Skip to main content

Photocontact Dermatitis and Its Clinical Mimics: an Overview for the Allergist

Abstract

Photo-contact dermatitis (PCD) describes the adverse cutaneous reaction that occurs in some patients as a result of simultaneous exposure to a contactant and to light. PCD can be subdivided into photo-allergic and photo-irritant dermatitis depending on whether the contactant respectively invokes an allergic or irritant reaction. Photo-irritant reactions are commonly caused by plants, psoralens, and medications taken internally, whereas photo-allergic reactions are commonly caused by sunscreens and topical nonsteroidal anti-inflammatory medications. The work-up of photo-contact dermatitis includes a thorough history and physical exam augmented by patch and/or photopatch testing, as the cornerstone of treatment for PCD is identification and avoidance of the irritating or allergenic chemical. Photo-contact dermatitis has the potential to significantly impact quality of life, so an informed approach to diagnosis and management is critical. Clinical mimics of PCD include polymorphic light eruption, solar urticaria, actinic prurigo, hydroa vacciniforme, cutaneous porphyrias, and systemic disorders with photosensitivity such as lupus and dermatomyositis. Herein, we review the clinical presentation, differential diagnosis (including the clinical mimics mentioned above), pathogenic mechanisms, diagnostic testing, and therapeutic considerations for PCD.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Dooms-Goossens A (1993) The red face: contact and photocontact dermatitis. Clin Dermatol 11:289–295

    CAS  Article  Google Scholar 

  2. 2.

    Coffin SL, Turrentine JE, Cruz PD Jr (2017) Photodermatitis for the allergist. Curr Allergy Asthma Rep 17:36

    Article  Google Scholar 

  3. 3.

    Oakley AM, Ramsey ML (2017) Polymorphic Light Eruption. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430886/. Accessed 11 December, 2017

  4. 4.

    Vega Memije ME, Cuevas Gonzalez JC, Hojyo-Tomoka MT, Rodríguez Lobato E (2017) Actinic prurigo as a hypersensitivity reaction type 4. Int J Dermatol 56:135–136

    Article  Google Scholar 

  5. 5.

    Badri T, Schlessinger J (2017) Urticaria, Solar. StatPearls publishing. https://www.ncbi.nlm.nih.gov/books/NBK441986/. Accessed 11 December 2017

  6. 6.

    Kutlubay Z, Sevim A, Engin B, Tüzün Y (2014) Photodermatoses, including phototoxic and photoallergic reactions (internal and external). Clin Dermatol 32:73–79

    Article  Google Scholar 

  7. 7.

    Dawe R (2017) An Overview of the cutaneous porphyrias. F1000Res, 6: 1906 doi: https://doi.org/10.12688/f1000research.10101.1. eCollection 2017

  8. 8.

    Minder EI, Barman-Aksözen J (2015) Iron and erythropoietic porphyrias. Blood 126(2):130–132. https://doi.org/10.1182/blood-2015-05-646737

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Biolcati G, Marchesini E, Sorge F et al (2015) Long-term observational study of afamelanotide in 115 patients with erythropoietic protoporphyria. Br J Dermatol 172(6):1601–1612. https://doi.org/10.1111/bjd.13598

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Harms JH, Lautenschlager S, Minder CE et al (2009) Mitigating photosensitivity of erythropoietic protoporphyria patients by an agonistic analog of alpha-melanocyte stimulating hormone. Photochem Photobiol 85(6):1434–1439. https://doi.org/10.1111/j.1751-1097.2009.00595.x

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Langendonk JG, Balwani M, Anderson KE et al (2015) Afamelanotide for erythropoietic protoporphyria. N Engl J Med 373(1):48–59. https://doi.org/10.1056/NEJMoa1411481

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Menagé H, Ross JS, Norris PG, Hawk JL, White IR (1995) Contact and photocontact sensitization in chronic actinic dermatitis: sesquiterpene lactone mix is an important allergen. Br J Dermatol 132:543–547

    Article  Google Scholar 

  13. 13.

    Merklen P (1904) Urticaria. In: Besnier E, Brocq L, Jacquet L (eds) La Pratique Dermatologique: Trait de Dermatologie Appliquée. Masson et Cie, Paris, pp 728–771

    Google Scholar 

  14. 14.

    Ward SB (1905) Erythema and urticaria with a condition resembling angioneurotic edema caused by exposure to sun’s rays. NY Med J 81(742):743

    Google Scholar 

  15. 15.

    Duke WW (1923) Urticaria caused by light. JAMA 80:1835–1838

    Article  Google Scholar 

  16. 16.

    Abajian M, Schoepke N, Altrichter S, Zuberbier T, Maurer M (2014) Physical urticarias and cholinergic urticaria. Immunol Allergy Clin N Am 34(1):73–88

    Article  Google Scholar 

  17. 17.

