DermHelpCentral

Sun Poisoning

(also known as) Acute Polymorphous Light Eruption

Have you experienced an annoying itchy rash on arms, chest or legs in the late spring or early summer?  Has your winter trip to Florida, Mexico or Hawaii been marred by such an eruption?  If so, you may be among those people who have a common form of light sensitivity.  Read on...

In 1985, along with Morison and Hood, we reported on this entity which we also call "papulovesicular light eruption or PVLE.  PVLE is the most common type of polymorphous light eruption and is seen in up to 10% of individuals.  It occurs early in the season before a susceptible individuals skin has had time to "harden" or when one travels from an area of low UV (e.g. Massachusetts in February) to more intense radiation (e.g. Mexico).  It appears when such a person gets a large dose of ultraviolet light and it is not predictably prevented by sunscreens.

Photo:  Fairly typical picture of papules and vesicles.

We saw 150 patients with PVLE is a three year period in Hawaii.  Eighty-five percent of these people  were using sunscreens at the time the rash developed. Over 90% were tourists to the islands.  The eruption is usually located on the arms, upper chest and legs and consists of red papules and often vesicles (water blisters).

Sun Poisoning is self-limited. With repeated sun-exposures it gradually disappears over a couple of weeks. We believe it can usually be prevented by getting graded and gradual exposures. Tanning booths appear to prevent PVLE if used with care (since too much light will trigger the eruption).

The treatment is symptomatic. Wet dressings and a potent corticosteroid cream or ointment for a few days along with hydroxizine 10 - 50 mg h.s. are often helpful. For severe cases, or when quick improvement is desired, 40 - 60 mg of prednisone in divided doses for 4-5 days will provide relief.

References:
1. Elpern DJ, Morison WL, Hood AF Papulovesicular light eruption. A defined subset of polymorphous light eruption.Arch Dermatol 1985 Oct;121(10):1286-8
A distinctive photodermatitis is seen commonly in tourists visiting Hawaii. Analysis of 150 cases revealed that the eruption is acute in onset following exposure to sunlight, is confined to exposed areas, and mainly affects young to middle-aged white women. The clinical presentation is remarkably uniform, consisting of papules, papulovesicles, or vesicles. These findings are consistent with a diagnosis of polymorphous light eruption (PMLE) and the histologic picture supports this diagnosis. Other clinical variants of PMLE were not seen in our patients, however, which suggests that this condition is more monomorphous than polymorphous. We suggest papulovesicular light eruption as a suitable name for this common and distinctive subset of PMLE

2. Morison WL, Stern RS. Polymorphous light eruption: a common reaction uncommonly recognized. Acta Derm Venereol 1982;62(3):237-40
Polymorphous light eruption (PMLE) is usually considered to be an uncommon complaint, although the prevalence in the general population has not been studied. In a survey of 271 apparently healthy subjects, 10% gave a history consistent with a diagnosis of PMLE. The clinical characteristics in the survey cases of PMLE were similar in most respects to those of patients presenting to a clinic with this disorder. However, there was one notable exception, in that there was a striking difference between the clinic and survey cases in the amount of sunlight required to trigger the eruption. Clinic patients required a mean exposure of 30 min as compared with over 3 h in the survey cases. These findings suggest that PMLE is a common disorder but that many individuals have a high threshold of response to sunlight exposure.

Tanning: Fake 'n' Bake

A peculiar article appeared in the Sunday, April 15 NY Times on artificial tanning.  It is written in an annoying (to us) tongue-in-cheek tone; but it covers the area well.  What we disagree with is the implication that tanning is bad for all of us.  Indeed, it is not recommended for people with Type I and II* skin, especially if they have a family history of skin cancer, but it is not all that dangerous for darker-skinned individuals.

That being said, there are lots of individuals who may benefit from looking tan.

The essay begins: "[Are you s]till playing Russian roulette with your skin?... Especially with tons of self-tanners on tap and a real possibility that one of them won’t turn you into one of Willy Wonka’s Oompa-Loompas or, worse, George Hamilton. The Samurai Shopper began fiddling with self-tanners during an arctic chill, practicing for summer. At first I jumped into the fray without reading directions carefully, the same way I jump into swimming pools without testing the waters with my big toe. Though self-tanners are much improved from their Coppertone beginnings, you ignore directions at your own pumpkinesque peril. And every self-tanner says: Don’t even think of doing this without exfoliating first.  Moisturize, too, especially your body’s bonier bits: knees, knuckles, ankles, elbows."

You can read the entire submission "Samurai Shopper -- Fake 'n' Bake by S.S. Fair (? a nom de plume?) on Permalink

*Skin Types

Skin Type                         Typical Features                                       Tanning Ability      
    I                   Pale white skin, blue/hazel eyes, blond/red hair       Always burns/never tans
    II                  Fair Skin, blue eyes                                                  Burns easily, tans poorly
    III                 Darker white skin                                                     Tans after initial burn
    IV                 Light brown skin                                                       Burns minimally/tans easily
     V                 Brown skin                                                                Rarely burns, tans darkly
    VI                 Dark brown to black skin                                           Never burns, tans darkly

Moss Lecture References

A Power Point file with references to:
The Moss Lectures
University of Wisconsin
April 27, 2007

CyberDermatology and Why Read?

can be found at:  Moss Lectures '07  It may take a minute or two to download depending on your bandwidth.

