RESUMEN
RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).
ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).
Asunto(s)
Humanos , Masculino , Femenino , Pacientes/clasificación , Trastornos por Fotosensibilidad/epidemiología , Trastornos por Fotosensibilidad/diagnóstico , Efectos de la Radiación , Diagnóstico Clínico , Lentigo/diagnóstico , Melanosis/diagnósticoRESUMEN
BACKGROUND: We have observed an increasing number of patients referred to the Scottish Photobiology Service (SPS), who were later diagnosed with actinic folliculitis (AF) and had positive phototesting results. Treatment options for AF are limited, with only a few reports in the literature. The use of prophylactic narrowband ultraviolet B (NB-UVB) phototherapy for AF has not previously been described, and we report on this for the first time. AIM: To analyse the clinical characteristics, phototesting results and responses to treatment for patients with AF diagnosed by the SPS. METHODS: We undertook a retrospective review over 10 years of all case notes of patients who were assessed and diagnosed with AF through the SPS, based at the Photobiology Unit, Dundee, UK. RESULTS: All 10 patients were women. Mean age of onset was 25 years and mean time to referral for investigation was 7 years. The commonest site involved was the face, with the main clinical feature being monomorphic pustules appearing after sunlight exposure. The eruption could be provoked with iterative doses of broadband UVA irradiation in five patients. All patients were offered photoprotective advice and prophylactic NB-UVB phototherapy. Five patients proceeded with phototherapy; four of these completed the desensitization course and all four reported either a delay in symptom onset or total prevention of rash induction, with complete efficacy of desensitization maintained for 3 years in one patient. CONCLUSION: We demonstrate the successful use of UVA provocation testing as a diagnostic tool in AF. Additionally, we recommend the use of prophylactic NB-UVB phototherapy in AF as an effective and well-tolerated approach.
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Foliculitis/radioterapia , Trastornos por Fotosensibilidad/radioterapia , Terapia Ultravioleta/métodos , Adulto , Femenino , Foliculitis/diagnóstico , Humanos , Trastornos por Fotosensibilidad/diagnóstico , Estudios RetrospectivosAsunto(s)
Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/terapia , Fototerapia/métodos , Diagnóstico Diferencial , Femenino , Fluorescencia , Humanos , Iluminación/efectos adversos , Persona de Mediana Edad , Trastornos por Fotosensibilidad/clasificación , Trastornos por Fotosensibilidad/inmunología , Luz Solar/efectos adversosRESUMEN
Ultraviolet light (UV) and visible light are important components in the diagnosis of photodermatoses, and UV has the unique ability to also be used to manage photodermatoses. Phototesting, provocative light testing, and photopatch testing can provide important information in diagnosing patients with photodermatoses; phototesting can be used to determine the starting dose for phototherapy in these patients. Once photosensitivity is established, narrowband UVB and UVA1 therapy have helped to improve the quality of life of photosensitive patients, such as those with polymorphous light eruption, chronic actinic dermatitis, and solar urticaria.
Asunto(s)
Manejo de la Enfermedad , Trastornos por Fotosensibilidad/terapia , Fototerapia/métodos , Urticaria/prevención & control , Humanos , Trastornos por Fotosensibilidad/diagnóstico , Pruebas Cutáneas/métodosRESUMEN
BACKGROUND: Current treatment options for rosacea include topical agents, oral therapies, phototherapy using lasers, or intense pulsed light (IPL). Combination therapy for rosacea often yields better results than monotherapy. The safety of laser/light treatments in combination with systemic doxycycline has been questioned because of the theoretical risk of photosensitivity. OBJECTIVE: The purpose of this study was to assess the incidence of phototoxicity or photosensitivity in rosacea patients receiving concomitant laser or light treatments and systemic doxycycline. METHODS: Treatment records of 36 patients receiving laser/light treatments while also being treated with standard dose or anti-inflammatory dose of doxycycline were retrospectively reviewed. RESULTS: No adverse reactions related to doxycycline combined with laser/light therapy were reported. Specifically, no photosensitivity or sensitivity to wavelengths in the pulsed dye laser (PDL), or IPL range was observed in this cohort. All patients achieved some degree of clearance. CONCLUSION: The results of this retrospective study demonstrate that doxycycline used in conjunction with laser or nonlaser light therapy is a valid combination therapy for improving signs and symptoms of rosacea. No photosensitivity reactions were observed to commonly used IPL or PDL devices.
