Solar urticaria: report of two cases with augmentation spectrum

Two adult Japanese patients with severe solar urticaria are reported. In both patients, an action spectrum existed in the visible light range, and an augmentation spectrum was demonstrated in the visible light range longer than the action spectrum. The augmentation phenomenon has rarely been documented, and in the previous reports, it was induced by preirradiation with the augmentation spectrum. In our cases, however, only postirradiation with the augmentation spectrum enhanced urticarial reactions.     

The clinical and photobiological characteristics of solar urticaria in 40 patients

Forty patients with solar urticaria, 16 male and 24 female, were examined personally during the past 25 years. The median age at onset of symptoms was 32 years, ranging from 13 to 76 years. Most commonly (45%) solar urticaria first appeared during the third decade. The mean duration of the disease was 3.6 years at presentation. The action spectrum was found in the visible light range in 24 patients (60%), in the ultraviolet (UV) A range in four, in the UVB in four, from the UVA to UVB in three, from the UVA to visible light in one and in a broad range from UVB to visible light in four patients. An inhibition spectrum was detected in 13 of 19 patients (68%), occurring at longer wavelengths than the action spectrum in 12 of these cases. The augmentation spectrum was found in only four of 14 patients (29%) examined. Twenty-four of 31 patients (77%) developed an urticarial reaction to autologous serum, which had been previously irradiated in vitro at the action spectrum for that patient. In a single patient, solar urticaria was caused by a drug, namely chlorpromazine. In two patients, polymorphic light eruption occurred in association with solar urticaria. No single modality of treatment was satisfactory, but combined use of antihistamines, sunbathing, psoralen UVA photochemotherapy and/or sunscreening agents partially suppressed the symptoms.     

Inhibition spectra of solar urticaria: a case report and a review of the Japanese cases

A 34-year-old Japanese female with solar urticaria is described, who had an episode of urticarial response when she was exposed to indoor fluorescent light first and sunlight later. The action spectrum was found to range from 480 to 520 nm with an inhibition spectrum above 650 nm in the visible light by both postirradiation and preirradiation. Injection of in vitro-irradiated serum did not produce an urticarial wheal on the patient. In the Japanese literature, 17 cases of solar urticaria with inhibition spectra have been reported. The wavelength of the inhibition spectrum was longer than that of the action spectrum in each case.     

Two patients with solar urticaria manifesting pruritic erythema.

Two patients with solar urticaria are described. They complained of transient pruritic erythema, but not frank wheal, on sun-exposed areas. However, urticarial wheals were elicited by polychromatic radiation in the ultraviolet and visible light ranges; the action spectra for solar urticaria ranged from 400 to 550 nm in case 1 and from UVA to 550 nm in case 2. In patients manifesting only transient pruritic erythema on sun-exposed areas, phototests are essential for making a confident diagnosis of solar urticaria.     

Production and inhibition of solar urticaria by visible light exposure

The mechanisms of production and inhibition of solar urticaria were investigated in two patients whose eruptions were induced by wavelengths ranging from approximately 400 to 500 nm. They developed urticarial reactions to their own sera, which had been exposed previously to light in vitro. The exposure of skin to light from which activating wavelengths were eliminated with a glass filter (O-55), immediately after the exposure to urticaria-eliciting light, significantly inhibited the development of urticaria. The irradiation with the filtered light prior to the exposure of urticaria-eliciting light revealed no inhibitory effect. The simultaneous exposure of action and inhibition spectra seemed to suppress urticaria formation. The exposure of the inhibition spectrum did not affect wheal formation produced by histamine and a histamine-releasing agent. The photosensitizer produced by the action spectrum may be inactivated by the inhibition spectrum, or the interaction between photosensitizer and antibody may be blocked by the irradiation with the inhibition spectrum.     