    Chong WS, Khoo SW (2004) Solar urticaria in Singapore: an uncommon photodermatosis seen in a tertiary dermatology center over a 10-year period. Photodermatol Photoimmunol Photomed 20(2):101–104

    Article  Google Scholar 

  18. 18.

    Horio T (2003) Solar urticaria-idiopathic? Photodermatol Photoimmunol Photomed 19(3):147–154

    Article  Google Scholar 

  19. 19.

    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(4):638–643

    Article  Google Scholar 

  20. 20.

    Ryckaert S, Roelandts R (1998) Solar urticaria. A report of 25 cases and difficulties in phototesting. Arch Dermatol 134(71):74

    Google Scholar 

  21. 21.

    Uetsu N, Miyauchi-Hashimoto H, Okamoto H, Horio T (2000) The clinical and photobiological characteristics of solar urticaria in 40 patients. Br J Dermatol 142(1):32–38

    CAS  Article  Google Scholar 

  22. 22.

    Steven G, Peter E (2015) Solar Urticaria. J Dtsch Dermatol Ges 13(12):1250–1253

    Google Scholar 

  23. 23.

    Hochstadter EF, Ben-Shoshan M (2014) Solar urticaria in a 1-year-old infant: diagnosis and management. BMJ Case Rep doi: https://doi.org/10.1136/bcr-2013-202

  24. 24.

    Williams-Arya P, Hogan MB, Wilson NW (1996) Solar urticaria in a 6-year-old child. Ann Allergy Asthma Immunol 76(2):141–143

    CAS  Article  Google Scholar 

  25. 25.

    Fityan A, McGibbon D, Fassihi H, Sarkany RS (2018) Paediatric solar urticarial: a case series. Br J Dermatol Accepted Author Manuscript 178:1453–1454. https://doi.org/10.1111/bjd.16325

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Kogame T, Uetsu N, Nguyen CTH, Kawada A, Okamoto H (2017) Solar urticaria with an augmentation spectrum in a child. The Journal of Dermatology Sep 44(9):e214–e215. https://doi.org/10.1111/1346-8138.13914

    Article  Google Scholar 

  27. 27.

    Frei W (1925) Lokale urtikarielle Hautreaktion auf Sonnenlicht. Arch Dermatol Syph (Berl) 149:124–135

    Article  Google Scholar 

  28. 28.

    Blum HF, West RJ (1937) Studies of an urticarial response to blue and violet light in man. J Clin Invest 16:261–267

    CAS  Article  Google Scholar 

  29. 29.

    Reinauer S, Leenutaphong V, Holzle E (1993) Fixed solar urticaria. J Am Acad Dermatol 29(2 Pt 1):161–165

    CAS  Article  Google Scholar 

  30. 30.

    Juhlin L, Malmros-Enander I (1986) Solar urticaria: mechanism and treatment. Photodermatology 3(164):168

    Google Scholar 

  31. 31.

    Botto NC, Warshaw EM (2008) Solar Urticaria. J Am Acad Dermatol 59(6):909–920

    Article  Google Scholar 

  32. 32.

    Rajka E (1942) Passive transfer in light urticaria. J Allergy Clin Immunol 13:327–345

    Google Scholar 

  33. 33.

    Leenutaphong V, Hölzle E, Plewig G (1989) Pathogenesis and classification of solar urticaria: a new concept. J Am Acad Dermatol 21(2 Pt 1):237–240

    CAS  Article  Google Scholar 

  34. 34.

    Harber LC, Holloway RM, Wheatley VR, Baer RL (1963) Immunologic and biophysical studies in solar urticaria. J Investig Dermatol 41:439–443

    CAS  Article  Google Scholar 

  35. 35.

    Fukunaga A, Horikawa T, Yamamoto A, Yamada Y, Nishigori C (2006) The inhibition spectrum of solar urticaria suppresses the wheal-flare response following intradermal injection with photo-activated autologous serum but not with compound 48/80. Photodermatol Photoimmunol Photomed 22(3):129–132

    CAS  Article  Google Scholar 

  36. 36.

    Hasei K, Ichihashi M (1982) Solar urticaria: determinations of action and inhibition spectra. Arch Dermatol 118:346 350

    Article  Google Scholar 

  37. 37.

    Magerl M, Altrichter S, Borzova E, Giménez-Arnau A, Grattan CEH, Lawlor F, Mathelier-Fusade P, Meshkova RY, Zuberbier T, Metz M, Maurer M (2016) The definition, diagnostic testing, and management of chronic inducible urticarias—the EAACI/GA(2) LEN/EDF/UNEV consensus recommendations 2016 update and revision. Allergy 71(6):780–802

    CAS  Article  Google Scholar 

  38. 38.