Asunto(s)
Antibacterianos/efectos adversos , Doxiciclina/efectos adversos , Tratamiento de Luz Pulsada Intensa/efectos adversos , Terapia por Luz de Baja Intensidad/efectos adversos , Rosácea/terapia , Administración Cutánea , Adolescente , Adulto , Anciano , Antibacterianos/administración & dosificación , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Preparaciones de Acción Retardada/administración & dosificación , Preparaciones de Acción Retardada/efectos adversos , Doxiciclina/administración & dosificación , Femenino , Humanos , Tratamiento de Luz Pulsada Intensa/instrumentación , Tratamiento de Luz Pulsada Intensa/métodos , Láseres de Colorantes/efectos adversos , Terapia por Luz de Baja Intensidad/métodos , Masculino , Persona de Mediana Edad , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/etiología , Estudios Retrospectivos , Piel/efectos de los fármacos , Piel/efectos de la radiación , Resultado del Tratamiento , Adulto JovenRESUMEN
Photodermatoses occur in males and females of all races and ages. Onset can be variable in timing and influenced by genetic and environmental factors. Photodermatoses are broadly classified as immunologically mediated, chemical- and drug-induced, photoaggravated, and genetic (defective DNA repair or chromosomal instability) diseases. Advances in the field have led to improved recognition and treatment of many photodermatoses. The purpose of this focused review is to provide an update on the diagnosis and management of a variety of photodermatoses, both common and less common, with review of recent updates in the literature pertaining to their diagnosis and management.
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Fármacos Dermatológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Luz/efectos adversos , Trastornos por Fotosensibilidad/diagnóstico , Fototerapia/métodos , Administración Cutánea , Administración Oral , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/etiología , Diagnóstico Diferencial , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/etiología , Humanos , Lupus Eritematoso Cutáneo/diagnóstico , Trastornos por Fotosensibilidad/etiología , Trastornos por Fotosensibilidad/patología , Trastornos por Fotosensibilidad/terapia , Piel/patología , Piel/efectos de la radiación , Protectores Solares/administración & dosificación , Protectores Solares/efectos adversos , Resultado del Tratamiento , Urticaria/diagnóstico , Urticaria/etiologíaRESUMEN
El eritema polimorfo solar es la fotodermatosis más frecuente y suele aparecer en primavera con la primera exposición intensa al sol. Sus manifestaciones cutáneas son variadas y el diagnóstico se basa en la clínica junto al antecedente de exposición solar. En los casos leves, la fotoprotección suele ser suficiente para el control de la enfermedad, pero en formas más graves se requieren otras terapéuticas, como corticoides, antihistamínicos, o fototerapia, que genera una "fotoadaptación" de las áreas de piel afectadas. Presentamos un caso típico de erupción polimorfa solar que respondió de forma adecuada a medidas de fotoprotección. (AU)
The polymorphic solar eruption is the most frequent photodermatosis, and usually appears in spring with the first intense exposure to the sun. It has multiple cutaneous manifestations, and its diagnosis is based on the clinic and the antecedent of solar exposition. In mild cases, photoprotection is usually enough to control the disease, but in more severe forms, other therapies are required, such as corticosteroids, antihistamines, or phototherapy to generate a "photo-adaptation" of the affected skin areas. We present a typical case of polymorphic solar eruption that responded adequately to photoprotection measurements. (AU)
Asunto(s)
Humanos , Femenino , Adulto , Trastornos por Fotosensibilidad/diagnóstico , Luz Solar/efectos adversos , Eritema/diagnóstico , Fototerapia , Trastornos por Fotosensibilidad/inmunología , Trastornos por Fotosensibilidad/patología , Calidad de Vida , Estaciones del Año , Protectores Solares/uso terapéutico , Azatioprina/uso terapéutico , Talidomida/uso terapéutico , Rayos Ultravioleta/efectos adversos , Terapia Ultravioleta , Corticoesteroides/uso terapéutico , Colecalciferol/uso terapéutico , Eritema/etiología , Eritema/inmunología , Eritema/patología , Antagonistas de los Receptores Histamínicos/uso terapéutico , Antimaláricos/uso terapéuticoRESUMEN
Polymorphous light eruption (PLE) is the commonest immuno-mediated photodermatosis. It occurs after solar or artificial UV-light exposure and affects only the sun-exposed areas with preference of the V-area of the chest, of arms and forearms, legs, upper part of the back, and rarely the face. The lesions are itching or burning, and vary morphologically from erythema to papules, vesico-papules and occasionally blisters, plaques, sometimes erythema multiforme-like, insect bite-like wheals and purpura. The clinical manifestations befall within a few hours to days from light exposure, last a few days, and subside in about a week without sequelae. Its diagnosis is based on history, morphology and phototests. PLE is considered as a delayed hypersensitivity response to newly UV induced, but still unidentified, antigen(s). Usually, MED is normal, but the provocative phototests with UVA or UVB reproduce the spontaneous lesions in about 50% of the patients. Broad spectrum sunscreens and antioxidants, photohardening with PUVA or narrow band UVB may be beneficial to prevent the disease. Therapy is based mainly on topical or systemic corticosteroids.
