Severe and refractory solar urticaria treated with intravenous immunoglobulins: a phase II multicenter study.

BACKGROUND: Retrospective data have suggested the effectiveness of intravenous immunoglobulins (IVIG) for solar urticaria (SU). OBJECTIVE: We sought to prospectively assess the efficacy of IVIG for SU. METHODS: We conducted a multicentric phase II study to test the efficacy of a single course of IVIG (2 g/kg) in patients with severe and refractory SU. The primary outcome was remission of SU on phototesting at 12 weeks after IVIG treatment. Secondary objectives included clinical remission, improved quality of life, and 50% improvement in disease intensity as measured on a visual analog scale. RESULTS: Of the 9 patients who received IVIG injection, 2 showed remission of SU on phototesting, corresponding to a response rate of 22.2% (95% confidence interval 2.8%-60.0%). In all, 6 patients (67%) showed at least 1 response criterion after 4 weeks and 5 (56%) after 12 weeks. Response was maintained after 24 weeks for 2 patients and after 48 weeks for 1 patient. About half of the patients (56%) had moderate to severe headache. LIMITATIONS: Lack of control arm and small number of patients are limitations. CONCLUSION: A single course of IVIG appears insufficient to obtain prolonged significant control of SU; future evaluation of different schedules of IVIG administration is warranted.

A new sunscreen application technique to protect more efficiently from ultraviolet radiation.

BACKGROUND: UV radiation protection is an important health issue. Sophisticated sunscreen formulations have been developed to improve compliance. However, sunscreen is still inadequately applied, leaving large body areas without effective protection. AIM: This study aims to validate a newly developed sunscreen application technique for adults and children. METHODS: Fifty-eight volunteers were recruited to participate in a monocenter, intraindividual, sequential, comparative study. The covering potential of their currently used sunscreen application technique and of a newly developed systematized application technique (Dose, Apply, Spread) were compared. Evaluation criteria included the amount of product applied, the homogeneity of sunscreen application as measured by the Wood's lamp, and the volunteers' appreciation of the new technique. RESULTS: Fifty-eight volunteers participated in the study: 20 women, 19 men, and 19 children. Respecting the new application technique resulted in a statistically significant (P < 0.05) more evenly spread sunscreen on the different parts of the body and an increase in the amount of product applied. Furthermore, the body surface area covered was significantly increased (P < 0.05), and the new technique was well perceived and accepted by the volunteers. CONCLUSION: The proposed new application technique ensures that more sunscreen will be used and that it will be applied more evenly. Educational work could help improve the efficient use of sunscreens, therefore providing better UV protection.

Solar urticaria treated with intravenous immunoglobulins.

BACKGROUND: Solar urticaria (SU) is a rare idiopathic photodermatosis induced immediately after sun exposure. This disorder may considerably restrict normal daily life and management is extremely difficult when treatment with oral H1 antihistamines and sun avoidance are ineffective. OBJECTIVE: We sought to report the effectiveness of intravenous immunoglobulins (IVIG) in severe SU. METHODS: We performed a retrospective multicentric study via the mailing of a questionnaire to the French photodermatology units to analyze all cases of patients with SU who were treated with IVIG. RESULTS: Seven patients (5 women) with a mean age of 40 years (range 32-55 years) and a mean disease duration of 5 years (range 2-10 years) received IVIG. The administration schedule differed from one patient to another: 1.4 to 2.5 g/kg were infused over 2 to 5 days. Five of 7 patients obtained a complete remission. The number of courses necessary to obtain clinical remission varied from 1 to 3 courses. Complete remission was maintained during 4 to more than 12 months but antihistamines were still required. In one case, psoralen plus ultraviolet A photochemotherapy was administered. LIMITATIONS: Retrospective study design, limited number of patients, and variations in the IVIG administration schedule could limit the interpretation of the results. CONCLUSION: Our case series suggests a beneficial effect of IVIG in severe SU but additional prospective trials including a larger number of patients are needed to demonstrate the effectiveness of IVIG and to specify the optimal modalities of their administration in this disease.

Solar urticaria successfully treated with intravenous immunoglobulins.

BACKGROUND: Idiopathic solar urticaria (SU) is a rare type of physical urticaria, occurring immediately after exposure to visible or ultraviolet (UV) light. Treatment is based on sun avoidance and on high doses of antihistamines, but is sometimes inefficient. METHODS: We report on a 41-year-old patient with severe SU who was successfully treated with a single course of 2 g/kg of intravenous immunoglobulins (IVIG). RESULTS: A dramatic improvement in UVA and UVB tolerance was rapidly observed, with an increase of up to 10 times the UVA minimal urticarial dose on day 3. The treatment with terfenadine was continued. Healing of photosensitivity was persistent since 100 days after the single course of IVIG, no urticarian reaction was provoked with polychromatic irradiation rising above 8.3 J/cm(2) or after UVA doses rising above 15 J/cm(2). CONCLUSION: Use of IVIG in severe SU can be discussed when high-dose antihistamines are inefficient and quality of life is affected.

Phototoxic reaction associated with Malarone (atovaquone/proguanil) antimalarial prophylaxis.

Phototoxic reaction has not been reported previously as an adverse reaction to the combination of atovaquone and proguanil (AP) (Malarone) used for antimalarial prophylaxis and therapy. We report here a 32-year-old patient treated with AP who presented with clinical manifestations of photosensitivity. AP-induced phototoxicity in this patient was further supported by phototesting. Malarone is not known to photosensitize and render the skin more susceptible to severe sunburn-like reactions. That it may do so, as in this case, is of importance especially as this drug is used predominantly by those travelling to sunnier climes. A notification of potential phototoxic effects of AP should be published for the choice of prophylaxis made by tourists traveling in malarial areas.

Octocrylene, an emerging photoallergen.

BACKGROUND: Octocrylene is a new emerging photoallergen. We report and discuss 50 cases of photoallergic contact dermatitis from octocrylene use and/or positive photopatch test reactions to this UV filter and draw attention to the unexpected association in adults with a history of photoallergic contact dermatitis from ketoprofen. OBSERVATIONS: Patients were divided in 3 groups: group A comprised 11 children; group B, 28 adults with a history of photoallergy from sunscreen products; and group C, 14 adults systematically tested with octocrylene because of a history of photoallergy from ketoprofen. All patients but 3 in group C had positive test reactions to octocrylene. Ten of 11 children in group A and 9 of 28 adults in group B had positive patch test reactions to octocrylene. One child in group A, the other 19 adults in group B, and 11 of 14 adults in group C had positive photopatch test reactions to octocrylene. All adults in group C and 24 of 28 adults in group B had a history of photoallergy from ketoprofen and positive patch test or photopatch test reactions to other allergens that are often positive in patients with photoallergy from ketoprofen, especially fragrance components. CONCLUSIONS: Octocrylene appears to be a strong allergen leading to contact dermatitis in children and mostly photoallergic contact dermatitis in adults with an often-associated history of photoallergy from ketoprofen. Patients with photoallergy from ketoprofen frequently have positive photopatch test reactions to octocrylene. These patients need to be informed of sunscreen products not containing octocrylene, benzophenone-3, or fragrances.