Molluscum

It's a common scenario.  A mother brings in a young child with a number of (usually) asymptomatic bumps on the torso, extremities, or face.  Often, they know the diagnosis, sometimes not.  These are molluscum contagiosa, a common, benign, self-limited viral infection of children.  For a brief overview, go to DermNet

It is our feeling that these lesions are vastly over-treated.  The disease poses no threat to the child, the therapies can be painful or can take weeks to months, and the disorder runs its course over time.  It is likely that if one lets nature take her course life-long immunity ensues.  Aggressive therapy may prevent this and set the scenario for molluscum to recur when a child becomes sexually active.  At that time, molluscum are more psychologically troublesome.

For an indepth discussion, Prodigy Guidance is super.

You may feel differently and want your child treated.  This is your decision and you should discuss your goals with your pediatrician or dermatologist. 

Cosmetic Minimalism

Every day, patients (mostly women) have questions about skin care.  Sadly, one's education does not provide the answers and there are few to no good studies on this subject.  A small number of dermatologists have good ideas.  These are mostly women who have thought about this area and tried lots of products themselves. 
Years ago, we heard the phrase that cosmetics companies sell "Hope in a Bottle."  So, it was with some degree of surprise that an inspired patient told me recently of a product she has used called "Hope in a Jar" which is manufactured by a company called Philosophy.  Their product line is interesting -- the best named I have ever come across.

Here is a helpful article on the basics of "skin care" from the NY Times.  Download basic_skin_care.pdf

A colleague, Dr. Brenda Dintiman from Fairfax, Virginia liked the article and sent these useful comments:  "The article in the NY times on cosmetic minimalism definitely intrigues me.  Since I started dermatology in 1988, almost 20 year ago, there has been an explosion of skin care products, cosmeceuticals and stores that carry skin care products.  In addition to the numerous cosmetic counters in the department stores, there are stores totally devoted to skin care and makeup lines, such as Sephora, that are very successful and now the cornerstones of malls.

Although minimalism fits my needs, personality and skin type, I am obviously not the majority.  When asked over the years what my skin care regimen was, it was almost embarrassing to admit that I was a "water" girl not even a "soap and water" girl. Maybe it came from my years as a student where self-care was low on my priority list.  I gently washed my face, using a little soap, applied sunscreen in the summer, and  wore minimal to no makeup-- mascara, lip gloss and some blush.  Of course, in my heart I knew that I had been blessed by my mother with low maintenance, "good" skin" and that many people were not.

I was trained the same way as other dermatologists and instructed to recommend dove soap, sunscreen and moisturizer from the drug store and that toners, astringents and any creams with placenta were a waste of time.  Yet, as time passed and many patients came to me wanting more specific recommendations and my  own skin aged, I started to pay closer attention to what was available. At the same time that the vitamin C products, retinol products, alpha hydroxy lines were developed, the over the counter product companies such as Neutrogena, Oil of Olay, Purpose, Aveeno changed their lines and there was a product explosion.

So what does it all mean? How do I incorporate the patient's desire for skin care guidance, the struggle between research and anecdotal evidence and my own personal views on the skin care lines available?

I still believe in minimalism with a little expansion of the regimen.  I listen to my patients and get feedback from them on what things irritate their skin especially if they have acne or rosacea or eczema.  Then, I provide them with guidance from my favorite list. Unfortunately, if they are told to just use soap and water and some over the counter moisturizer, they will be seduced by a $300.00 line and I will have to incorporate this into their acne care.  As a result, I give them guidance.

Keep it simple.  The less products the better is my philosophy.
Don't expect over the counter products to do what medicines, such as retinoids, topical antibiotics and topical steroids, do.
There are no miracle products but some do make your skin appear fresher, brighter and less dry.

Here are 4 of my favorite skin care lines.
Neutrogena
Oil of Olay
Vanicream
Hylunia

I recommend the foaming gentle cleanser by Neutrogena, the SPF 30 moisturizer for year round, SPF 55 sunscreen for spring and summer.Men will wear the SPF 30 moisturizer since it is light and low fragrance.
I also like their makeup line and shaving products.
People have problems with the healthy skin moisturizer because it often stings.

Oil of Olay has gentle cleansers.
I like their REgenerist product.  Who knows why but it has a silky moisturizing feel on the skin?

I love Vanicream.  It is a small company and you can get their products online.
It is fragrance, paraben, preservative free and great for eczema patients, irritant dermatitis patients, patients with undetermined allergies to products.
The liquid cleanser is great.
The moisturizer comes in a light cream or heavier moisturizer.
There is a shampoo and conditioner and a bath oil.
Great, cost effective line.

And last but not least is the Hylunia line.
It is also preservative and fragrance and masking fragrance free.  Designed for children with eczema.
Great for sensitive skin patients, acne patients so they can tolerate their retin A and differin and benzoyl peroxide and my rosacea patients swear by it.

Last but not least, I will add a vitamin C serum a patient really wants to try one of the cosmeceuticals.  There are a few others but again I try to keep it simple and cost effective, yet give specific recommendations because they will go elsewhere and buy anyway.