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

table 1
ointment 0.05% to the affected areas of the face for 1-2 weeks, and patient was advised to begin using broad spectrum facial sunscreen with an SPF of at least 30.
Patient returned to the clinic for a 2-week follow-up where he reported mild improvement and minimal pruritus of his facial rash. On examination of his face revealed multiple flesh colored 1-2mm papules on the cheeks and malar prominences. Patient was offered a biopsy during this visit, but declined due to concern of developing a scar. The use of fluocinonide ointment was discontinued, and patient was told to continue using sunscreen. Patient’s facial papular lesions resolved with subsequent visits.

DISCUSSION

PMLE is the most common chronic idiopathic photosensitivity disorder. Lesions manifest as a wide range of morphological variants with the pinpoint papular variant presenting most commonly in patients with skin of color, for example, African Americans and Asians,4 which was reported in this case series. Although PMLE has often been described as sparing the face, we report two cases where facial involvement is the dominant feature of the disorder. Recognition of this variant of PMLE along with the distribution is important for diagnosing and managing these patients.
Diagnosis of PMLE is frequently made by obtaining a thorough history and physical examination, with specific attention to the morphology, location, seasonal variation, and time course to the evolution of the lesions following UV radiation exposure.4 In the treatment of PMLE, prevention is important with sun avoidance and photoprotection. Additionally, hardening can be achieved with the use of narrowband UVB (as demonstrated in case 1), or photochemotherapy with psoralen and UVA (PUVA) before the beginning of sunny period.2 Other treatment modalities include topical corticosteroids, antimalarials; although rare, systemic corticosteroids may be required.2

disclosures

Dr. Lim serves as a consultant for Clinuvel Pharmaceuticals Limited, Estee Lauder Companies, Ferndale, La Roche-Posay, Pierre Fabre, Palatin and Uriage and has received clinical research grants from Clinuvel and Estee Lauder. Dr. Isedeh does not have any relevant conflicts to disclose.

References

  1. Honigsmann H, Hojyo-Tomoka MT. Polymorphous Light Eruption, Hydroa Vacciniforme, and Actinic Prurigo. In Lim, HW, Honigsmann H, Hawk JLM eds. Photodermatology. New York: Informa Healthcare. 2007; 149-165.
  2. Bansal I, Kerr H, Janiga JJ, Qureshi HS, Chaffins M, Lim HW, Ormsby A. Pinpoint papular variant of polymorphous light eruption: clinical and pathological correlation. J Eur Acad Dermatol and Venereol. 2006; 20:406-410.
  3. Chiam, LYT and Chong W. Pinpoint popular polymorphous light eruption in Asian skin: a variant in darker-skinned individuals. Photodermatol, Photoimmunol and Photomed. 2009; 25:71-74.
  4. Kontos, AP, Cuscak CA, Chaffins M, Lim HW. Polymorphous light eruption in African Americans: pinpoint papular variant. Photodermatol Photoimmunol Photomed. 2002; 18: 303-306.
  5. Kerr HA and Lim HW. Photodermatoses in African Americans: A retrospective analysis of 135 patients over a 7-year period. J Am Acad Dermatol. 2007; 57: 638-43.

AUTHOR CORRESPONDENCE

Henry W. Lim MDhlim1@hfhs.org
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