Insights into proton pump inhibitor-induced photosensitivity: An observational study in a tertiary photobiology service.

BACKGROUND: Proton pump inhibitors (PPIs) are extensively prescribed but may cause photosensitivity and drug-induced lupus erythematosus (DILE), which can be overlooked as the drug may have been taken for years prior to presentation. METHODS: We reviewed the clinical and investigation findings of patients diagnosed with PPI-induced photosensitivity, diagnosed through the Scottish Photobiology Service. RESULTS: We report 11 patients with median age of onset 61-years and mean duration of PPI ingestion of 5-years [DILE (n = 6), phototoxicity (n = 3) and drug-induced solar urticaria through a lupus mechanism (n = 2)]. Five had Anti-Ro antibodies (three also ANA positive). Predominantly UVA and visible light photosensitivity was observed on phototesting. DISCUSSION: PPIs are a reversible cause of photosensitivity and DILE. Time to onset from drug initiation to symptoms can be prolonged, so clinicians should have a high index of suspicion in those taking PPIs. Most are diagnosed through clinical assessment and lupus serology, with phototesting indicated if there is diagnostic uncertainty.

A rapidly expanding nodule on the lower leg.

We present a case of a 34-year-old man who developed a lesion over his posterior calf. We discuss the clinical and histopathological features, as well as relevant immunohistochemical markers. Click here for the corresponding questions to this CME article.

A newly growing asymptomatic facial lesion.

A 23-year-old man presenting with a 1-year history of a lesion of the right cheek. We highlight this case for awareness as this tumour may mimic other benign lesions, such as pilomatrixoma or benign cysts, as it does not have any uniquely identifying clinical or dermoscopic features. Additionally, it is of concern as malignant transformation can occur and therefore surgery should be considered as both for diagnostic and therapeutic benefit.

Decision-making in dermatologic surgery.

Good clinical decision-making is important in dermatologic surgery. Experience and knowledge help considerably, but take time to acquire. However, how the clinician thinks is also a significant contributory factor. How we think is influenced by many factors, including our beliefs, prejudices, confidence and variables like how we are feeling at that moment physically and emotionally. Thought process can be either fast and subconscious or slow and analytical. Fast thinking contributes to the majority of decision-making and is especially prone to a range of biases which may contribute to suboptimal clinical outcomes. We wish to highlight and illustrate common biases in thinking encountered by the dermatologic surgeon.