    Masuoka E, Fukunaga A, Kishigami K, Jimbo H, Nishioka M, Uchimura Y, Taguchi K, Ohgou N, Nishigori C (2012) Successful and long-lasting treatment of solar urticaria with ultraviolet a rush hardening therapy. Br J Dermatol 167(1):198–201

    CAS  Article  Google Scholar 

  39. 39.

    Addo HA, Sharma SC (1987) UVB phototherapy and photochemotherapy (PUVA) in the treatment of polymorphic light eruption and solar urticaria. Br J Dermatol 116(4):539–547

    CAS  Article  Google Scholar 

  40. 40.

    Duschet P, Leyen P, Schwarz T, Höcker P, Greiter J, Gschnait F (1987) Solar urticaria—effective treatment by plasmapheresis. Clin Exp Dermatol 12(3):185–188

    CAS  Article  Google Scholar 

  41. 41.

    Puech-Plottova I, Michel JL, Rouchouse B, Perrot JL, Dzviga C, Cambazard F (2000) Solar urticaria: one case treated by intravenous immunoglobulin. Ann Allergy Asthma Immunol 127(10):831–835

    CAS  Google Scholar 

  42. 42.

    Morgado-Carrasco D, Fusta-Novell X, Podlipnik S, Combalia A, Aguilera P (2017) Clinical and photobiological response in eight patients with solar urticaria under treatment with omalizumab, and review of the literature. Photodermatol Photoimmunol Photomed 34:194–199. https://doi.org/10.1111/phpp.12370

    Article  Google Scholar 

  43. 43.

    Rodriguez-Jimenez P, Chicharro P, Perez-Plaza A, de Argila D (2017) Response to Omalizumab in solar urticaria: report of 3 cases. Actas Dermosifiliogr 108(8):e53–e55. https://doi.org/10.1016/j.ad.2016.08.011

    CAS  Article  PubMed  Google Scholar 

  44. 44.

    Beattie PE, Dawe RS, Ibbotson SH, Ferguson J (2003) Characteristics and prognosis of idiopathic solar urticaria: a cohort of 87 cases. Arch Dermatol 139(9):1149–1154

    Article  Google Scholar 

  45. 45.

    Greenspoon J, Ahluwalia R, Juma N, Rosen CF (2013) Allergic and photoallergic contact dermatitis: a 10-year experience. Dermatitis 24:29–32

    CAS  Article  Google Scholar 

  46. 46.

    Kerr A, Ferguson J (2010) Photoallergic contact dermatitis. Photodermatol Photoimmunol Photomed 26:56–65

    CAS  Article  Google Scholar 

  47. 47.

    Gaspari AA (1996) Mechanisms of resolution of allergic contact dermatitis. Am J Contact Dermat 7:212–219

    CAS  PubMed  Google Scholar 

  48. 48.

    Hindsén M, Zimerson E, Bruze M (2006) Photoallergic contact dermatitis from Ketoprofen in Southern Sweden. Contact Dermatitis 54:150–157

    Article  Google Scholar 

  49. 49.

    Sánchez-Pérez J, Sánchez TS, García-Díez A (2001) Combined contact and photocontact allergic dermatitis to etofenamate in flogoprofen gel. Am J Contact Dermat 12:215–216

    Article  Google Scholar 

  50. 50.

    Kim HJ, Lee E, Lee M, Ahn S, Kim J, Liu J, Jin SH, Ha J, Bae IH, Lee TR, Noh M (2017) Phosphodiesterase 4B plays a role in benzophenone-3-induced phototoxicity in normal human keratinocytes. Toxicol Appl Pharmacol 26:174–181

    Google Scholar 

  51. 51.

    Ibbotson SH (2017) Shedding light on drug photosensitivity reactions. Br J Dermatol 176:850–851

    CAS  Article  Google Scholar 

  52. 52.

    Möller H (1990) Contact and photocontact allergy to psoralens. Photodermatol Photoimmunol Photomed 7:43–44

    PubMed  Google Scholar 

  53. 53.

    Heurung AR, Raju SI, Warshaw EM (2014) Benzophenones. Dermatitis 25:3–10

    CAS  Article  Google Scholar 

  54. 54.

    Schram SE, Glesne LA, Warshaw EM (2007) Allergic contact cheilitis from benzophenone-3 in lip balm and fragrance/flavorings. Dermatitis 18:221–224

    Article  Google Scholar 

  55. 55.

    Chou M, Dhingra N, Strugar TL (2017) Contact sensitization to allergens in nail cosmetics. Dermatitis 28:231–240

    CAS  Article  Google Scholar 

  56. 56.

    Heurung AR, Raju SI, Warshaw EM (2014) Adverse reactions to sunscreen agents: epidemiology, responsible irritants and allergens, clinical characteristics, and management. Dermatitis 25:289–326

    CAS  Article  Google Scholar 

  57. 57.

