Aktuelle Dermatologie 2007; 33(1/02): 17-25
DOI: 10.1055/s-2006-945164
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie idiopathischer Photodermatosen

Diagnosis and Treatment of Idiopathic PhotodermatosesT.  Gambichler1 , S.  Boms2
  • 1Klinik für Dermatologie und Allergologie der Ruhr-Universität Bochum, St. Josef Hospital (Direktor: Prof. Dr. P. Altmeyer)
  • 2Universitätsklinikum Heidelberg, Hautklinik (Direktor: Prof. Dr. A. Enk)
Further Information

Publication History

Publication Date:
22 February 2007 (online)

Zusammenfassung

Die idiopathischen Photodermatosen (IPD) stellen eine heterogene Gruppe von Erkrankungsbildern dar, die durch pathologische Hautreaktionen in Erscheinung treten, welche durch optische Strahlung insbesondere im Ultraviolett-A-Wellenlängenbereich ausgelöst werden. Die Ätiopathogenese der IPD ist unklar. Die polymorphe Lichtdermatose, die Hidroa vacciniformia, die solare Urtikaria, die aktinische Prurigo und die chronische aktinische Dermatitis sind die wichtigsten Erkrankungen, die zu den IPD gehören. Aufgrund der oft störenden Symptomatik führen die IPD häufig zu einer deutlichen Beeinträchtigung der Lebensqualität der betroffenen Personen. Zur exakten Bestimmung der Aktionsspektren sowie Klärung des Ausmaßes der Photosensitivität sind photodiagnostische Testverfahren unentbehrlich. Die Photoprovokationsprotokolle, Light-Hardening-Verfahren und medikamentösen Behandlungsformen der IPD sind jedoch kaum standardisiert. In diesem Übersichtsartikel werden die klinischen Charakteristika, diagnostischen Maßnahmen und Therapieoptionen der oben genannten IPD kurz diskutiert.

Abstract

The idiopathic photodermatoses (IPD) represent a heterogenous group of conditions appearing with pathological skin reactions that are triggered by optical radiation, particularly in the ultraviolet A wavelength region. The pathogenesis of IPD is obscure. Polymorphic light eruption, hydroa vacciniformia, solar urticaria, and chronic actinic dermatitis are the most important conditions that belong to the IPD. Due to bothersome symptoms such as intractable itch, the IPD frequently result in a significant reduction in quality of life of affected individuals. Photodiagnostic procedures are mandatory for the exact determination of action spectra and degree of photosensitivity. However, photoprovocation tests, light hardening regimens, and drug therapy of IPD are hardly standardized. In this review, the characteristic clinical features, diagnostic measures, and treatment options of IPD are briefly discussed.

