INTRODUCTION
Polymorphous light eruption (PMLE) is a photosensitivity disorder that presents as, erythematous papulovesicles in sun-exposed regions of the skin that can progress to large plaques and bullae.1,2 While the exact mechanism of PMLE is unknown, a delayed-type hypersensitivity, involving type 1 helper (Th1) cells, immunological reaction with failure of ultraviolet-induced local immunosuppression is implicated.1,3 Patients will typically react to ultraviolet B (UVB) rays, but lesions can be produced by any wavelength or energy source if there is sufficient exposure. Typical treatments include sun protection, corticosteroids, systemic anti-malarial and desensitizing phototherapy.3 However, these treatments can be ineffective and laborious, especially desensitization phototherapy. We present a case of a patient with PMLE who experienced resolution after treatment with roflumilast 0.3% cream.
A 40-year-old-female with no significant past medical history presented to the clinic with extremely pruritic, photo-distributed, edematous, erythematous pink papules and plaques on her forearms, dorsal hands, and neck of 5 months (Figures 1 and 2). A Punch biopsy of the right forearm showed papillary dermal edema and a superficial to mid-dermal perivascular infiltrate consisting of lymphocytes, histiocytes, and scattered eosinophils. Clinicopathologic correlation is consistent with PMLE. The eruptions and symptoms did not improve with strict sun protection and clobetasol ointment of 0.5% twice a day for two months. The patient declined systemic therapy, and her schedule prevented her from undergoing prophylactic phototherapy. She experienced significant improvement in symptoms and rash clearance after using roflumilast 0.3% cream once daily for 2 weeks (Figures 3 and 4). In the areas of frequent