Asunto(s)
Hipersensibilidad Tardía/etiología , Trastornos por Fotosensibilidad/etiología , Piel/efectos de la radiación , Luz Solar/efectos adversos , Rayos Ultravioleta/efectos adversos , Corticoesteroides/uso terapéutico , Animales , Antioxidantes/uso terapéutico , Humanos , Hipersensibilidad Tardía/diagnóstico , Hipersensibilidad Tardía/inmunología , Hipersensibilidad Tardía/prevención & control , Terapia PUVA , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/inmunología , Trastornos por Fotosensibilidad/prevención & control , Factores de Riesgo , Piel/inmunología , Piel/patología , Protectores Solares/uso terapéutico , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Fototerapia/métodos , Psoriasis/radioterapia , Dosis de Radiación , Eritema/prevención & control , Trastornos por Fotosensibilidad/diagnósticoRESUMEN
Introducción y objetivos: La dosis de inicio en la fototerapia UVB de banda estrecha (UVBBE) viene determinada por el fototipo o por la determinación de la dosis eritematógena mínima (DEM). El cálculo de la DEM identifica pacientes con fotosensibilidad no sospechada. El objetivo de nuestro estudio es conocer la influencia que puedan tener en una DEM disminuida los fármacos fotosensibilizantes concomitantes, el diagnóstico, la asociación con acitretina en pacientes con psoriasis y evidenciar si la DEM alterada provoca más reacciones adversas y más graves. Material y métodos: Se trata de un estudio observacional de una cohorte retrospectiva desde el período comprendido entre el 1 de febrero de 2009 al 31 de marzo de 2015. La determinación de la DEM se categorizó en DEM normal o patológica. Resultados: Trescientos dos pacientes con distintas dermatosis inician UVBBE en función de la DEM. No se han encontrado diferencias entre el grupo con DEM patológica respecto al normal, ni en el número de fármacos consumidos (p = 0,071), ni en el potencial fotosensibilizante (p = 0,806). El análisis multivariante ajustado por edad, sexo y fototipo reveló que la psoriasis es un factor protector de DEM patológica (OR = 0,31 [IC 95%: 0,16-0,58]). No se encontró riesgo significativo de eritema ni prurito en los pacientes con DEM alterada OR = 1,68 (IC 95%: 0,91-3,29) y OR = 2,04 (IC 95%: 0,99-4,22), respectivamente. Conclusiones: La psoriasis protege de tener una DEM patológica. Si bien el eritema y el prurito fueron más frecuentes en los pacientes con DEM patológica, las diferencias no fueron estadísticamente significativas (AU)
Introduction and objectives: The starting dose for narrowband UV-B phototherapy is determined by a patient's skin phototype or minimal erythema dose (MED). Calculation of MED identifies patients with unsuspected photosensitivity. The aim of this study was to investigate the influence of factors such as concomitant use of photosensitizing agents, diagnosis, and combination with acitretin in patients with psoriasis on the frequency and severity of adverse effects in patients with a low MED to narrowband UV-B phototherapy. Material and methods: We undertook a retrospective observational cohort study between February 1, 2009 and March 31, 2015. MED values were classified as normal or low. Results: In total, 302 patients with different skin conditions started narrowband UV-B phototherapy at a dose determined by their MED. No differences were found between patients with a low MED and those with a normal MED for number of drugs taken (P = .071) or use of photosensitizing agents (P = 0.806). Following adjustment for age, sex, and phototype, the multivariate analysis showed that psoriasis exerted a protective effect against a low MED (OR = 0.31 [95% CI, 0.16-0.58]). No significant risk of erythema or pruritus was detected in patients with a low MED (OR = 1.68; 95% CI, 0.91-3.29 and OR = 2.04; 95% CI, 0.99-4.22, respectively). Conclusions: Psoriasis protects against a low MED. Although erythema and pruritus were more common in patients with a low MED, the differences were not significant (AU)
