Photosensitivity

Definition

Photosensitivity refers to any increase in the reactivity of the skin to sunlight.

Description

The skin is a carefully designed interface between our bodies and the outside world. It is infection-proof when intact, nearly waterproof, and filled with protective mechanisms. Sunlight threatens the health of the skin. Normal skin is highly variable in its ability to resist sun damage. Natural skin pigmentation is its main protection. The term photosensitivity refers to any increase beyond what is considered normal variation.

Causes and symptoms

There are over three dozen diseases, two dozen drugs, a variety of herbal preparations, and several perfume and cosmetic components that can cause photosensitivity. There are also several different types of reaction to sunlight—phototoxicity, photoallergy, and polymorphous light eruption. In addition, prolonged exposure to sunlight, even in normal skin, leads to skin aging and cancer. These effects are accelerated in patients who have photosensitivity.

• Phototoxicity is a severely exaggerated reaction to sunlight caused by a new chemical in the skin. The primary symptom is sunburn, which is rapid and can be severe enough to blister (a second degree burn). The chemicals associated with phototoxicity are usually drugs. The list includes several common antibiotics—quinolones, sulfonamides, and tetracyclines; diuretics (water pills); major tranquilizers; oral diabetes medication; and cancer medicines. There are also some dermatologic drugs, both topical and oral, that can sensitize skin.
• Photoallergy produces an intense itching rash on exposure to sunlight. Patients develop chronic skin changes (lichen simplex) as a result of scratching. Some of the agents that cause phototoxicity can also cause photoallergy. Some cosmetic and perfume ingredients, including a compound that was formerly used in sunscreens—para-amino benzoic acid (PABA)—can do this. Most sunscreen preparations in the early 2000s, however, no longer include PABA.
• Polymorphous light eruption (PLE) resembles photoallergy in its production of intensely itching rashes in sunlight. However, this condition lessens with continued light exposure, and so is seen mostly in the spring. Also, there does not seem to be an identifiable chemical involved. PLE is most likely to develop in fair-skinned individuals. It is estimated to affect about 10% of the United States population compared to 21% of the Swedish population. The female: male ratio is 2.5: 1, but it is thought that the imbalance may be due to the fact that women are more likely than men to seek treatment for PLE.
• There is a form of inherited PLE that affects Native Americans. The inheritance pattern is autosomal dominant.

Diseases of several kinds increase skin sensitivity:

• A hereditary disease called xeroderma pigmentosum includes a defect in repair mechanisms that greatly accelerates skin damage from sunlight.
• A family of metabolic diseases called porphyrias produce chemicals (porphyrins) that absorb sunlight in the skin and thereby cause damage.
• Albinos lack skin pigment through a genetic defect and are thus very sensitive to light.
• Malnutrition, specifically a deficiency of niacin known as pellagra, sensitizes the skin.
• Several diseases like acne, systemic lupus erythematosus, rosacea, and herpes simplex (fever blisters) decrease the resistance of the skin to sun damage. Rosacea is sometimes described as a photoaggravated skin disorder because its symptoms increase in severity when patients are exposed to sunlight.
• Photosensitivity is increasingly recognized as a common development in HIV-positive patients. Risk factors for photosensitivity in this group include African American ethnicity and treatment with highly active antiretroviral therapy (HAART).

Diagnosis

The pattern of appearance on the skin, a history of drug or chemical exposure, and the timing of the symptoms often suggests a diagnosis. A skin biopsy may be needed for further clarification.

Treatment

Removal of the offending drug or chemical is primary. Direct sunlight exposure should be limited. Some people must avoid sunlight altogether, while others can tolerate some direct sunlight with the aid of sunscreens.

Prevention

A sunscreen with an SPF of 15 or greater protects most skin from damage. Such protective garments as hats and long-sleeved shirts are highly recommended in addition.

KEY TERMS

Albino— A person or animal lacking normal coloring in the eyes, hair, and skin due to a hereditary inability to produce the skin pigment melanin. The condition itself is called albinism.

Biopsy— Surgical removal of tissue for examination.

Rosacea— A chronic skin disease characterized by persistent redness of the skin and periodic outbreaks of pustules, usually affecting the middle third of the face.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Pigmentation Disorders." Section 10, Chapter 123 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Reactions to Sunlight." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Bilu, D., A. J. Mamelak, R. H. Nguyen, et al. "Clinical and Epidemiologic Characterization of Photosensitivity in HIV-Positive Individuals." Photodermatology, Photoimmunology and Photomedicine 20 (August 2004): 175-183.

Ciocon, J. O., D. G. Ciocon, and D. J. Galindo. "Dietary Supplements in Primary Care. Botanicals Can Affect Surgical Outcomes and Follow-Up." Geriatrics 59 (September 2004): 20-24.

Levy, Stanley B., MD. "Sunscreens and Photoprotection." eMedicine November 25, 2002. 〈http://www.emedicine.com/derm/topic510.htm〉.

Murphy, G. "Ultraviolet Light and Rosacea." Cutis 74, Supplement 3 (September 2004): 13-16, 32-34.

Palmer, R. A., C. B. van de Pas, E. Campalani, et al. "A Simple Method to Assess Severity of Polymorphic Light Eruption." British Journal of Dermatology 151 (September 2004): 645-652.

Shirin, Sophie, MD, Raul DelRosario, MD, and Ada Winkielman, MD. "Polymorphous Light Eruption." eMedicine October 16, 2003. 〈http://www.emedicine.com/derm/topic342.htm〉.

ORGANIZATIONS

American Academy of Dermatology (AAD). P. O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. 〈http://www.aad.org〉.

United States Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857-0001. (888) INFOFDA. 〈http://www.fda.gov〉.

photosensitivity (foh-toh-sen-si-tiv-iti) n. abnormal reaction of the skin to sunlight, which characterizes certain skin diseases (see photodermatosis). Drugs, such as tetracyclines, phenothiazines, and NSAIDs, can also cause photosensitivity.
—photosensitive adj.