Literatur

  • 1 Ferguson J, Dover J S (eds). Photodermatology. London; Manson Publishing 2006
  • 2 Ferguson J. Diagnosis and treatment of the common idiopathic photodermatoses.  Australas J Dermatol. 2003;  44 90-96
  • 3 Stratigos A J, Antoniou C, Papathanakou E, Daboudi M, Tranaka K, Tsara K, Katsambas A D. Spectrum of idiopathic photodermatoses in a Mediterranean country.  Int J Dermatol. 2003;  42 449-454
  • 4 Hölzle E. Photodermatosen.  Akt Dermatol. 1996;  22 15-19
  • 5 Sassa S. The porphyrias.  Photodermatol Photoimmunol Photomed. 2002;  18 56-67
  • 6 Meffert B, Meffert H. Optische Strahlung und ihre Wirkungen auf die Haut.  Biomed Technik. 2000;  45 98-104
  • 7 Mathes R, Sliney D (eds). Measurements of optical radiation hazards. München; Märkl-Druck 1998
  • 8 McKinlay A F, Diffey B L. A reference action spectrum for ultraviolet induced erythema in human skin.  CIE J. 1987;  6 17-22
  • 9 Lehmann P. Diagnostic approach to photodermatoses.  J Dtsch Dermatol Ges. 2006;  4 965-975
  • 10 Roelandts R. The diagnosis of photosensitivity.  Arch Dermatol. 2000;  136 1152-1157
  • 11 Wolf R, Oumeish O Y. Photodermatoses.  Clin Dermatol. 1998;  16 41-57
  • 12 Van de Pas C B, Hawk J L, Young A R, Walker S L. An optimal method for experimental provocation of polymorphic light eruption.  Arch Dermatol. 2004;  140 286-292
  • 13 Dummer R, Ivanova K, Scheidegger E P, Burg G. Clinical and therapeutical aspects of polymorphous light eruption.  Dermatology. 2003;  207 93-95
  • 14 Ling T C, Richards H L, Janssens A S, Anastassopoulou L, Antoniou C, Aubin F, Diepgen T L, Fazakerley R, de Gruijl F R, Jansen C T, Pavel S, Smedley A, Stratigos A J, Webb A R, Gibbs N K, Rhodes L E. Seasonal and latitudinal impact of polymorphic light eruption on quality of life.  J Invest Dermatol. 2006;  126 1648-1651
  • 15 Boonstra H E, van Weelden H, Toonstra J, van Vloten W A. Polymorphous light eruption: a clinical, photobiologic and follow-up study of 110 patients.  J Am Acad Dermatol. 2000;  42 199-207
  • 16 Ling T C, Gibbs N K, Rhodes L E. Treatment of polymorphic light eruption.  Photodermatol Photoimmunol Photomed. 2003;  19 217-227
  • 17 Kolgen W, van Meurs M, Jongsma M, van Weelden H, Bruijnzeel-Koomen C A, Knol E F, van Vloten W A, Laman J, de Gruijl F R. Differential expression of cytokines in UV-B-exposed skin of patients with polymorphous light eruption: correlation with Langerhans cell migration and immunosuppression.  Arch Dermatol. 2004;  140 295-230
  • 18 Hjorth N, Sjolin K E, Sylvest B, Thomsen K. Acne aestivalis-Mallorca acne.  Acta Derm Venerol. 1972;  52 61-63
  • 19 Verbov J. Actinic folliculitis.  Br J Dermatol. 1985;  113 630-631
  • 20 Veysey E C, George S. Actinic folliculitis.  Clin Exp Dermatol. 2005;  30 659-661
  • 21 Gupta G, Man I, Kemmett D. Hydroa vacciniforme: a clinical and follow-up study of 17 cases.  J Am Acad Dermatol. 2000;  42 208-213
  • 22 Demachi A. et al . Characterization of Epstein-Barr Virus (EBV)-positive NK cells isolated from hydroa vacciniforme-like eruptions.  Microbiol Immunol. 2003;  47 543-552
  • 23 Iwatsuki K, Xu Z G, Takata M. et al . The association of latent Epstein-Barr virus infection with hydroa vacciniforme.  Br J Dermatol. 1999;  140 715-721
  • 24 Iwatsuki K. et al . Pathogenic link between hydroa vacciniforme and Epstein-Barr virus-associated hematologic disorders.  Arch Dermatol. 2006;  142 587-595
  • 25 Schauder S. Solar urticaria.  Hautarzt. 2003;  54 952-958
  • 26 Sams W M. Solar urticaria: studies of the active serum factor.  J Allerg. 1970;  45 295-301
  • 27 Kojma M, Horiko T, Nakamara Y, Aoki T. Solar urticaria: relationship of photoallergen and action spectrum.  Arch Dermatol. 1986;  122 550-555
  • 28 Leenutapong V, Hölzle E, Plewig G. Solar urticaria: studies on the mechanisms of tolerance.  Br J Dermatol. 1990;  122 601-606