Asunto(s)
Humanos , Eritema/prevención & control , Terapia Ultravioleta/métodos , Enfermedades de la Piel/terapia , Fototerapia/métodos , Dosis de Radiación , Trastornos por Fotosensibilidad/diagnóstico , Rayos Ultravioleta/efectos adversos , Psoriasis/terapiaRESUMEN
Few studies have been conducted in chronic actinic dermatitis (CAD) treated with narrowband ultraviolet B (NB UVB) phototherapy, especially in Asian patients. We aim to evaluate the efficacy and safety of NB UVB phototherapy in Chinese patients with CAD. 19 CAD patients of Fitzpatrick skin phototype IV received NB UVB phototherapy in spring and treatments were given 3 times weekly with incremental dose and maintenance therapy was given twice weekly for 3-4 weeks. The mean initial, endpoint, and cumulative dose of NB UVB was 0.08, 0.33, and 6.0 J/cm2 , respectively. Patients totally received 27 times of treatments in average. 87.5% of previously ultraviolet Bï¼UVBï¼ sensitive patients and 75% of previously ultraviolet Aï¼UVAï¼ sensitive patients had normal or improved MED after phototherapy. The percentage of patients returned to normal UVB phototesting was higher than that of patients returned to normal UVA phototesting (68.8% vs. 37.5%). The mean 1-week DLQI and the need for using immunosuppressive agents and antihistamines were significantly reduced after treatment (p < .01 or p < .05). In conclusion, prophylactic NB UVB phototherapy is effective and safe in treatment of CAD in Chinese patients with Fitzpatrick skin phototype IV.
Asunto(s)
Trastornos por Fotosensibilidad/radioterapia , Terapia Ultravioleta/métodos , Anciano , China , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Trastornos por Fotosensibilidad/diagnóstico , Inducción de Remisión , Factores de Tiempo , Resultado del Tratamiento , Terapia Ultravioleta/efectos adversosRESUMEN
The treatment of solar urticaria is regarded as difficult. In some cases good responses to the anti-IgE antibody omalizumab (Xolair®), approved for treatment of chronic spontaneous urticaria, have been reported. We report on a 50-year-old Caucasian woman who for the last 5 years has developed localized itching and stinging erythemas following exposure to sunlight accompanied sometimes by anaphylactic reactions. Oral antihistamines in three- to four-fold doses and a topical sun screen had been only partially effective in long-term use. Positive immediate-type reactions with whealing appeared in phototesting with low doses of UVB and UVA. Three weeks after s. c. injection of 300 mg omalizumab, the minimal urticarial dose (MUD) for UVB was increased at least 20-fold (from <0.001 to 0.02 J/cm2) and for UVA four-fold (from 0.1 to 0.4 J/cm2) and the patient reported no itching at the test area. On the other hand, MUD for UVA1 remained unchanged (5.0 J/cm2). The weekly urticarial activity score (UAS7) was reduced from 30 points before omalizumab administration to 14 points in weeks two and three. Overall, a partial response of solar urticaria to omalizumab therapy could be observed in the present case.