Fixed solar urticaria induced by UVA and visible light: a report of a case

Fixed solar urticaria (FSU) is a rare and less severe subgroup of solar urticaria. It is characterized by urticarial eruptions, which occurs on the same parts of the body following sun exposure. The lesions are reproducible at the same sites with similar morphology and distribution pattern after repeated sun exposure. The action spectrum of FSU is broad (300-700 nm). We reported a case of FSU induced by UVA and visible light. The patient responded well to cetirizine treatment.     

Inducción de fototolerancia con ultravioleta B de banda estrecha en urticaria solar

Introduction

Solar urticaria is an uncommon photodermatosis. First-line treatment is with antihistamines; second-line treatment includes induction of light tolerance using UV phototherapy.

Solar urticaria treated successfully with intravenous high‐dose immunoglobulin: a case report

Solar urticaria is an idiopathic, chronic and rare photodermatosis, characterized by the sudden onset of pruritic urticarial hives and plaques on the exposed areas of the skin, after a brief period of exposure to the natural sunlight or to an artificial light source. A Caucasian 27‐year‐old man presented with clinical features suggestive of solar urticaria was referred to our photodermatology unit, where phototesting confirmed the diagnosis of solar urticaria induced by visible light. As he was refractory to oral antihistamines and had slight improvement under UVA plus visible phototherapy, human high‐dose intravenous immunoglobulin was administered, with an excellent clinical‐sustained response.     

Solar urticaria—effective treatment by plasmapheresis

Some cases of solar urticaria are characterized by a circulating, transferable serum factor being essential in the pathogenesis of this disease. A patient with severe solar urticaria exhibited clinically, and both by in vivo and in vitro testing, marked urticarial reactions after irradiation with visible and UVA light. Treatment by plasmapheresis led to a sudden and dramatic therapeutic effect. A significant increase of the light tolerance was demonstrated by a battery of in vivo and in vitro tests and the patient was able to spend her holidays on the beaches of southern Europe. The therapeutic effect of one plasmapheresis tasted for more than 5 months. Plasmapheresis may represent a new and powerful therapeutic facility for some patients with solar urticaria.     

Drug-induced solar urticaria due to tetracycline

Solar urticaria is an uncommon disorder characterized by pruritus, erythema and whealing commencing within minutes of exposure to ultraviolet (UV) and visible light, and generally resolves in a few hours. We describe a 28-year-old woman who developed pruritus and erythema 5 min after sun exposure while on tetracycline for treatment of perioral dermatitis. Phototesting elicited urticarial reactions in the UVA, UVB and visible spectra. Repeat phototesting after cessation of tetracycline was negative. This report documents the first case of solar urticaria induced by tetracycline.     

Synergistic effect of broad-spectrum sunscreens and antihistamines in the control of idiopathic solar urticaria

BACKGROUND: It can be difficult to provide patients with idiopathic solar urticaria adequate protection from sunlight. In a nonrandomized controlled trial, we used a standardized phototest procedure to determine the effects of using sunscreen and antihistamine to control idiopathic solar urticaria. OBSERVATIONS: Three patients with idiopathic solar urticaria underwent phototesting with UV-B and UV-A radiation. The minimal urticarial dose (MUD) was determined 15 minutes after irradiation. The patients were subsequently tested with 5 times the MUD, and the reaction was graded every minute for 15 minutes. The patients were then treated with a high-protection, broad-spectrum sunscreen and a nonsedative antihistamine alone and in combination and underwent similar phototesting. The use of sunscreen allowed the patients to tolerate much higher doses of UV radiation (32-38 times the MUD on untreated skin). Antihistamine use did not increase the patients' MUD but did suppress wheal formation and itch, and only immediate erythema sharply located in the irradiated areas occurred. The combination of sunscreen and antihistamine acted synergistically and increased the tolerance to UV radiation markedly (80-267 times the MUD on untreated skin). Conclusion High-protection, broad-spectrum sunscreens and antihistamines protect patients with solar urticaria in different ways and are highly effective when combined.     

