Polymorphous Light Eruption

Kate de Kanter, RN, DNC

Disclosures

Dermatology Nursing. 2008;20(3):222-223. 

Content

Description: An 11-year-old male presented to clinic with a 2-year history of an extremely pruritic rash with associated swelling of his hands and face. On exam he had coalescing erythematous and edematous papules over both dorsal hands and some involvement of his palms (see Figure 1). These lesions also extended up his forearms. He had inflamed papules on his ears (see Figure 2) and an erythematous plaque on his right cheek. A biopsy had been done by a previous physician, but those results were unknown by the parents.

Figure 1.

Coalescing erythematous and edematous papules over both dorsal hands.

Figure 2.

Inflamed papule on ear.

Etiology: Polymorphous light eruption (PMLE) is an acquired disease, but the etiology is not fully known. PMLE is an idiopathic photodermatosis in a group of related sun-sensitive conditions. Sunlight is clearly the primary factor.

Hallmark: The initial eruption consists of an itchy, acute facial or forearm dermatitis with edematous papules and vesicles (Weston, Lane, & Morelli, 2002), all of which are on sun-exposed areas. The reaction is delayed from within hours to days of exposure.

Treatment: Treatment for PMLE can be multifold. The use of topical glucocorticoids can be used twice daily to control the dermatitis. This patient was given a short course of oral steroids so that he could return to regular activities at school. He was also started on 200 mg of hydroxychloroquine twice a day. Strict photo protection was also emphasized with the parents and the patient. Of note, the previous biopsy slides were reviewed and confirmed the diagnosis of PMLE. A followup appointment was scheduled for 6 weeks at which time the rash and associated symptoms had subsided (see Figures 3 & 4).

Figure 3.

Symptoms subsided at 6 week followup.

Figure 4.

Symptoms subsided at 6 week followup.

Normal Course: PMLE generally occurs in the spring months with first significant sun exposure and then subsides by autumn. PMLE can subside sooner with proper sun protection and medical intervention.

Patient Education/Nursing Measures: Sun-protection methods should be discussed and written information on these methods given to the parents and the patient. Information on Solumbra® and Coolibar® protective clothing can be given, as well as information on the laundry additive Sun Guard® for extra sun protection through clothing. It is also important for the patient to have a baseline eye exam if anti-malarials are used for treatment. Parents and patients need to understand that it is acceptable to be outdoors and to be exposed to the sun as long as the patient with PMLE is properly sun protected in all exposed areas.

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