case report
Case 1
An otherwise healthy 14-year old African American male presents
to the Henry Ford Dermatology Clinic in June 2010 for a
“rash†on the body as well as facial swelling. Patient reports
2 days prior to his presentation to the clinic he had spent all
day outside during a friend’s pool party. On the morning after
the pool party, patient developed a pruritic eruption with small
papules on all sun-exposed areas as well as significant redness
and swelling of the face and lips. Patient denied swelling of the
tongue or shortness of breath. Patient had been using fexofenadine
and pseudoephedrine to reduce the swelling. Of note,
patient reported having similar episodes during the previous
summer, on five different occasions, where he developed eruption
on exposed areas several hours after being exposed to the
sunlight. However, patient reported that this was the first time
he had swelling associated with the rash.
On physical examination, the patient had numerous, scattered,
1-2 mm skin colored to slightly erythematous pinpoint papules
on face, ears, neck, chest, back, abdomen and upper extremities.
A presumptive diagnosis of polymorphous light eruption
(PMLE) was made. Skin biopsy from the left arm was showed
mild epidermal acanthosis and epidermal spongiosis, spongiotic
microvesicles, perivascular infiltrate of lymphocytes, histiocytes
and rare eosinophils localized within the superficial dermis; these
were consistent with the papulovesicular variant of PMLE. Laboratory
evaluation, which included antinuclear antibody panel, basic
metabolic profile, and complete blood count, were all within normal
limits or negative. His glucose-6-phosphate dehydrogenase was low at 1.7 (normal: 7-20.5 U/g Hb). The eruption resolved in
two weeks with residual hyperpigmentation.
In May 2012, patient returned to the clinic due to his PMLE flaring
after patient was out in the sun for an hour and a half during
baseball practice. Patient noticed an eruption on his cheeks,
perioral area, and dorsal hands.
On physical examination, multiple 1-mm skin colored papules
were observed on his cheeks and perioral area (Fig 1). Also noted
on the dorsum of his hands and less predominantly on the forearms
were similar skin colored papules. Patient was prescribed
triamcinolone 0.1% ointment twice a day to the affected areas;
narrowband UVB desensitization therapy, 3 times per week for 7
weeks, was administered. These resulted in marked improvement
in his photosensitivity and his ability to tolerate sunlight.
Case 2
A 32 year old African-American male with atopic dermatitis, involving
his forehead and dorsum of hands and feet, presented
on July 2003 to the Henry Ford Dermatology clinic with a complaint
of his face continuing to break out and itch in spite of
the use of topical corticosteroids given for his atopic dermatitis.
Examination of his face revealed multiple erythematous
papules, some coalescing into small plaques located on the
forehead and malar prominence, in a sun-exposed distribution
(Figure 2). A clinical diagnosis of PMLE of the forehead and malar
eminence was made. Patient was prescribed fluocinonide
