The patient is a 75 yo man with a 7 day history of a pruritic papular eruption on his legs. This began on a recent trip to Florida after sun exposure. He is on no photosensitizing medications.
O/E: Erythematous non-blanching papules on both lower extremities.
Clinical Images:
Pathology: No evidence of vasculitis
Diagnosis: Could this be an example of Papulo-vesicular Light Eruption?
References:
1. Papulovesicular light eruption. A defined subset of
polymorphous light eruption.
Elpern DJ, Morison WL, Hood AF.
Arch Dermatol. 1985 Oct;121(10):1286-8.
Abstract: A distinctive photodermatitis is seen commonly in tourists
visiting Hawaii. Analysis of 150 cases revealed that the eruption is acute in
onset following exposure to sunlight, is confined to exposed areas, and mainly
affects young to middle-aged white women. The clinical presentation is
remarkably uniform, consisting of papules, papulovesicles, or vesicles. These
findings are consistent with a diagnosis of polymorphous light eruption (PMLE)
and the histologic picture supports this diagnosis. Other clinical variants of
PMLE were not seen in our patients, however, which suggests that this condition
is more monomorphous than polymorphous. We suggest papulovesicular light
eruption as a suitable name for this common and distinctive subset of PMLE.
2.
Papulovesicular light eruption. A defined subset of
polymorphous light eruption.
Elpern DJ, Morison WL, Hood AF. Arch Dermatol. 1985 Oct;121(10):1286-8.
Abstract: A distinctive photodermatitis is seen commonly in tourists
visiting Hawaii. Analysis of 150 cases revealed that the eruption is acute in
onset following exposure to sunlight, is confined to exposed areas, and mainly
affects young to middle-aged white women. The clinical presentation is
remarkably uniform, consisting of papules, papulovesicles, or vesicles. These
findings are consistent with a diagnosis of polymorphous light eruption (PMLE)
and the histologic picture supports this diagnosis. Other clinical variants of
PMLE were not seen in our patients, however, which suggests that this condition
is more monomorphous than polymorphous. We suggest papulovesicular light
eruption as a suitable name for this common and distinctive subset of PMLE.
from Dr. Adam Fityan, UK, "We have seen a number of patients in our photodermatology clinic with typical PLE developing a more purpuric variant over the lower limbs following episodes of more significant exposure. In some cases there is vasculitis on histology (solar vasculitis), but generally the feeling is that this is all a severe form of PLE. Provocation can sometimes reproduce the purpuric element, but more often than not it provokes typical PLE."
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