Solar urticaria: a time-extended retrospective series of 61 patients and review of literature.

BACKGROUND: Solar urticaria is a rare, disabling, chronic disease. Few large series are available. OBJECTIVE: To report the epidemiological, clinical, phototesting, treatment and patient outcome data of a large series. METHODS: Data from 61 patients' files were retrospectively retrieved in a tertiary referral centre. RESULTS: 43 women and 18 men were included (mean age at first symptoms: 34 y). 3 patients had a medical history of chronic urticaria and 29% of atopy. Urticaria occurred before the 15(th) minute of sun-exposure in 95% of the patients and resolved spontaneously after its interruption within 1h in 76.4%. Determination of the action spectra revealed UVA sensitization in 91.8% of the patients, alone (49.2%) or with UVB (24.6%) or visible light (14.75%). 61.7% of the patients received antihistamines, 75% noted a significant improvement. 36.2% benefited from UVA phototherapy and were satisfied. 3 patients reported complete remission after 4 to 11 years. CONCLUSIONS: Our study is the second largest in the literature. Main discrepancies with previous series concern the absence of associated photodermatoses and the predominance of UVA sensitization over visible light, which could be explained by suboptimal phototesting in the most ancient cases. Interpretation of our results is restricted because data were missing in 10 to 25% of the patients' files. The response to treatment was evaluated upon the dermatologist's observation, which highlights the need of validated tools to evaluate patients' disability and response to treatment.

Solar urticaria treated with intravenous immunoglobulins.

BACKGROUND: Solar urticaria (SU) is a rare idiopathic photodermatosis induced immediately after sun exposure. This disorder may considerably restrict normal daily life and management is extremely difficult when treatment with oral H1 antihistamines and sun avoidance are ineffective. OBJECTIVE: We sought to report the effectiveness of intravenous immunoglobulins (IVIG) in severe SU. METHODS: We performed a retrospective multicentric study via the mailing of a questionnaire to the French photodermatology units to analyze all cases of patients with SU who were treated with IVIG. RESULTS: Seven patients (5 women) with a mean age of 40 years (range 32-55 years) and a mean disease duration of 5 years (range 2-10 years) received IVIG. The administration schedule differed from one patient to another: 1.4 to 2.5 g/kg were infused over 2 to 5 days. Five of 7 patients obtained a complete remission. The number of courses necessary to obtain clinical remission varied from 1 to 3 courses. Complete remission was maintained during 4 to more than 12 months but antihistamines were still required. In one case, psoralen plus ultraviolet A photochemotherapy was administered. LIMITATIONS: Retrospective study design, limited number of patients, and variations in the IVIG administration schedule could limit the interpretation of the results. CONCLUSION: Our case series suggests a beneficial effect of IVIG in severe SU but additional prospective trials including a larger number of patients are needed to demonstrate the effectiveness of IVIG and to specify the optimal modalities of their administration in this disease.

Octocrylene, an emerging photoallergen.

BACKGROUND: Octocrylene is a new emerging photoallergen. We report and discuss 50 cases of photoallergic contact dermatitis from octocrylene use and/or positive photopatch test reactions to this UV filter and draw attention to the unexpected association in adults with a history of photoallergic contact dermatitis from ketoprofen. OBSERVATIONS: Patients were divided in 3 groups: group A comprised 11 children; group B, 28 adults with a history of photoallergy from sunscreen products; and group C, 14 adults systematically tested with octocrylene because of a history of photoallergy from ketoprofen. All patients but 3 in group C had positive test reactions to octocrylene. Ten of 11 children in group A and 9 of 28 adults in group B had positive patch test reactions to octocrylene. One child in group A, the other 19 adults in group B, and 11 of 14 adults in group C had positive photopatch test reactions to octocrylene. All adults in group C and 24 of 28 adults in group B had a history of photoallergy from ketoprofen and positive patch test or photopatch test reactions to other allergens that are often positive in patients with photoallergy from ketoprofen, especially fragrance components. CONCLUSIONS: Octocrylene appears to be a strong allergen leading to contact dermatitis in children and mostly photoallergic contact dermatitis in adults with an often-associated history of photoallergy from ketoprofen. Patients with photoallergy from ketoprofen frequently have positive photopatch test reactions to octocrylene. These patients need to be informed of sunscreen products not containing octocrylene, benzophenone-3, or fragrances.