrne SN et al (2012) Patients with polymorphic light eruption have decreased serum levels of 25-hydroxyvitamin-D3 that increase upon 311 nm UVB photohardening. Photochem Photobiol Sci 11:1831–1836
Reid SM, Robinson M, Kerr AC et al (2012) Prevalence and predictors of low vitamin D status in patients referred to a tertiary photodiagnostic service: a retrospective study. Photodermatol Photoimmunol Photomed 28:91–96
Cantorna MT (2000) Vitamin D and autoimmunity: is vitamin D status an environmental factor affecting autoimmune disease prevalence? Proc Soc Exp Biol Med 223:230–233
Boonstra HE, van Weelden H, Toonstra J et al (2000) Polymorphous light eruption: A clinical, photobiologic, and follow-up study of 110 patients. J Am Acad Dermatol 42:199–207
Guarrera M, Micalizzi C, Rebora A (1993) Heterogeneity of polymorphous light eruption: a study of 105 patients. Arch Dermatol 129:1060–1061
Hölzle E, Plewig G, Hofmann C et al (1982) Polymorphous light eruption. Experimental reproduction of skin lesions. J Am Acad Dermatol 7:111–125
Leroy D, Dompmartin A, Verneuil L et al (2002) La sensibilité du phototest polychromatique supérieure à celle du phototest UVA dans les lucites. Ann Dermatol Venereol 129:860–864
Salomon N, Messer G, Dick D et al (1997) Phototesting for polymorphic light eruption [ PLE] with consecutive UVA1/UVB-irradiation. Photodermatol Photoimmunol Photomed 13:72–74
Das S, Lloyd JJ, Walshaw D et al (2004) Provocation testing in polymorphic light eruption using fluorescent ultraviolet [ UV] A and UVB lamps. Br J Dermatol 151:1066–1070
Schmutz JL, Trechot P (2011) Polymorphous light eruption caused by ultraviolet C light. Ann Dermatol Venereol 138:639
Majoie IM, van Weelden H, Sybesma IM et al (2010) Polymorphous light eruption-like skin lesions in welders caused by ultraviolet C light. J Am Acad Dermatol 62:150–151
Gudmundsen KJ, Murphy GM, O’Sullivan D et al (1991) Polymorphic light eruption with contact and photocontact allergy. Br J Dermatol 124:79–82
Matekovits A, Dalamaga M, Stratigos A et al (2016) Polymorphous light eruption under the Mediterranean sun: a clinico-epidemiological and photobiological study. Eur J Dermatol 26:304–306
Lembo S, Fallon J, O’Kelly P et al (2008) Polymorphic light eruption and skin cancer prevalence: is one protective against the other? Br J Dermatol 159:1342–1347
Ferguson J (2003) Diagnosis and treatment of the common idiopathic photodermatoses. Aust J Dermatol 44:90–96
Richards HL, Ling TC, Evangelou G et al (2007) Psychologic distress in polymorphous light eruption and its relationship to patients’ beliefs about their condition. J Am Acad Dermatol 56:426–431
Ling TC, Richards HL, Janssens AS et al (2006) Seasonal and latitudinal impact of polymorphic light eruption on quality of life. J Invest Dermatol 126:1648–1651
Richards HL, Ling TC, Evangelou G et al (2008) Evidence of high levels of anxiety and depression in polymorphic light eruption and their association with clinical and demographic variables. Br J Dermatol 159:439–444
Bissonnette R, Nigen S, Bolduc C (2012) Influence of the quantity of sunscreen applied on the ability to protect against ultraviolet-induced polymorphous light eruption. Photodermatol Photoimmunol Photomed 28:240–243
Buenger J, Driller H (2004) Ectoin: an effective natural substance to prevent UVA-induced premature photoaging. Skin Pharmacol Physiol 17:232–237
Swanbeck G, Wennersten G (1972) Treatment of polymorphous light eruptions with beta-carotene. Acta Derm Venereol 52:462–466