Solar urticaria in Singapore: an uncommon photodermatosis seen in a tertiary dermatology center over a 10-year period

BACKGROUND: Solar urticaria is an uncommon photodermatosis, characterized by the appearance of pruritic wheals after sun exposure. In this study, we examine the photobiological characteristics of solar urticaria in the heterogeneous group of Singaporean patients. METHODS: The photobiological features of all patients treated for solar urticaria at a tertiary dermatology center in Singapore over a 10-year period were retrospectively examined. RESULTS: A total of 19 patients were diagnosed to have solar urticaria from 1993 to 2002. The mean age at diagnosis was 26 years, with a racial distribution of 17 (90%) Chinese, one (5%) Malay, and one (5%) Indian. Fifteen (79%) patients were males and four (21%) were females. The face/neck (47%) and arms/forearms (58%) were most often affected. Six (32%) patients had a history of atopy and two (11%) had dermographism. Fifteen (79%) patients had Fitzpatrick's skin type IV, three (16%) had skin type III and one (5%) patient had skin type V. The mean exposure time to wheal formation was 23 min. The action spectra of solar urticaria were visible light for 12 (63%) patients, ultraviolet (UV) A for one (5%), visible light and UVA for five (27%), and natural sunlight for one (5%) patient. All patients reported partial improvement with a combination of antihistamines and sunscreens as the main modality of treatment. CONCLUSIONS: Our data suggest that solar urticaria is an uncommon photodermatosis and a rare form of urticaria. Wheals were mostly elicited by visible light and/or UVA. A combination of antihistamines and sunscreens provided a useful form of therapy for patients with solar urticaria.     

Solar urticaria enhanced through clothing

Solar urticaria is characterized by itching, erythema and wheeling immediately after exposure to radiation in the ultraviolet (UVB, UVA) and visible spectra. Although its exact mechanism remains unknown, evidence supports an immunologic pathogenesis. We describe an unusual patient with solar urticaria who had more severe involvement in skin irradiated with UVA light through white clothing. We propose that optical whiteners in clothing and detergents had absorbed UVA radiation, transforming it into visible light, which was responsible for the urticarial response.     

Solar urticaria in the visible spectrum successfully treated with astemizole

Three cases of solar urticaria in the visible spectrum successfully treated with astemizole, a H1 antihistamine, are reported. The administration of 10 mg a day of the drug increased the minimal urticarial dose from 2 to 12 times.     

Changes of photosensitivity and action spectrum with time in solar urticaria

BACKGROUND: Solar urticaria is a rare photosensitivity disorder characterized by the rapid onset of a pruritic, erythematous and urticarial rash following sun-exposure. The action spectrum and degree of photosensitivity have been observed to change over time in several isolated reports. METHODS: Monochromator phototesting was performed on multiple occasions on 12 patients with solar urticaria. RESULTS: Six patients demonstrated normal responses in the initial phototest. They remained normal in five patients upon subsequent testing. Seven patients demonstrated abnormal immediate responses, most frequently at UVA wavelengths. Within some individuals, variations in action spectrum and/or degree of photosensitivity were observed over the years, but not over days. CONCLUSION: Significant changes in action spectrum and degree of photosensitivity may occur over years in solar urticaria. However, changes over shorter periods of time are likely to be minor and not have clinical significance.     

Leukocytoclastic vasculitis in urticaria induced by ultraviolet irradiation

A 35-year-old woman would develop urticarial lesions over one to four hours after irradiation with sunlight or artificial ultraviolet radiation. Lesions could persist for days before resolving. Although lesions were morphologically typical of solar urticaria, their evolution and resolution were both much slower than expected. Histologically, the lesions showed leukocytoclastic vasculitis. This unexpected finding suggests the possibility that there may be novel mechanisms involved in the pathogenesis of some cases of solar urticaria.     