    Hu Y, Wang D, Shen Y, Tang H (2016) Photopatch testing in Chinese patients over 10 years. Dermatitis 27:137–142

    CAS  Article  Google Scholar 

  58. 58.

    Crowe MJ, Banks SL, Guin JD (1992) Photoallergic and allergic contact dermatitis to butyl-methoxydibenzoylmethane. Am J Contact Dermatitis 3:33–34

    Article  Google Scholar 

  59. 59.

    Ricci C, Vaccari S, Cavalli M, Vincenzi C (1997) Contact sensitization to sunscreens. Am J Contact Dermat 8:165–166

    CAS  PubMed  Google Scholar 

  60. 60.

    Nedorost S (2005) Ensulizole (Phenylbenzimidazole-5-sulfonic acid) as a cause of facial dermatitis: two cases. Dermatitis 16:14

    Google Scholar 

  61. 61.

    Warshaw E, Wang M, Howard M et al (2013) Patch test reactions associated with sunscreen products and the importance of testing to an expanded series: retrospective analysis of north American contact dermatitis group data, 2001 to 2010. Dermatitis 24:176–182

    CAS  Article  Google Scholar 

  62. 62.

    Sugiyama M, Nakada T, Hosaka H, Sueki H, Iijima M (2001) Photocontact dermatitis to Ketoprofen. Am J Contact Dermat 12:180–181

    CAS  PubMed  Google Scholar 

  63. 63.

    Arevalo A, Blancas R, Ancona A (1995) Occupational contact dermatitis from piroxicam. Am J Contact Dermatitis 6:113–114

    Article  Google Scholar 

  64. 64.

    Gao L, Hu Y, Ni C, Xu Y, Ma L, Yan S, Dou X (2014) Retrospective study of photopatch testing in a Chinese population during a 7 year period. Dermatitis 25:22–26

    CAS  Article  Google Scholar 

  65. 65.

    de Groot A, Schmidt E (2016) Essential oils part V: peppermint oil, lavender oil, and lemongrass oil. Dermatitis 27:325–332

    Article  Google Scholar 

  66. 66.

    Wu PA, James WD (2011) Lavender. Dermatitis 22:344–347

    CAS  PubMed  Google Scholar 

  67. 67.

    Dunkel FG, Elsner P, Pevny I, Burg G (1990) Olaquindox-induced photoallergic contact dermatitis and persistent light reaction. Am J Contact Dermat 1:235–239

    Article  Google Scholar 

  68. 68.

    Rai R, Thomas M (2016) Photopatch and UV-irradiated patch testing in photosensitive dermatitis. Indian Dermatol Online J 7:12–16

    Article  Google Scholar 

  69. 69.

    Mark K, Brancaccio R, Cohen D (1999) Allergic contact and photoallergic contact dermatitis to plant and pesticide allergens. Arch Dermatol 135:67–70

    CAS  Article  Google Scholar 

  70. 70.

    Asemota E, Crawford G, Kovarik C, Brod BA (2017) A survey examining photopatch test and phototest methodologies of contact dermatologists in the United States: platform for developing a consensus. Dermatitis 28:265–269

    Article  Google Scholar 

  71. 71.

    Shaw T, Simpson B, Wilson B, Oostman H, Rainey D, Storrs FT (2010) Photoallergy to sunscreens is rare despite popular belief. Dermatitis 21:185–198

    CAS  PubMed  Google Scholar 

  72. 72.

    Braunberger T, Lynn D, Reimer C, Doctor M, Hill MK, Mounessa J, Dunnick CA (2016) Disease severity and quality of life measurements in contact dermatitis: a systematic review 2005-2015. Dermatitis 27:362–371

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Margaret Snyder.

Ethics declarations

Conflicts of Interest

Margaret Snyder, B.S.A. declares that she has no conflicts of interest. Jake E. Turrentine, M.D. is the Section Editor of the Self-Assessment Section of Dermatitis and serves on the Investment Committee for the American Contact Dermatitis Society. Ponciano D. Cruz, Jr., M.D. is the Editor-in-Chief of Dermatitis and is a consultant for Mary Kay Cosmetics, Inc.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Not applicable as there were no individual participants in this review.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Snyder, M., Turrentine, J.E. & Cruz, P.D. Photocontact Dermatitis and Its Clinical Mimics: an Overview for the Allergist. Clinic Rev Allerg Immunol 56, 32–40 (2019). https://doi.org/10.1007/s12016-018-8696-x

Download citation

Keywords

  • Photo-contact dermatitis
  • Photo-allergic dermatitis
  • Photo-irritant dermatitis
  • Solar urticaria
  • Photopatch testing