  • 29 Fukunaga A, Horikawa T, Yamamoto A, Yamada Y, Nishigori C. The inhibition spectrum of solar urticaria suppresses the wheal-flare response follwing intradermal injection with photo-activated autologous serum but not with compound 48/80. Photodermatol Photoimmunol.  Photomed. 2006;  22 129-132
  • 30 Hojyo-Tomoka M T, Vega-Memije M E, Cortes-Franco R, Dominguez-Soto L. Diagnosis and treatment of actinic prurigo.  Dermatol Ther. 2003;  16 40-44
  • 31 Lippert U, Schauder S, Neumann C. Aktinische Prurigo.  Hautarzt. 2000;  51 597-603
  • 32 Arrese J E, Dominguez-Soto L, Hojyo-Tomoka M T. et al . Effectors of inflammation in actinic prurigo.  J Am Acad Dermatol. 2001;  44 957-961
  • 33 Gomez A, Umana A, Trespalacios A A. Immune responses to isolated human skin antigens in actinic prurigo.  Med Sci Monit. 2006;  12 106-113
  • 34 Hawk J LM. Chronic actinic dermatitis.  Photodermatol Photoimmunol Photomed. 2004;  20 312-314
  • 35 Yap L M, Foley P, Crouch R, Baker C. Chronic actinic dermatitis: a retrospective analysis of 44 cases referred to an Australian photobiology unit.  Australas J Dermatol. 2003;  44 256-262
  • 36 Menage H duP, Sattar N K, Haskard D O, Hawk J LM, Breathnach S M. A study of the kinetics and pattern of E-selectin, VCAM-1 and ICAM-1 expression in chronic actinic dermatitis.  Br J Dermatol. 1996;  134 262-268
  • 37 Chu A C, Robinson D, Hawk J L, Meacham R, Spittle M F, Smith N P. Immunologic differentiation of the Sezary syndrome due to cutaneous T-cell lymphoma and chronic actinic dermatitis.  J Invest Dermatol. 1986;  86 134-137
  • 38 Bakels V, van Oostveen J W, Preesman A H, Meijer C JLM, Willemze R. Differentiation between actinic reticuloid and cutaneous T cell lymphoma by T cell receptor y gene rearrangement analysis and immunophenotyping.  J Clin Pathol. 1998;  51 154-158
  • 39 Bilsland D, Crombie I K, Ferguson J. The photosensitivity dermatitis and actinic reticuloid syndrome: no association with lymphoreticular malignancy.  Br J Dermatol. 1994;  131 209-214
  • 40 Neumann N J, Fritsch C, Lehmann P. Photodiagnostische Testverfahren Teil 1.  Hautarzt. 2000;  51 113-125
  • 41 Fitzpatrick T B. The validity and practicality of sun-ractive skin types I and IV.  Arch Dermatol. 1988;  124 869-887
  • 42 Beattie P E, Dawe R S, Ferguson J, Ibbotson S H. Dose-response and time-course characteristics of UV-A1 erythema.  Arch Dermatol. 2005;  141 1549-555
  • 43 Gambichler T, Moussa G, Tomi N S, Paech V, Altmeyer P, Kreuter A. Reference limits for erythema effective ultraviolet doses.  Photochem Photobiol. 2006;  82 1097-1102
  • 44 Murphy G M. Investigation of photosensitive disorders.  Photodermatol Photoimmunol Photomed. 2004;  20 305-311
  • 45 Das S, Lloyd J J, Walshaw D, Farr P M. Provocation testing in polymorphic light eruption using fluorescent ultraviolet (UV) A and UVB lamps.  Br J Dermatol. 2004;  151 1066-1070
  • 46 Bruynzeel D P, Ferguson J, Andersen K, Goncalo M, English J, Goosens A, Hölzle E, Ibbotson S H, Lecha M, Lehmann P, Leonard F, Moseley H, Pigatto O, Tanew A. Photopatch testing: a consensus methodology for Europe.  J Eur Acad Dermatol Venereol. 2004;  18 679-682
  • 47 Gambichler T, Laperre J, Hoffmann K. The European standard for sun-protective clothing: EN 13 758.  J Eur Acad Dermatol Venereol. 2006;  20 125-130
  • 48 Hampton P J, Farr P M, Diffey B L, Lloyd J J. Implication for photosensitive patients of ultraviolet A exposure in vehicles.  Br J Dermatol. 2004;  151 873-876
  • 49 Gambichler T, Altmeyer P, Hoffmann K. Role of clothes in sun protection.  Recent Results Cancer Res. 2002;  160 15-25
  • 50 Gambichler T, Laperre J, Altmeyer P, Hoffmann K. UVA and UVB transmission of fabrics: critical wavelength based on absorbance and effective dose.  Exog Dermatol. 2002;  1 290-295
