[16] This includes emotional distress, anxiety and depression[12], Thomas Bateman, following on from findings of his predecessor, Robert Willan,[24] first recorded a description of PLE in the nineteenth century, defining it as eczema solare with recurrent non scarring eczematous lesions triggered by sun exposure. Lembo S, et al. Dark lips are often the result of hyperpigmentation. To reduce the effects of PMLE, the American Academy of Dermatology (AAD) recommends seeking shade and applying sunscreen. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Polymorphous light eruption (PLE) is a common skin rash that occurs due to sunlight exposure. Phototesting can be considered but is not carried out in all patients with PMLE. 2008 Aug; [PubMed PMID: 18510674], Papular polymorphic light eruption on lower legs in female. [2], The rash may persist for many days to a couple of weeks,[5] resolving spontaneously without scarring as long as further sunlight exposure is avoided. This may suggest a genetic component, but researchers have not proven this. PMLE affects all ages, sexes, races and ethnicities. Clinical and therapeutic aspects of polymorphous light eruption. [11], PLE appears on areas of the skin newly exposed to sunlight such as the visible part of the neckline, backs of hands, arms and legs, and feet, but less commonly the face. Your healthcare provider may recommend a blood test to rule out other medical conditions, like lupus erythematosus, an autoimmune disease that can also cause a rash following sun exposure. If they are not sure, they may suggest a skin biopsy. Erythema multiforme This generally shows more extensive epidermal necrosis, less spongiosis and the infiltrate often exclusively lymphocytic, Books about skin diseasesBooks about the skin Eruptions appear on sun-exposed areas, usually 30 minutes to several hours after exposure; however . It can feel sore or burning. Photodermatol. [4] It can, however, occur in all age groups and all skin types. [2], The main differential diagnosis is photosensitivity associated with lupus erythematosus, which may behave and appear similar but tends to be more persistent. [4]Neutrophils may be seen in early lesions. Photohardening of polymorphic light eruption patients decreases baseline epidermal Langerhans cell density while increasing mast cell numbers in the papillary dermis. It occurs 1-2 days after intense sun exposure. Journal of the European Academy of Dermatology and Venereology : JEADV. http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens#.UbdQaJzm9lP. window.__mirage2 = {petok:"qA58IQ768GeOLKFViL7kQqLnoC_jvex_EJRsbmd4PEw-1800-0"}; DermNet does not provide an online consultation service.If you have any concerns with your skin or its treatment, see a dermatologist for advice. Careers. You can learn more about how we ensure our content is accurate and current by reading our. You can learn more about how we ensure our content is accurate and current by reading our. She spent most of her time on the beach, in the shade. The rash usually appears as tiny, inflamed bumps or slightly raised patches of skin. About three-quarters of patients acquire PLE after UV-A exposure only, one-tenth after UV-B exposure only, and the rest after a combination of UV-A and UV-B exposure. This hormone may prevent UV radiation from suppressing the skins immune responses. Symptoms of PMLE usually begin within a few hours to days after sunlight exposure, typically in the spring or early summer. Please enable it to take advantage of the complete set of features! A doctor may suggest taking a vitamin D supplement instead. Have you had a similar rash before? Ultraviolet radiation causes less immunosuppression in patients with polymorphic light eruption than in controls. Lesions may vary from patient to patient; however, spontaneous resolution (on cessation of sun exposure) is often a unifying trait. Emergency Nurse. Polymorphous light eruption, also known as "sun allergy" or "sun poisoning" is the most common photosensitivity. Polymorphous light eruption (PMLE) is a common skin rash that develops in people who are sensitive to ultraviolet (UV) light. Endogenous estrogen exacerbates UV-induced inflammation and photoaging in mice. In: Weedon's Skin Pathology. What Causes White Spots to Form on Your Nipple? All rights reserved. Polymorphic Light Eruption Article - StatPearls 2017 Nov 1;35(6):751-757. doi: 10.1016/j.biotechadv.2017.07.006. There is no cure for PLE, but the condition often gets better on its own in a few days. Summarize the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by polymorphic light eruption. Doctors still aren't completely sure why, but for people with PMLE, ultraviolet light from the sun stimulates an immune response that includes inflammation, swelling, itchiness, and a variety of rashes, including tiny blisters and raised, plaque-like skin. Other conditions considered as sun allergies are solar urticaria (hives and reddish patches that usually start 30 minutes to two hours after the sun exposure), actinic . Other light eruptions and eczematous reactions Photoallergic reactions