Neumann R, Rappold E, Pohl-Markl H (1986) Treatment of polymorphous light eruption with nicotinamide: a pilot study. Br J Dermatol 115:77–80
Corbett MF, Hawk JL, Herxheimer A, Magnus I (1982) A Controlled therapeutic trials in polymorphic light eruption. Br J Dermatol 107:571–581
Ortel B, Wechdorn D, Tanew A, Hönigsmann H (1988) Effect of nicotinamide on the phototest reaction in polymorphous light eruption. Br J Dermatol 118:669–673
Del Rosso JQ (2016) Use of Polypodium leucotomas Extract in Clinical Practice: A Primer for the Clinician. J Clin Aesthet Dermatol 9:37–42
Winkelmann RR, Del Rosso J, Rigel DS (2015) Polypodium leucotomos extract: a status report on clinical efficacy and safety. J Drugs Dermatol 14:254–261
Tanew A, Radakovic S, Gonzalez S et al (2012) Oral administration of a hydrophilic extract of Polypodium leucotomos for the prevention of polymorphic light eruption. J Am Acad Dermatol 66:58–62
Stern RS, Nichols KT, Väkevä LH (1997) Malignant melanoma in patients treated for psoriasis with methoxsalen [ psoralen] and ultraviolet A radiation [ PUVA]. The PUVA Follow-Up Study. N Engl J Med 336:1041–1045
Horkay I, Bodolay E, Kósa A (1986) Immunological aspects of prophylactic UVB and PUVA therapy in polymorphic light eruption. Photo-Dermatology 3:47–49
Murphy GM, Logan RA, Lovell CR et al (1987) Prophylactic PUVA and UVB therapy in polymorphic light eruption–a controlled trial. Br J Dermatol 116:531–538
Rücker BU, Häberle M, Koch HU et al (1991) Ultraviolet light hardening in polymorphous light eruption – a controlled study comparing different emission spectra. Photodermatol Photoimmunol Photomed 8:73–78
Naleway AL (2002) Polymorphous light eruption. Int J Derm 41:377–383
Santoro FA, Lim HV (2011) Update on photodermatoses. Semin Cutan Med Surg 30:229–238
Bilsland D, George SA, Gibbs NK, Aitchison T, Johnson BE, Ferguson JA (1993) Comparison of narrow band phototherapy [ TL-01] and photochemotherapy [ PUVA] in the management of polymorphic light eruption. Br J Dermatol 129:708–712
Janssens AS, Pavel S, Out-Luiting JJ et al (2005) Normalized ultraviolet [ UV] induction of Langerhans cell depletion and neutrophil infiltrates after artificial UVB hardening of patients with polymorphic light eruption. Br J Dermatol 152:1268–1273
Patel DC, Bellaney GJ, Seed PT, McGregor JM, Hawk JL (2000) Efficacy of short-course oral prednisolone in polymorphic light eruption: a randomized controlled trial. Br J Dermatol 143:828–831
Murphy GM, Hawk JL, Magnus IA (1987) Hydroxychloroquine in polymorphic light eruption: a controlled trial with drug and visual sensitivity monitoring. Br J Dermatol 116:379–386
Norris PG, Hawk JL (1989) Successful treatment of severe polymorphous light eruption with azathioprine. Arch Dermatol 125:1377–1379
Shipley DR, Hewitt JB (2001) Polymorphic light eruption treated with cyclosporin. Br J Dermatol 144:446–447
Lasa O, Trebol I, Gardeazabal J, Diaz-Perez JL (2004 Nov) Prophylactic short-term use of cyclosporin in refractory polymorphic light eruption. J Eur Acad Dermatol Venereol 18(6):747–748
Ling TC, Gibbs NK, Rhodes LE (2003) Treatment of polymorphic light eruption. Photodermatol Photoimmunol Photomed 19:217–227
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Guarrera, M. (2017). Polymorphous Light Eruption. In: Ahmad, S. (eds) Ultraviolet Light in Human Health, Diseases and Environment. Advances in Experimental Medicine and Biology, vol 996. Springer, Cham. https://doi.org/10.1007/978-3-319-56017-5_6
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