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November 2007
By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 37-year-old man gives a four-day history of a pruritic rash on his upper back accompanied by malaise and chills. Examination reveals erythematous, slightly indurated patches and plaques. A similar eruption has appeared in each of the preceding three years during the late spring. For the past two weeks he has spent a great deal of time exposed to the sun. He denies any use of oral medications or new skin care products; he says calamine lotion provides partial relief of the pruritus.
WHAT IS YOUR DIAGNOSIS? |
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This patient is experiencing a polymorphic light eruption, which is the most common photodermatosis developing hours to days after sunlight exposure. Common morphologic forms include papular and plaque variants. Papulovesicular, eczematous, hemorrhagic, and erythema multiforme types have also been documented. Other symptoms in addition to the erythematous eruption may include chills, nausea, and malaise. Light sensitivity tends to decrease with repeated sun exposure, a phenomenon known as hardening. Use of sunscreens and protective clothing and avoiding the midday sun may help prevent recurrence. Treatment options include topical steroids, ultraviolet phototherapy to induce hardening, and
antimalarial medications such as hydroxychloroquine. |
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Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 39(11):27-28, 2007
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