HPI: This 17 yo student has an 8 year history of a summer eruption. She has a pruritic eruption of her hands and distal forearms starting in spring and lasting till late fall. In winter her skin is perfectly normal. She has used triamcinalone 0.1% ointment without relief and similarly has not been helped with sunscreens.
O/E: Mild lichenification and a fine micro-papular eruption on the dorsum of the hands. A few serum crusts. No vesicles or h/o vesicles.
Photos (7/16/09)
Note no facial lesions
Diagnosis: Atypical Photodermatitis in a teenaged girl. Consider PCT, Hydroa variant, photoactivated atopoic dermatitis (nothing fits perfectly at this time)
Plan: 24 hour urine for porphyrins. Broad spectrum sunscreen for hands and clobetasol ointment after a 20 minute soak. Not sure biopsy will be helpful, but will do at next visit. PCT would be unusual but the porphyrias need to be ruled out.
Comments and suggestions?
It is a case of Polymorphous Light Eruption which we see very commonly in India.Face is often spared because of "hardening" phenomenon
ReplyDeleteSmall papular PLE sparing the face, often affecting
women on vacation, is sometimes known as benign summer
light eruption in continental Europe.(ROOK)
From personal experience, i can say that in PLE more than the sunscreens protective clothing, umbrellas & gloves help. Typically the rash itches/burns more at night than during acute exposure.
I am new to this site...and hence the very delayed response
DR Priya