and contact dermatitis can show a dense lymphocytic infiltrate to resemble PMLE. Avoid sunlight, choose shaded areas if outdoors and sit away from windows. A mucin stain will be negative and confirm dermal oedema rather than mucin (which would suggest a form of lupus). government site. [2], Depending on the clinical signs, histology of a skin biopsy may vary. Levels and function of regulatory T cells in patients with polymorphic light eruption: relation to photohardening. Topics AZ It is primarily caused by either UVA (7590%) or UVB light alone or UVA and UVB light concurrently, UVA can penetrate window glass and some sunscreens do not protect against it. False negative responses occur in 10% to 40% of tested individuals. https://melanomafoundation.org/melanoma-prevention. Seasonal, occurring in spring and early summer and usually disappearing completely in winter. Accessibility It does not seem to be associated with systemic disease or drugs. Polymorphous light eruption: clinic aspects and pathogenesis. Polymorphic light eruption occurs in 18% of Europeans and does not show higher prevalence with increasing latitude: multicenter survey of 6,895 individuals residing from the Mediterranean to Scandinavia. Murphy F, et al. Explain that UV-A is a large component of sunlight and can cause the light eruption without sunburn (as sunburn is mainly due to UV-B). The lesions are itching or burning, and vary morphologically from erythema to papules, vesico-papules and occasionally blisters, plaques, sometimes erythema multiforme-like, insect bite-like wheals and purpura. Several types of PLE exist, each with slightly different symptoms. Accessed Nov. 12, 2021. The rash usually appears as tiny, inflamed bumps or slightly raised patches of skin. UV-A is a major constituent of sunlight, can pass through glass, is relatively resistant to sunscreen and can cause light eruption without sunburn. Broad spectrum sunscreens and antioxidants, photohardening with PUVA or narrow band UVB may be beneficial to prevent the disease. In short, jock itch can spread between, Keloids can appear on your ear in response to any type of wound, including a piercing. It is sometimes referred to as "sun poisoning" or "sun allergy". Figure 2 The lesions are itching or burning, and . Mayo Clinic; 2021. Dermatologists can expose you to UV light a few times per week before the sun becomes strong in the spring to help avoid severe PMLE. When in situations that are likely to provoke the rash, cover up as much as possible with densely woven clothing. //]]>. official website and that any information you provide is encrypted Polymorphous light (PML) eruption is the most common light-induced skin disease. Willan House, 4 Fitzroy Square, London, W1T 5HQ | admin@bad.org.uk | +44 (0)020 7383 0266 J Invest Dermatol. You might start feeling the symptoms at any age, but it typically begins in ages 20 to 40. It may range from small red dots to clear fluid-filled dots (vesicles), eczema-looking dry patches, large plaques/papules, or target-like lesions. Federal government websites often end in .gov or .mil. PLE causes small bumps or raised plaques on the skin. Is the ketogenic diet right for autoimmune conditions? The disorder may be confused with many other skin disorders and thus is best managed by a dermatologist. 2014;23(6):42830. In rare cases, PMLE causes symptoms such as: In general, symptoms of PMLE last for two to three days. Exposure to sunlight in spring or summer results in an irritable rash that resolves within a few days, providing further exposure is avoided. Accessed Nov. 12, 2021. Dermatoses resulting from physical factors. Ultraviolet-radiation-induced erythema and suppression of contact hypersensitivity responses in patients with polymorphic light eruption. Rarely, systemic features such as fever, malaise, and headaches, have been associated with the eruption. If your symptoms are severe, your health care provider may prescribe anti-itch medicine (a corticosteroid cream or pill). Exposure may be to sunlight or to an artificial or medical source of ultraviolet radiation.[3]. Clipboard, Search History, and several other advanced features are temporarily unavailable. Specialized centers may undertake photoprovocation testing in late winter, to determine inciting wavelengths. [2] Due to its many clinical appearances, it is named polymorphic or polymorphous and the terms are used interchangeably. doi:10.1111/jdv.12470. [2], The cause of PLE is not yet understood, but several factors may be involved. However, once the diagnosis is made, the patient may be monitored by the primary care physician and nurse practitioner. Long-term course of polymorphic light eruption: A registry analysis. Variants include juvenile spring eruption (vesicles on the ears of young boys) and PMLE sine eruption (pruritus on sun-exposed skin without visible skin changes). Gradual hardening is one form of treating PMLE. Do they require any special preparation? Treatment for burn blisters: Debride or leave intact? This means that, as youre exposed to UV light, your skin can build up a UV tolerance. Consider wearing a broad-brimmed hat, which provides more protection than does a cap or visor. These changes are thought to restore the skins normal immunosuppressive response to UV light and hence reducing or resolving PMLE over time. Hematoxylin-eosin staining shows subepidermal edema and a mixed, predominantly lymphoid perivascular infiltrate in the superficial and deep dermis. Epub 2010 Jul 8. van de Pas CB, Kelly DA, Seed PT, Young AR, Hawk JL, Walker SL. Feel free to get in touch with us and send a message. He has since been credited with coining the term "polymorphic light eruption".