Management of Acute Sunburn

Current literature documents the use of many pharmacologic agents in the management of acute sunburn. While numerous studies have been undertaken, there is no consensus on an algorithm for such treatment. We review the literature for an evidence-based approach to the management of sunburn. A MEDLINE search was conducted whereby all published articles related to sunburn or ultraviolet (UV)-induced erythema from 1966-2001 were evaluated. Studies and reviews were excluded if they were not conducted in human beings. The results of these studies are varying and often conflicting in terms of clinical effectiveness or feasibility. A total of 40 studies were reviewed. Fourteen out of the 40 studies addressed the actual treatment of sunburn (i.e. the application of a substance after the development of signs or symptoms). The majority concluded that either corticosteroids, NSAIDs, antioxidants, antihistamines or emollients were ineffective at decreasing recovery time. The remaining studies showed mild improvement with such treatments, but study designs or methods were flawed. Furthermore, regardless of the treatment modality, the damage to epidermal cells is the same. Given the lack of convincing data and consensus of opinion regarding sunburn management, the most effective and practical approach to acute sunburn is symptomatic treatment of UV light-induced symptoms, including erythema, pain and pruritus.     

Acute alopecia totalis

From a group of 1,189 AA patients seen in our dermatology unit, thirteen (3 males, 10 females) experienced hair shedding that started profusely and diffusely over the entire scalp. They were under observation for about 5 years, histopathology and trichograms being performed in all instances. The mean age of the patients was 26.7 years. It took only 2.3 months on average from the onset of hair shedding to total denudation of the scalp. The trichogram at the time of diffuse shedding showed that about 80% had dystrophic roots and the remaining 20% had telogen roots. Histopathological findings and exclamation mark hairs were compatible with alopecia areata. Regrowth of hair was noted 3.2 month after the onset of hair shedding and recovery observed in 4.8 months. All patients were treated by methylprednisolone pulse therapy. During the follow-up period, 53 months on average after recovery, 8 of the 13 patients (61.5%) showed normal scalp hair without recurrence, in 4 patients the recovery was cosmetically acceptable in spite of focal recurrences and only 1 patient showed a severe relapse after recovery. Considering all of the above findings, this group of the patients should be delineated by the term acute alopecia totalis.     

Acute acral pustulosis

We report a patient with a pustular eruption in an acral distribution that developed abruptly 4 days after a streptococcal pharyngitis. The histology showed an intraepidermal vesicle filled with neutrophils with an underlying lymphocytic vasculitis. Direct immunofluorescence demonstrated heavy deposition of C3 within the vessel walls. In addition, circulating immune complexes were found.     

Acute diffuse scleroderma

A case of acute diffuse scleroderma without contemporaneous visceral involvement is described. Antibodies to endothelial cells have been found in the skin.     

Acute oral ulcers

In general, a detailed history and examination of the patient provides sufficient information for diagnosis. The pattern, frequency, and natural history of ulcer episodes are helpful. The presence or absence of associated features and the site of oral involvement guides most physicians accurately in the diagnosis. Additional investigations, including blood tests, and occasionally the use of oral cultures or biopsy, are needed to make a definitive diagnosis. A multispecialty approach is often necessary to evaluate patients with other systemic features. Most acute oral ulcers heal spontaneously without specific therapy being necessary, but an understanding of the cause of the ulcer is reassuring to the patient and guides the clinician in management to prevent recurrent episodes of oral ulceration, or chronicity of ulcers.     

Acute lymphangitic nocardiasis

The third case of lymphangitic nocardiasis caused by Nocardia brasiliensis to be recorded in Uruguay is presented. The clinical picture showed some of the features of sporotrichosis, but it was more acute, the nodules developing rapidly into abscesses. A review of eight similar cases, reported previously, reveals that N. brasiliensis was properly identified in five of them. All cases were localized on the upper limbs, and granules were not seen on direct examination. Mycetomas caused by N. brasiliensis have not been observed in Uruguay.     

Acute palmoplantar pustulosis

This paper describes five cases of an uncommon acral rash, acute palmoplantar pustulosis, which is precipitated by infection, and may represent a true pustular bacteria. Acute and chronic palmoplantar pustulosis are probably different forms of the same disease, but the prognosis in the acute form is good and aggressive therapy is not indicated. The relationship to psoriasis is discussed.