Polymorphous Light Eruption Presenting as Pinhead Papular Eruption on the Face

November 2013 | Volume 12 | Issue 11 | Case Reports | 1285 | Copyright © November 2013

Prescilia Isedeh MD and Henry W. Lim MD

Multicultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, MI

Polymorphic light eruption (PMLE) is the most common of the immunologically mediated photodermatoses.1 Onset is typically within the first three decades of life and affects females two to three times more than males.2,3 It occurs 30 minutes to 1-3 days after sun exposure and usually resolves in 7 to 10 days.2 Lesions present as non-scarring, erythematous and minimally pruritic papules, vesicles, papulovesicles, plaques or nodules.3
A pinpoint papular variant of PMLE has been reported in individuals with skin phototype IV-VI,4 characterized by the development of pinpoint papules, 1 to 2 mm, on sun-exposed areas after ultraviolet radiation.5 PMLE has a predilection for the arms, forearms, hands, head and neck region, usually with sparing of the face.2,4 We report two cases of American-American males who presented with the pinpoint papular variant of PMLE involving the face.

J Drugs Dermatol. 2013;12(11):1285-1286.

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