Photosensitivity Diseases Are Not Just for Lightly Pigmented Individuals

Craig A. Elmets, MD

Keep photosensitivity in mind — even for patients with more heavily pigmented skin.

Photodermatoses occur when there is an abnormal response to sun exposure. Although heavily pigmented individuals are also known to develop these diseases, most studies evaluating their frequency and the range of diagnoses have been conducted in fair-skinned individuals (Fitzpatrick sun-reactive skin types I–III). In this report, investigators evaluated the incidence of photodermatoses in Indian patients (Fitzpatrick types IV and V) seen at a tertiary referral center over a 22-month period (January 2009–October 2010).

Of >125,000 dermatology patients, 362 were diagnosed with a photodermatosis. The 0.28% incidence was substantially lower than has been reported among lighter-skinned patients. There was a 3:2 female:male predominance, and most patients were 21 to 40 years old. The most common symptoms were burning, itching, and stinging in sun-exposed areas of skin. As in patients with Fitzpatrick types I–III, the most frequent diagnosis was polymorphous light eruption (PMLE; 60%). In these patients, >30% had micropapular lesions (rarely, if ever, found in fair-skinned individuals). The next most common was chronic actinic dermatitis (13.8%); other conditions included photoaggravated atopic dermatitis, lupus erythematosus, dermatomyositis, lichen planus actinicus, lichen planus pigmentosus, and rare photosensitive genodermatoses. There were no cases of solar urticaria, actinic prurigo, or hydroa vacciniforme.

Citation(s):

Wadhwani AR et al. A clinical study of the spectrum of photodermatoses in dark-skinned populations. Clin Exp Dermatol 2013 Jun 13; [e-pub ahead of print].