Due to the urgency of the problem of photosensitive dermatosis, which aggravates or first appears in the summer, we have prepared answers to some of the main questions that a young dermatologist may have. Many photodermatoses do not pose a threat to the patient, although they frighten him with acute manifestations. But some photosensitive dermatoses can signal serious systemic disorders, and the task of the doctor in this case is to make the correct diagnosis in a timely manner, prescribe an examination and treatment.
- Which definition is most accurate for photosensitivity and photodermatosis?
Most dermatologists consider photosensitivity to be a manifestation of dermatosis or its exacerbation caused by exposure to sunlight. Photodermatosis is manifested most often by itching and soreness of the skin, swelling, redness, rashes. Sometimes photosensitivity does not appear immediately, and patients do not associate painful sensations on the skin with excessive insolation. The doctor should not only ask the patient in detail about when the first symptoms appeared, what medications he took or how he treated the skin, but also make sure that the skin is affected in photo-illuminated areas, which clearly indicates the dependence of dermatosis on sun exposure. Please note that drug-induced photosensitive dermatosis is very similar to sunburn, but occurs in response to a very small dose of sunlight.
- Is there a classification of photosensitive dermatoses and on what basis?
Photodermatoses are usually classified into acute and chronic. Acute photosensitive dermatosis develops after sun exposure, which occurred for a short time - a few minutes or hours. A classic example of acute photosensitive dermatosis is sunburn.
Acute photodermatoses also commonly include solar urticaria, erythropoietic porphyria, phototoxic drug reaction, photocontact dermatitis.
Chronic photosensitive dermatoses are less acute and painful, but they are persistent and require painstaking long-term treatment. Such photodermatoses include, for example, discoid lupus erythematosus, actinic reticuloid, late porphyria, polymorphic solar rashes. Some forms of skin cancer are also linked to chronic exposure to the sun.
- What questions should I ask a patient if I suspect photosensitive dermatosis?
How long did it take between exposure to the sun and the appearance of rashes on the skin?
Have you had similar rashes before, how often, at what time of the year? (Some photodermatoses recur only in spring or summer, others appear only once.)
Have relatives had similar rashes or other symptoms? (Photosensitive dermatitis may be hereditary).
Has the skin been treated with something shortly before sun exposure? (Photodermatosis can be caused by soaps, creams, perfumes, and numerous other cosmetic products.)
What medications is the patient taking by mouth? (Some drugs can cause photosensitive dermatosis.)
Apart from itching or rash, what other symptoms do you have?
What else in the state of health is of concern? (Some photodermatoses are accompanied by abdominal pain, increased pressure, and other symptoms.)
- What symptom can be considered the key in determining photodermatosis?
The most important sign by which photosensitive dermatosis is defined is the localization of skin lesions: usually rashes or red spots appear in areas where sunlight hits. The face and neck, décolleté, shoulders, back of the hands are most exposed to insolation. If we are talking about photodermatosis caused by a substance applied to the skin, then it is precisely those areas where perfume or cosmetics got into that are affected.
- What are the most common causes of photosensitive dermatosis?
Priority among the causes of photosensitive dermatosis is kept by medications (both local and systemic). Moreover, the list of drugs that can cause photodermatosis is constantly expanding. A common cause of acute photosensitive dermatosis is the application of cosmetic products containing methylcoumarin, as well as some plants containing furocoumarins (for example, lemon, rosehip, celery, fig tree, and many others).
Polymorphic light rashes are the most common cause of chronic photodermatosis.
The physician should be aware that exposure to sunlight can exacerbate other skin conditions that are similar in symptoms to photosensitive photodermatosis. We are talking about some dermatoses that are provoked by the herpes virus, as well as erythema multiforme, granuloma annulare, erythematous pemphigus. Careful history taking, attention to symptoms, diagnostic studies will help to correctly diagnose the disease and start treatment in a timely manner.
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