Solar urticaria: one case treated by intravenous immunoglobulin

BACKGROUND: Solar urticaria is a rare photodermatosis which often begins from the third to the fifth decade. Usual treatment consists of photoprotection measures and antihistamines although disease control is sometimes unsatisfactory with both. We report herein a very severe case of solar urticaria we treated with intravenous immunoglobulins. CASE-REPORT: A 55-year-old woman suffered for 3 years from very severe solar urticaria which resisted treatment. Phototests revealed two action spectra: the first in UVA near 380 nm with a minimal urticarian dose of 0.025 J/cm(2), the second near 500 nm in visible light. RESULTS: As last resort treatment, we gave our patient intravenous immunoglobulins. After the third course of treatment, the improvement was impressive as the patient could tolerate visible light and 15 minutes of intense solar exposure. The minimal urticarian dose was raised from 0.025 J/cm(2) to 27 J/cm(2) in UVA. One year after treatment, the solar urticaria has disappeared. CONCLUSIONS: We report herein the first case of solar urticaria treated with success with immunoglobulin. Intravenous immunoglobulin treatment is well for its effectiveness in many autoimmune diseases such as autoimmune thrombocytopenic purpura, and also, as recently proven, in some cases of severe idiopathic chronic urticaria.     

Solar urticaria. Further studies on the role of inhibition spectra

A 27-year-old woman exhibited an urticaria only to monochromatic light in the range from 400 to 525 nm, but not to polychromatic light longer than 360-nm ultraviolet (UV) and visible light. An urticarial response induced by 475-nm monochromatic light was completely inhibited by preirradiation, simultaneous irradiation, and postirradiation with light having wave bands longer than 650 nm. Two other patients with sunlight-induced solar urticaria, who had an erythema-and-wheal reaction during and after exposure to sunlight, had no suppressive wave bands in either the UV or visible-light range. These observations strongly indicate an important role for inhibition wave bands in the development of light-induced immediate erythema and urticaria. In some cases of solar urticaria, preirradiation and postirradiation with longer visible light wavelengths could be useful in preventing the development of urticaria.     

A case of porphyria cutanea tarda with experimental light urticaria

Photobiological tests were carried out on a 32-year-old man who suffered from porphyria cutanea tarda (PCT). The patient developed an immediate type of skin reaction with erythema and whealing following monochromatic irradiation at 400 nm, but did not have any abnormal immediate skin reaction after exposure to natural sunlight. Pre- or simultaneous irradiation with visible light, wavelength greater than 650 nm, suppressed the development of urticaria induced by 400 nm monochromatic radiation. On the basis of these findings and our previous observation of an inhibitory spectrum in two cases of solar urticaria, we suggest that there is also an inhibitory spectrum in PCT. This could explain the extremely low incidence of immediate erythematous or urticarial reactions in sun-exposed skin in these patients.     

Photosensitizing properties of nonsteroidal antirheumatic drugs in the photopatch test

The non-steroidal anti-inflammatory drugs, aspirin, carprofen, diclofenac, ketoprofen, piroxicam, and tiaprofenic acid, were tested in a standard photopatch test series. The routine irradiation dose was 15 J/cm2 UV-A; in most patients additional test series were exposed to non-erythematogenic doses of UV-B and a combination of UV-B and UV-A. In the photopatch test, there were reactions to tiaprofenic acid in 43 of 175 (24.6%), to carprofen in 21 of 86 (24.4%), to aspirin in 7 of 76 (9.2%), to piroxicam in 7 of 84 (8.3%), to diclofenac in 5 of 75 (6.7%), and to ketoprofen in 2 of 53 (3.8%). In 16 patients positive photopatch test results did not start to develop until after the 3rd test day (between day 7 and day 34). In some cases there were positive reactions within the non-irradiated control series. Most of the positive photopatch test reactions could be elicited by UV-A alone; in some cases, however, combined irradiation with UV-B plus UV-A was necessary to yield positive results; only rarely did positive reactions occur exclusively with UV-B. The high incidence of positive photopatch test reactions to non-steroidal anti-inflammatory drugs is a possible indication of a phototoxic action. However, in some cases a photoallergic pathomechanism seems probable with regard to the development of reactions after the 3rd test day, a high UV-sensitivity in the photopatch threshold test, and the results of the histological evaluation of test reactions in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)