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Omalizumab/administración & dosificación , Trastornos por Fotosensibilidad/tratamiento farmacológico , Trastornos por Fotosensibilidad/etiología , Luz Solar/efectos adversos , Urticaria/tratamiento farmacológico , Urticaria/etiología , Antialérgicos/administración & dosificación , Femenino , Humanos , Persona de Mediana Edad , Trastornos por Fotosensibilidad/diagnóstico , Resultado del Tratamiento , Urticaria/diagnósticoRESUMEN
BACKGROUND: Daylight PDT (dPDT) is easy to use and does not require light equipment. Such therapy has been exhaustively proved to be successful in the treatment of actinic keratosis, but its use in skin photodamage remains unclear. OBJECTIVE: To evaluate dPDT's efficacy in skin facial photodamage. PATIENTS AND METHODS: This was a parallel-group double-blind, randomized placebo-controlled trial. Sixty participants with symmetric facial photodamage were allocated to topical methyl aminolevulinate (MAL) and daylight vs. matching placebo and daylight. Primary outcome was global photodamage improvement/failure 1 month after the third session. Secondary outcomes included: pain evaluation; specific photodamage severity scores; sun irradiance quantification and Skindex-29 scores. Adverse events were also investigated. RESULTS: Primary analysis included all randomized patients. All patients sun-exposed for 120min in 3 sessions. The risk of failure was lower in the MAL-dPDT group than in the placebo plus daylight group (RR: 0.18; 95% CI: 0.08-0.41). Mean solar irradiance (W/m2) during the first, second and third sessions was 480.82, 430.07 and 435.84, respectively. Items 5 and 14 of Skindex-29 in the MAL-dPDT group showed statistical significant differences. Two patients in the MAL-dPDT group had serious and non-serious events not directly related to the product. CONCLUSION: dPDT with MAL was un-painful, effective and safe for the treatment of facial photodamage. Herpes simplex prophylaxis should be considered before sessions)
INTRODUCCIÓN: La terapia fotodinámica con luz-día (TFDd) es fácil de usar y no requiere de equipo alguno. Tal terapia ha demostrado ser útil en el tratamiento de las queratosis actínicas, pero su uso en el fotodaño no es claro. OBJETIVO: Evaluar la eficacia de la TFDd en el fotodaño facial. Pacientes y MÉTODOS: Se realizó un ensayo clínico doble-ciego controlado con placebo y con asignación aleatoria. Sesenta participantes con fotodaño facial simétrico se asignaron a recibir bien TFD con Metil-Aminolevulinato (MAL) y luz de día o placebo y luz de día. El resultado primario fue la mejoría/fracaso en el fotodaño facial global un mes después de la tercera sesión. Los resultados secundarios incluyeron: dolor; fotodaño específico, irradiancia recibida y la puntuación en el Skindex-29. RESULTADOS: Todos los pacientes se expusieron a la luz de día durante 120 minutos en 3 sesiones. El riesgo de fracaso fue menor en el grupo de TFD con MAL y luz de día que en el grupo placebo (RR:0,18; 95%; IC:0,08 a 0.41). La media de la irradiancia solar (W.m-2) durante la primera, segunda y tercera sesión fue de 480,82, 430,07 y 435,84, respectivamente. Los ítems 5 y 14 del Skindex-29 en el grupo de TFDd con MAL mostraron diferencias estadísticamente significativas. Dos pacientes en el mismo grupo presentaron eventos adversos serios y no serios pero estos no tuvieron relación directa con el producto evaluado. CONCLUSIÓN: La TFDd con MAL fue es un tratamiento indoloro, eficaz y seguro para el tratamiento del fotoenvejecimiento facial. La profilaxis del Herpes simple debe ser considerada antes de cada sesión
Asunto(s)
Humanos , Masculino , Femenino , Fototerapia/instrumentación , Fototerapia/métodos , Fototerapia , Luz Solar , Trastornos por Fotosensibilidad/complicaciones , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/terapia , Queratosis Actínica/diagnóstico , Queratosis Actínica/terapia , Método Doble Ciego , Distribución AleatoriaRESUMEN
Pseudoporphyria refers to a rare bullous dermatosis characterized by the clinical and histological features of porfiria cutanea tarda without abnormalities in porphyrin metabolism. The pathogenesis is heterogeneous and several exogenous factors may promote the bullous lesion formation, including medications, end stage renal disease, dialysis and tanning beds. Regarding treatment of this condition, in literature different therapy have been reported, such as glutathione and his precursor N-acetylcysteine, which presents anti-oxidant properties; however even more toxic drugs, such as chloroquine, are used. Moreover, in patients with drug-induced PP discontinuation of the offending agent, if possible, is a crucial aspect of the clinical management. We report two cases of dialysis patients presenting blisters on extremities, which healed with the avoidance of UV exposure and oral Vitamin D supplementation. Interestingly Vitamin D despite the lack of antioxidant properties led to a completely resolution of PP in both our patients within 30 days. A possible explanation of this finding is that Vitamin D, playing a key role in the regulation of serum Ca2+, can modulated cadherin-cadherin interactions and led to healing of pseudoporphyria bullous lesions. Finally we highlight the prominent role of UV-exposure in PP elicitation thus a good photoprotection is essential for all patients with pseudoporphyria.
