[EFFECT OF SUNLIGHT ON PSORIASIS PATIENTS IN THE DERMATOLOGIC CLINIC OF LEEDS].
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The acute development of an irritating rash often results in a patient presenting to the Emergency Department instead of scheduling an office visit. This rash is frequently the result of the patient's interaction with the environment. Consequently, it is important that emergency physicians become more familiar with environmentally induced skin disorders. Sunburn and poison ivy are examples of these types of disorders. These and less common environmentally related skin disorders are reviewed.
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BACKGROUND: Reticular erythematous mucinosis (REM) syndrome is a rare disorder. Its clinical course is cyclic with remissions and exacerbations. In this disease, photosensitivity has previously been noticed but rarely demonstrated. We report three new cases with positive photobiological investigation. CASE REPORTS: Three patients (two males, one female) with a mean age 47 years were seen with reticular erythematous papules on the upper chest and or back. After sun exposure, the lesions were exacerbated. Skin biopsies showed dermal lymphocytic perivascular infiltration with mucin deposition between collagen bundles. Direct immunofluorescence was negative. Antinuclear antibodies were absent. In cabin, ultraviolet (UV)A exposure reproduced clinically and histologically REM lesions in our cases. UVA and UVB provocating phototests were negative. In all patients treatment with oral antimalarials and external photoprotection was effective. CONCLUSIONS: In our patients, we confirm the photosensitive feature of REM syndrome by provocative irradiation in UVA cabin. The mechanism of triggering is actually unclear. It is supposed that UV radiation, heat, and perspiration are necessary to reveal this affection.
BACKGROUND: Jessner's lymphocytic infiltration of the skin is a rare and benign disorder. Its clinical course is cyclic with remissions and exacerbations. In this disease, photosensitivity was previously noticed by authors and recently demonstrated. We report four new cases with positive photobiological investigation. CASE REPORTS: Four patients (2 males, 2 females), with a mean age 36 years were seen with erythematous papules or discoid plaques on face, arms and upper trunk. The onset of disease occurred after sun exposure in summer. Skin biopsies showed perivascular lymphocytic infiltration in the dermis. All patients relapsed cyclically with incomplete healing during winter. Photobiological investigation elicited skin lesions in a broad spectrum of UV: UVB (2 cases), UVA (1 case), UVA and UVB (1 case). In all patients treatment with oral antimalarials and external photoprotection was effective. DISCUSSION: Our data suggest that photosensitivity history in patients with Jessner's lymphocytic infiltration of the skin should be searched for, and confirmed by provocative phototesting. This relevant event could guide the therapeutic strategy because antimalarials were effective for the Jessner's lymphocytic infiltration cases with photosensitivity.
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A patient with a pure red cell aplasia (Blackfan-Diamond Anemia), and with many congenital abnormalities and growth retardation, has been found to have a chromosome breakage syndrome. In this patient, the frequencies of spontaneous chromosome aberrations and micronuclei in PHA stimulated peripheral blood lymphocytes are elevated when compared to those in normal individuals. The frequency of sister chromatid exchanges is within normal range. The response to mitomycin C (MMC) in the micronucleus test, using lymphocytes, shows a similar increase in the patient's lymphocytes to that in normal individuals, indicating no increased sensitivity to MMC. The frequencies of X-ray induced dicentric chromosomes and micronuclei in the peripheral blood lymphocytes are elevated in the patient. But as the patient clinically does not have any signs of ataxia telangiectasia, this combination of clinical and laboratory findings of this case does not correspond with any of the other known 'chromosome breakage' syndromes.
1. Sensitivity to blue light was quantified using a Friedman Central Field Analyzer and the Dark Adaptation Threshold procedure. 2. Patients diagnosed as having a major depressive disorder using research diagnostic criteria had dark adaptation thresholds quantified after a 10 day drug wash out and again after antidepressant drug therapy. 3. Prior to drug treatment patients were significantly more sensitive to light than controls as measured by cone but not rod thresholds. 4. Following drug treatment both cone and rod thresholds were reduced in patients. In comparison to controls, drug treatment normalized cone threshold and reduced rod threshold in patients. 5. These data provide ophthalmological evidence for increased sensitivity to light in non medicated depressive disorder and a reduction in sensitivity following antidepressant drug therapy. 6. The possibility of altered retinal function and consequently the ability to perceive and use light for entrainment of circadian rhythm in affective disorder deserves further study.
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