  • 51 Peyron J L, Raison-Peyron N, Meynadier J, Moyal D, Rougier A, Hourseau C. Prevention of solar urticaria using a broadspectrum sunscreen and determination of a solar urticaria protection factor (SUP).  In: Rougier A, Schaefer H (eds). Protection of the skin against ultraviolet radiation. Paris; John-Libbey Eurotext 1998: 201-205
  • 52 Van den Keybus C, Laperre J, Roelandts R. Protection from visible light by commonly used textiles is not predicted by ultraviolet protection.  J Am Acad Dermatol. 2006;  54 86-93
  • 53 Schauder S, Schrader A, Ippen H. Göttinger Liste 1996. Sonnenschutzkosmetik in Deutschland. 4. neubearbeitete und erweiterte Auflage. Berlin; Blackwell 1996
  • 54 Tuchinda C, Lim H W, Osterwalder U, Rougier A. Novel emerging sunscreen technologies.  Dermatol Clin. 2006;  24 105-117
  • 55 Hönigsmann H. Mechanisms of phototherapy and photochemotherapy for photodermatoses.  Dermatol Therapy. 2003;  16 23-27
  • 56 Gambichler T, Breuckmann F, Boms S, Altmeyer P, Kreuter A. Narrowband UVB phototherapy in skin conditions beyond psoriasis.  J Am Acad Dermatol. 2005;  52 660-670
  • 57 Beissert S, Ständer H, Schwarz T. UVA rush hardening for the treatment of solar urticaria.  J Am Acad Dermatol. 2000;  42 1030-1032
  • 58 Collins P, Ferguson J. Narrow-band UVB (TL-01) phototherapy: an effective preventative treatment for the photodermatoses.  Br J Dermatol. 1995;  132 956-963
  • 59 Janssens A S, Pavel S, Out-Luiting J J, Willemze R, de Gruijl F R. Normalized ultraviolet (UV) induction of Langerhans cell depletion and neutrophil infiltrates after artificial UVB hardening of patients with polymorphic light eruption.  Br J Dermatol. 2005;  152 1268-1274
  • 60 Darras S, Segard M, Mortier L, Bonnevalle A, Thomas P. Treatment of solar urticaria by intravenous immunoglobulins and PUVA therapy.  Ann Dermatol Venerol. 2004;  131 65-69
  • 61 Jeanmougin M, Peyron J L, Thomas P, Beani J C, Guez E, Bachot N. Polymorphic light eruption: prophylaxis using a topical combination of antioxidants and UVA protection formulations.  Ann Dermatol Venereol. 2006;  133 425-428
  • 62 Patel D C, Bellaney G J, Seed P T, McGregor J M, Hawk J L. Efficacy of short-course oral prednisolone in polymorphic light eruption: a randomised controlled trial.  Br J Dermatol. 2000;  142 112-114
  • 63 Wu J J, Huang D B, Pang K R, Hsu S, Tyring S K. Thalidomide: dermatological indications, mechanisms of action and side-effects.  Br J Dermatol. 2005;  153 254-273
  • 64 Uetsu N, Okamoto H, Fujii K, Doi R, Horio T. Treatment of chronic actinic dermatitis with tacrolimus.  J Am Acad Dermatol. 2002;  47 881-884
  • 65 Edstrom D W, Ros A M. Cyclosporin A therapy for severe solar urticaria.  Photodermatol Photoimmunol Photomed. 1997;  13 61-63
  • 66 Mang R, Stege H, Budde M A, Ruzicka T, Krutmann J. Successful treatment of solar urticaria by extracorporeal photochemotherapy (photopheresis) - a case report. Photodermatol Photoimmunol.  Photomed. 2002;  18 196-198
  • 67 Collins P, Ahamat R, Green C, Ferguson J. Plasma exchange therapy for solar urticaria.  Br J Dermatol. 1996;  134 1093-1097
  • 68 Duschet P, Leyen P, Schwarz T, Hocker P, Greiter J, Gschnait F. Solar urticaria: effective treatment by plasmapheresis.  Clin Exp Dermatol. 1987;  12 185-187
  • 69 Evans A V, Palmer R A, Hawk J L. Erythrodermic chronic actinic dermatitis responding only to topical tacrolimus.  Photodermatol Photoimmunol Photomed. 2004;  20 59-61
  • 70 Calnan C D, Meara R H. Actinic prurigo (Hutchinson’s summer prurigo).  Clin Exp Dermatol. 1977;  2 365-372
  • 71 Londono F. Thalidomide in the treatment of actinic prurigo.  Int J Dermatol. 1973;  12 326-328

Dr. T. Gambichler

Klinik für Dermatologie und Allergologie
Ruhr-Universität Bochum

Gudrunstr. 56

44791 Bochum

Email: t.gambichler@klinikum-bochum.de