Asunto(s)
Trastornos por Fotosensibilidad/tratamiento farmacológico , Diálisis Renal/efectos adversos , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Luz Solar/efectos adversos , Rayos Ultravioleta/efectos adversos , Deficiencia de Vitamina D/complicaciones , Vitamina D/uso terapéutico , Anciano , Calcio/fisiología , Técnicas Cosméticas/efectos adversos , Cadherinas Desmosómicas/fisiología , Diagnóstico Diferencial , Femenino , Humanos , Uniones Intercelulares , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Persona de Mediana Edad , Nefroesclerosis/complicaciones , Diálisis Peritoneal/efectos adversos , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/etiología , Porfiria Cutánea Tardía/diagnóstico , Porfirinas/análisis , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/etiología , Vitamina D/fisiología , Deficiencia de Vitamina D/tratamiento farmacológicoAsunto(s)
Dermatología/organización & administración , Departamentos de Hospitales , Urticaria/diagnóstico , Urticaria/terapia , Antialérgicos/uso terapéutico , Terapia Biológica , Enfermedad Crónica , Frío/efectos adversos , Congresos como Asunto , Fármacos Dermatológicos/uso terapéutico , Dermatología/métodos , Pruebas Diagnósticas de Rutina , Manejo de la Enfermedad , Humanos , Educación del Paciente como Asunto , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/terapia , Rol del Médico , Guías de Práctica Clínica como Asunto , Urticaria/epidemiología , Urticaria/etiologíaRESUMEN
BACKGROUND: Methotrexate (MTX), alongside fumaric acid esters, is the most commonly used drug in the systemic therapy of psoriasis in Germany. It is sometimes used in combination with topical therapy and/or phototherapy due to synergistic effects. CASE REPORT: Here we describe a case of phototoxic dermatitis during treatment with MTX. Other cutaneous side effects of MTX include so-called UV recall, radiation recall, and skin tumor formation.
Asunto(s)
Metotrexato/efectos adversos , Trastornos por Fotosensibilidad/inducido químicamente , Trastornos por Fotosensibilidad/diagnóstico , Psoriasis/terapia , Terapia Ultravioleta , Adulto , Artritis Psoriásica/terapia , Terapia Combinada , Humanos , Masculino , Metotrexato/uso terapéutico , Neoplasias Inducidas por Radiación/inducido químicamente , Neoplasias Inducidas por Radiación/diagnóstico , Neoplasias Inducidas por Radiación/terapia , Trastornos por Fotosensibilidad/terapia , Radiodermatitis/inducido químicamente , Radiodermatitis/diagnóstico , Radiodermatitis/terapia , Factores de Riesgo , Neoplasias Cutáneas/inducido químicamente , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Terapia Ultravioleta/efectos adversosRESUMEN
Drug-induced photosensitivity is common. The principal mechanism of systemic drug photosensitivity is phototoxicity and the principal mechanism of topical drug photosensitivity is photoallergy. Photopatch testing is helpful to determine suspected topical agent photoallergies (eg, from ultraviolet filters in sunscreens) but generally not helpful in detecting systemic drug photosensitivity. Drug-induced photosensitivity is usually best managed by stopping the suspected drug. Other measures, including phototherapy using wavelengths that do not elicit the response, are sometimes necessary.
Asunto(s)
Trastornos por Fotosensibilidad , Salud Global , Humanos , Incidencia , Pruebas del Parche , Trastornos por Fotosensibilidad/inducido químicamente , Trastornos por Fotosensibilidad/diagnóstico , Trastornos por Fotosensibilidad/epidemiología , Piel/efectos de los fármacos , Piel/efectos de la radiaciónRESUMEN
BACKGROUND: Ultraviolet radiation (UVR) is a well-known exacerbating factor for cutaneous lupus erythematosus (CLE), with photosensitivity comprising one of the American College of Rheumatology (ACR) diagnostic criteria for systemic lupus erythematosus (SLE). However, discerning true photosensitivity in this population is difficult due to the broad language utilized by the ACR and the delayed-onset nature of photosensitive lupus lesions. AIMS: The objective of this report is to provide a review of photosensitivity, photoprovocation, and phototherapy in the context of CLE patients. METHODS: A literature review in PubMed was conducted using the terms 'ultraviolet light,' 'lupus erythematosus,' 'photoprovocation,' or 'photosensitivity.' RESULTS: Self-patient reporting of photosensitivity and the broad definition of photosensitivity have led to the wide range of photosensitivity rates in CLE patients. Photoprovocation testing provides a more objective method to measure photosensitivity, but even these trials demonstrate significant differences due to protocol variations. Despite UVR's deleterious effect on lupus patients, ultraviolet A (UVA)-1 may have therapeutic benefits as shown by observations on murine models and human lupus subjects. CONCLUSIONS: Accurately discerning photosensitivity has diagnostic implications for SLE and provides motivation for greater patient adherence to photoprotective methods.