[27][28]. DermNet provides Google Translate, a free machine translation service. James WD, et al. People living with PMLE should avoid exposure to sunlight, especially between 11 a.m. and 3 p.m., when UV rays are strongest. Dermatology Made Easybook. But the severity often improves with time. Polymorphous Light Eruption - American Osteopathic College of - AOCD Jock itch and related conditions can cause discomfort and itchy, irritated skin. In Germany the female to male ratio has been cited as 9:1. According to FDA regulations, sunscreen has a shelf life of 3 years. Polymorphic light eruption. The clinical presentation and the presence of massive dermal oedema can be helpful features. 2014 Jul;32(3):315-34, viii. The rash can appear following sun exposure or from other sources such as tanning beds. Sunscreen FAQs. Review the presentation of polymorphic light eruption. Outline the treatment and management options available for polymorphic light eruption. It lasts for up to 2 weeks, healing without scarring. It is more common in Northern Europe (15% in the UK) than in Australasia (5%). Interventions for polymorphic light eruption - PMC [10], As sun exposure is avoided, vitamin D levels may fall and hence supplements are sometimes advised. Photosensitivity. Its diagnosis is based on history, morphology and phototests. ncbi.nlm.nih.gov/pmc/articles/PMC7379702/, ncbi.nlm.nih.gov/pmc/articles/PMC8323194/, ncbi.nlm.nih.gov/pmc/articles/PMC6139322/, dermnetnz.org/topics/polymorphic-light-eruption, nhs.uk/conditions/polymorphic-light-eruption/, aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/what-to-wear-protect-skin-from-sun, Every Sunscreen Question You Have, Answered, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI. Your skin can build up a tolerance to UV light throughout the summer, but this will go away during the winter. Repeated UV light exposure while the rash is present may cause it to last longer. Food and Drug Administration. 2016 Mar;15(3):440-6. doi: 10.1039/c5pp00398a. [6], Half of patients have a family history of PLE,[6] demonstrating a clear genetic influence. The symptoms are usually self-limiting and go away after a few days. (n.d.). Frontiers in medicine. Oakley AM, et al. HHS Vulnerability Disclosure, Help 2008 May;58(5 Suppl 2):S149-54. Polymorphous means it looks different in different people. and transmitted securely. Direct immunofluorescence testing is negative. ago. Polymorphic light eruption (PMLE) pathology | DermNet This content does not have an English version. What side effects can I expect from treatment? The condition is benign but recurrences are common leading to emotional distress and isolation. Dermatology Made Easybook. Current theories involve two steps that lead to a polymorphous light eruption. Epub 2017 Jul 17. Some patients experience PMLE during phototherapy, which is used to treat skin conditions such as psoriasis and dermatitis. Look for clothes labeled with an ultraviolet protection factor (UPF) of 40 to 50. Is it possible this condition is related to a more serious illness? What is Polymorphous Light Eruption? - Pediatric Education The cause of polymorphic light eruption is unknown. Learn more about the condition and its treatments here. A 2014 study suggests that nutrition may also play a role in how sensitive a persons skin is to sun exposure. Solar urticaria occurs during or shortly after exposure and resolves within an hour or soof covering up. Accessed Dec. 9, 2021. PMLE often occurs in the spring when sunny weather returns. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Before Elsevier; 2020. https://www.clinicalkey.com. [10], Fever, fatigue and headaches have been previously associated with the eruption, but are rare. Usually, MED is normal, but the provocative phototests with UVA or UVB reproduce the spontaneous lesions in about 50% of the patients. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Most UV light you are exposed to comes from the sun. Its most common among: Polymorphous light eruption typically presents as an itchy rash on sun-exposed areas of your body. This should only be done by a professional. What's the most likely cause of my symptoms? polymorphic-light-eruption. PLE is considered as a delayed hypersensitivity response to newly UV induced, but still unidentified, antigen(s). It has been noted that PMLE appears to be less frequent and severe in women after menopause. Has the duration of your sunlight exposure increased recently? The reaction usually happens during spring and early summer when exposure to sunlight increases. Lupus Lupus will also show a superficial and deep dermatitis but there is also often basement membrane thickening and dermal mucin. [15], Oxidative stress and the modification of the redox status of the skin has been implicated in the expression of PLE. A skin biopsy, or tissue sample, may be obtained to confirm the diagnosis. