(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.