Lichenoid pseudovesicular papular eruption on nose: A papular facial dermatosis probably related to actinic lichen nitidus or micropapular polymorphous light eruption

Background: Facial papules are a feature of several clinical conditions and may present both diagnostic and therapeutic challenges. Aim: To describe a grouped papular eruption on the nose and adjoining cheeks that has not been well characterized previously. Materials and Methods: A series of consecutive patients with a papular eruption predominantly involving nose and cheeks were evaluated, treated and followed up prospectively at tertiary care centers. Demographic details, clinical features, histopathology and response to treatment were recorded. Results: There were five men and six women (mean age 29.9 ± 6.9 years) who had disease for a mean duration of 17.3 ± 11.1 months. All patients presented with a predominantly asymptomatic eruption of monomorphic, pseudovesicular, grouped, skin colored to slightly erythematous papules prominently involving the tip of nose, nasal alae, philtrum and the adjoining cheeks. A total of 15 biopsies from 11 patients were analyzed and the predominant finding was a dense, focal lymphoid infiltrate restricted to the upper dermis with basal cell damage and atrophy of the overlying epidermis. The eruption ran a chronic course from several months to years. Limitations: Direct immunofluorescence could not be performed except in one case. Immunohistochemical stains for CD4 and CD8 could not be done owing to nonavailability. Phototesting was undertaken in one patient only. Conclusion: Small grouped papules on the nose and adjoining skin with a lichenoid histopathology appear to represent a distinct clinicopathological entity. It may be related to actinic lichen nitidus/micropapular variant of polymorphous light eruption.

Llega la primavera y florecen los eritemas polimorfos solares / Spring arrives and with it the polymorphous light eruption

El eritema polimorfo solar es la fotodermatosis más frecuente y suele aparecer en primavera con la primera exposición intensa al sol. Sus manifestaciones cutáneas son variadas y el diagnóstico se basa en la clínica junto al antecedente de exposición solar. En los casos leves, la fotoprotección suele ser suficiente para el control de la enfermedad, pero en formas más graves se requieren otras terapéuticas, como corticoides, antihistamínicos, o fototerapia, que genera una "fotoadaptación" de las áreas de piel afectadas. Presentamos un caso típico de erupción polimorfa solar que respondió de forma adecuada a medidas de fotoprotección. (AU)

The polymorphic solar eruption is the most frequent photodermatosis, and usually appears in spring with the first intense exposure to the sun. It has multiple cutaneous manifestations, and its diagnosis is based on the clinic and the antecedent of solar exposition. In mild cases, photoprotection is usually enough to control the disease, but in more severe forms, other therapies are required, such as corticosteroids, antihistamines, or phototherapy to generate a "photo-adaptation" of the affected skin areas. We present a typical case of polymorphic solar eruption that responded adequately to photoprotection measurements. (AU)

Lamellar body distribution, ceramidase expression and skin barrier function in lesions of polymorphous light eruption / 中华皮肤科杂志

Objective To investigate the correlation of epidermal distribution of lamellar bodies and expression of ceramidase with skin barrier dysfunction in polymorphous light eruption.Methods Forty-seven patients with polymorphous light eruption and 40 healthy volunteers were recruited into this study.Noninvasive instruments were used to measure skin sebum content,transepidermal water loss(TEWL)and water content in stratum corneum in all of the subjects.Then,tissue specimens were obtained from the lesions at sunexposed sites in the patients and normal skin of the healthy volunteers.The ultrastructure and distribution of lamellar bodies were observed with transmission electron microscopy in five lesion and control specimens.Immunohistochemistry was performed to detect the expression of ceramidase in the tissue specimens.Results Compared with the normal skin from healthy volunteers,the lesions from patients showed decreased number of lamellar bodies in the granular layer and prick cell layer with a disorganized arrangement.Ceramidase was positively expressed in 20 lesion specimens and 36 normal control specimens,weakly expressed in 21 lesion specimens and 4 normal control specimens,and negative in 6 lesion specimens; there was a significant difference in the expression of ceramidase between the lesion specimens and normal control specimens(P ＜ 0.01).The lesions also showed high TEWL(34.2191 ± 12.70 vs.16.8350 ± 6.50,P ＜ 0.01),lower water content in stratum corneum(22.7319 ± 8.71 vs.29.4250 ± 5.08,P ＜ 0.01)and similar skin sebum content compared with the normal skin.Conclusions There is a disturbance in the synthesis of ceramide in patients with polymorphous light eruption,which may contribute to the impairment of skin barrier.

Clinical Observation of Polymorphous Light Eruption and Chronic Actinic Dermatitis Treated with Artemtherin / 昆明医科大学学报

Objective To observe the clinical effect and safety of polymorphous light eruption(PLE) and those of chronic actinic dermatitis(CAD) treated with Artemtherin.To further study better treatment methods for photodermatitis.Methods 105 patients with CAD and 63 patients with PLE were divided into the treatment group and the control group randomly.In the treatment group,63 cases of CAD and 32 cases of PLE were treated with Artemtherin.In the control group,42 cases of CAD and 31 cases of PLE treated with Hydroxychlorquine.The dosages of both groups were 40 mg and 200 mg at each time,twice a day respectively.Both groups were topically treated with 10% ointment zinc oxide,twice a day,for one month.Results The effective rate of treatment group and control group with PLE patients were 84.4%(27/32) and 80.6%(25/31),respectively.There was no significant difference between both groups in terms of the effective rate of PLE.The effective rate of treatment group and control group with CAD patients were 85.7%(54/63) and 81%(34/4),respectively.There was not any side-effect reported among these patients treated with Artemtherin.Conclusions It is effective,safe,economic,and convenient to treat PLE and CAD with Artemtherin.

Experimental Reproduction of Polymorphous Light Eruption: By Potent UVA Irradiating Instrument , Metal Halide Mercury Lamp / 대한피부과학회지

We report a case of experimental reproduction of the skin lesion of polymorphous light eruption by potent UVA irradiating instrument, metal halide mercury lamp. A 20-year-old female had complained skin lesion at sun-exposed area since childhood. The skin lesion was reproduced after repetitive exposure of high dose of UVA, and the histologic feaure of the lesion was consistent with polymorphous light eruption. Metal halide mercury lamp used in this patient has hight irradiance and exclusive of UVB and UVC. It can be convenient and precise one in phototest using high doses of UVA.

A Case of Polymorphous Light Eruption Confirmed by Phototest / 대한피부과학회지

Polymorphous light eruption(PMLE) is an idiopathic, scquired syndrome characterized by a delayed abnormal response to light and a varied morphology of recurrent erythema, papules, vesicles or plaques on light-exposed areas of skin. We report herein s 42-year-old male patient who was clinically and histologically compatible with PMLE. To confirm the diagnosis, the phototest was performed by 50,J/crn of UVA, 5MED-UVB and visible light irradiation to the extensor surface of the forearm. Numerous erythematous papules developed at the (JVA-irradiated site. The histopathologic findings of the phototest induced lesion were compatible with PMLE. Therefore, our patient was confirmed as having PMLE with action spectrum in the IJVA range.