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Copy edited by Gus Mitchell. Epub 2014 Mar 27. PMLE typically resolves on its own without treatment. Several hours to days later, an irritablerash appears on areas newly exposed to the light such as the dcolletage, forearms, backs of hands, lower legs and feet. We avoid using tertiary references. PLE symptoms typically appear around 2 hours after sun exposure and last for several days before improving on their own. Disclaimer. [18], Sunlight has been documented to trigger numerous skin conditions and the confusing terminology and categorisation previously has made the correct diagnosis and subsequent treatment difficult. Its the most common skin condition caused by sunlight. Wolf P, Gruber-Wackernagel A, Bambach I, et al. The exact cause of PMLE is unknown. Polymorphic light eruption (PMLE) DermNet Possible complications of polymorphous light eruption. Elsevier; 2021. https://www.clinicalkey.com. Elmets CA. [1], The prevalence of polymorphic light eruption varies worldwide. Mayo Clinic does not endorse companies or products. 2023 Healthline Media UK Ltd, Brighton, UK. Have you recently used a cosmetic or fragrance in the area of the rash? This won't totally protect you from a reaction, as ultraviolet A may penetrate through most sunscreens. It may persist for weeks or months if repeatedly exposed, although in most individuals gradual exposure leads to hardening so that the eruption does not occur in late summer. Nearly all cases of porphyria cutanea tarda[18] exhibit blister formation on the skin within 24 days of light exposure. Yet they can take some steps to reduce the symptoms, such as: If a person develops a rash suddenly, they should speak with a doctor for a diagnosis. Patterson JW. 2023 Healthline Media LLC. [16], In the United States, whilst one-quarter of people being investigated for a photosensitivity disorder were diagnosed with PLE, the prevalence in the general population is 10 to 15% and may even be as high as 40% as suggested in one study of more than 2000 people. sharing sensitive information, make sure youre on a federal Distribution can include areas exposed to sunlight such as the arms, lower legs, V of the neck, and the chest. It mimics the increased exposure you would experience during a summer. Call a healthcare provider if you develop an unexplained skin rash or changes to your skin. arrow-right-small-blue PMLE can be seen in all races and all skin types. [3] The bumps may become small blisters or plaques and may appear bloody,[3]often healing with minimal scarring. It is most often found in females in the second or third decade of life and occurs in 10-15% of the U.S. population. The British journal of dermatology. Schweintzger N, Gruber-Wackernagel A, Reginato E, Bambach I, Quehenberger F, Byrne SN, Wolf P. Br J Dermatol. [2], The rash is usually quite symmetrical and characteristic for each individual, appearing similar with each recurrence, but can look dissimilar in different people. [7][8](Level V), Gruber-Wackernagel A,Byrne SN,Wolf P, Polymorphous light eruption: clinic aspects and pathogenesis. For utmost sun protection, use your sunscreen before the stated expiration date. Photodermatol Photoimmunol Photomed. Accessed Dec. 9, 2021. Estradiol may act as an inhibitor to the UV light immunosuppression which would normally aid in reducing hypersensitivity reactions. Presents in temperate climates and is more common where sun exposure is uncommon. ", "Unique profile of antimicrobial peptide expression in polymorphic light eruption lesions compared to healthy skin, atopic dermatitis, and psoriasis", "Disease associations in polymorphous light eruption. This exposes the skin to small doses of UVA or UVB light that helps your skin be less sensitive to light. Sunscreens. Polymorphous light eruption (PMLE) is an allergic reaction to sunlight or other sources of ultraviolet (UV) light. PLE can look similar to other rashes, such as the rash that occurs in people with lupus erythematosus. 2014 Jul; [PubMed PMID: 24891054], Lembo S,Raimondo A, Polymorphic Light Eruption: What's New in Pathogenesis and Management. Some people are able to build a tolerance to UV light by gradually spending time outdoors or using phototherapy. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. It may affect up to 15% of people worldwide. A PLE rash does not usually leave scars or marks. It causes small, raised bumps measuring around 25 millimeters across. [6] It is thought to be due to a type IV delayed-type hypersensitivity to an allergen produced in the body following sunlight exposure,[12] in a genetically susceptible person. The rash may first appear in the spring and diminish as the spring and summer months progress.