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Posted by Brian Leveson on August 22, 2000 at 13:32:11:

In Reply to: sun allergy posted by steve dixon on June 06, 2000 at 13:10:17:

I too live in the UK and have had this condition since the age of 30. It is called PLE (polymorphous light eruptions) and sadly you are stuck with it for life. However, there are many things you can do to make your life easier.
1) High factor sun screens (Ambre Solaire do a very good SPF 60.
2) Clothes from Sun Precautions. They specialise in sun protective clothing with a range of Solumbra goods. They can be found on-line.
3) Careful exposure during the Summer should allow you to build what litle resistance you have.
4) Ask your doctor about PUVA which is a course of treatment which accomplishes (3)artificially.
5) I am pasting in a comprehensive US article I found which just about covers it. Good luck!

"Many so-called sun induced allergies are actually a problem called polymorphous light eruption. This condition, abbreviated PMLE, is a problem most commonly seen in parts of the world where the climate allows 4 seasons. In PMLE, the new springtime exposure to the sun stimulates this "allergic" response. The eruption forms only on the sun exposed portions of the body. PMLE may form anywhere from 24-96 hours after being exposed to the sun. This is called a delayed hypersensitivity reaction. Gradually as the skin becomes adjusted to the ultraviolet rays, the skin sensitivity becomes lessened, and the formation of the rash becomes far less further into the summer.

Polymorphous Light Eruption has no predisposition for either sex and may affect children as well as adults. The problem often begins however, sometime in early 20s to 30s. There is some evidence that there may be some genetic association as PMLE has a high rate amongst Native Americans.

PMLE is a rather nonspecific looking type of rash. Usually, it appears as reddish blotches, sometimes raised or hive-like. Sometimes, it may appear more like a wide patch of tiny red bumps. The distribution of the rash only on sun exposed skin is very important when trying to make the diagnosis, as is the sparing of skin folds, or areas out of the sun’s reach such as under the chin and jaw line.

WORK-UP

Whenever a new patient presents without a diagnosis, I always think it is important to rule out the possibility of the presence of an autoimmune disease such as Lupus. Autoimmune diseases generally are associated with heightened sun sensitivity and patients frequently suffer from rashes when exposed to the sun. It is very easy to screen them with a simple blood test called an ANA (antinuclear antibody test). Remember, a positive test does not always make for a diagnosis of autoimmune disease. The blood test itself should be significantly elevated, have the proper “pattern” and there should be other correlating factors. This is important to understand as many healthy people walk around without autoimmune disease but actually normally have a very low positive ANA. Your doctor should be able to discuss this with you should you ever have a positive result.

For patients who do not tend to get better as the summer progresses, I may biopsy the skin, again to confirm the diagnosis of PMLE. There are some people with normal ANAs who still have autoimmune diseases, or there may be another skin disorder occurring that is mimicking PMLE. If you find you are not responding to therapy as expected, ask your doctor about a skin biopsy. Also, if one is done, make sure a second test is performed upon the tissue called a DIF (Direct Immunofluorescence). This is a specialty stain that must be ordered at the time the biopsy is performed, and part of the tissue must be placed into a special fixative bottle in order for the stain to be performed. This is a very important test whenever the question of an autoimmune disease is raised.

Another way in which to make the diagnosis in hard to establish cases is a procedure called light testing. An area of skin that is unaffected is exposed multiple times to a set dose of ultraviolet B light. It is estimated that this method of testing has a high rate of positive results in PMLE patients, approximately 75% of the time.

TREATMENT

More annoying than the rash, itching is the biggest complaint associated with PMLE. The use of oral antihistamines, such as Benadryl or Atarax, are commonly used. Treatment of the rash with a topical steroid cream, often prescription strength is required as well. Anti-itch preparations such as Sarnol-HC 1%, PrameGel and Aveeno Oatmeal Anti-itch Concentrated Lotion and Oatmeal Baths are common OTC options for helping soothe the discomfort. The use of 1% hydrocortisone cream, such as Cortaid, is another nonprescription option.

The use of oral prescription medication in the antimalarial family, such as Plaquenil or Atabrine, may be used for those who fail to respond to traditional treatment and continue to have significant skin problems.

The use of medical grade ultraviolet light (UVA and/or UVB) has been done for some patients. Called “hardening” this may be done on a maintenance basis to help those patients who are simply too sensitive to seasonal fluctuations of sunlight to remain comfortable. As there are certainly issues related to the exposure to ultraviolet light such as the development of skin cancer, premature aging skin changes and cataract formation, this is done in a very controlled environment. It is not something individuals should try to do on their own at a tanning center.

SUN PROTECTION

Sun protection is very important, particularly for those who have chronic PMLE. Using a sunblock with both UVA and UVB blockers with a high SPF is a good start. Total Block Clear SPF 65 and Total Block Cover-Up/Make-Up SPF 60 are great products which completely block both UVA, UVB, as well as infrared and visible light rays. Also, consider wearing a California North SPF 30 Jacket where the jacket material has been specially treated to block out the ultraviolet light.

So next spring, should you find yourself with that odd little sun allergy that you have never been able to explain, think about the possibility of PMLE and ask your dermatologist what you can do to feel better.

Thank you for taking the time to read my newsletter. I hope you have found it informative.

Audrey Kunin, M.D.
(Any topic discussed in the this newsletter is not intended as medical advice. If you have a medical concern, please check with your doctor.)
Article posted July 4, 2000.

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