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The Sun & The
Skin
Classification
Acute
– Sunburn
– Plant-induced
– Solar urticaria
– Idiopathic
– Actinic prurigo
Chronic
–Dermatoheliosis
–Chronic actinic dermatitis
–Solar lentigo
–Solar keratosis
–Skin cancer
–Metabolic and Nutritional
Disorders
Acute Sun Burn
• Acute, delayed, and transient
inflammatory response of the skin
following exposure to ultraviolet
radiation
• Caused by UVB
• Damage to DNA with excision of
pyrimidine diamers is the initiating event
Acute Sun Burn
• Pruritus may be severe even in mild
sunburn; pain and tenderness with
severe sunburn.
• Constitutional symptoms may occur
• Confluent erythema, edema, vesicles,
and bullae confined strictly to areas
of exposure
Acute Sun Burn
• Cool wet dressings, topical
corticosteroids, NSAIDs like
indocid or Acetylsalcylic acid or
in severe cases short course oral
prednisolone 20 to 40 mg is used
• Usually heals with out scaring
Phototoxic Drug Eruption
• An exaggerated sunburn response
(erythema, edema, vesicles, etc.)
secondary to drugs
• Amiodarone, thiazides, coal tar ,
doxycycline are some of the known
drugs
• The damage is due to UVA
Phototoxic Drug Eruption
Three clinical patterns
–immediate erythema and urticaria,
–delayed sunburn-type pattern
–delayed melanin hyperpigmentation
Treatment is the same as sun burn
Photoallergic Drug Eruption
• Occurs in small percentage of
individuals previously sensitized with
the drug , and they have established
memory cells.
• Halogenated salicylanilides,
phenothiazines, sulfonamides with
UVA are some of the causes
Photoallergic Drug Eruption
• Resemble allergic contact eczematous
dermatitis and pruritis is universal
• Photopatch testing with the suspected
drug
Photoallergic Drug Eruption
• Avoid all possible causes
• Immunosupression with
azathipurine plus glucocorticoids
or oral cyclosporine may be
required.
Dermatoheliosis (Photoaging)
• A syndrome of polymorphic response
of various components of the skin
• Cumulative effect of chronic sun
exposure – UVA, UVB, VL, IR
• More severe in fair skin individuals
presenting after 40 years of age.
Dermatoheliosis
• Patient appears as wrinkled,
wizened, leathery, “prematurely
aged.
• Other signs of chronic
photodamage may be observed
Dermatoheliosis
• Tretinoin, 5-Fluorouracil and
sun screens may help.
• Generally has poor prognosis
Solar Lentigo
• A circumscribed brown macule
resulting from a localized
proliferation of melanocytes due to
chronic exposure to sunlight
• Again more common in fais skinned
individuals
• Cryosurgery and laser are effective
means of treatment
Porphyria Cutanea Tarda
• A photo aggravating metabolic
disorder that presents as “fragile skin”
of the exposed areas and at times tense
bullae
• UROGEN decarboxylase deficiency
Porphyria Cutanea Tarda
• Aggravating by alcohol,
estrogens, iron, polychlorinated
hydrocarbons, high dose
chloroquine, diabetes mellitus
and hemodialysis
Porphyria Cutanea Tarda
• Avoid ethanol
• Phlebotomy
• Low dose chloroquine

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18photodermatitis.ppt

  • 1. The Sun & The Skin
  • 2.
  • 3.
  • 4.
  • 5. Classification Acute – Sunburn – Plant-induced – Solar urticaria – Idiopathic – Actinic prurigo Chronic –Dermatoheliosis –Chronic actinic dermatitis –Solar lentigo –Solar keratosis –Skin cancer –Metabolic and Nutritional Disorders
  • 6. Acute Sun Burn • Acute, delayed, and transient inflammatory response of the skin following exposure to ultraviolet radiation • Caused by UVB • Damage to DNA with excision of pyrimidine diamers is the initiating event
  • 7. Acute Sun Burn • Pruritus may be severe even in mild sunburn; pain and tenderness with severe sunburn. • Constitutional symptoms may occur • Confluent erythema, edema, vesicles, and bullae confined strictly to areas of exposure
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13. Acute Sun Burn • Cool wet dressings, topical corticosteroids, NSAIDs like indocid or Acetylsalcylic acid or in severe cases short course oral prednisolone 20 to 40 mg is used • Usually heals with out scaring
  • 14. Phototoxic Drug Eruption • An exaggerated sunburn response (erythema, edema, vesicles, etc.) secondary to drugs • Amiodarone, thiazides, coal tar , doxycycline are some of the known drugs • The damage is due to UVA
  • 15. Phototoxic Drug Eruption Three clinical patterns –immediate erythema and urticaria, –delayed sunburn-type pattern –delayed melanin hyperpigmentation Treatment is the same as sun burn
  • 16.
  • 17.
  • 18.
  • 19. Photoallergic Drug Eruption • Occurs in small percentage of individuals previously sensitized with the drug , and they have established memory cells. • Halogenated salicylanilides, phenothiazines, sulfonamides with UVA are some of the causes
  • 20. Photoallergic Drug Eruption • Resemble allergic contact eczematous dermatitis and pruritis is universal • Photopatch testing with the suspected drug
  • 21.
  • 22.
  • 23.
  • 24. Photoallergic Drug Eruption • Avoid all possible causes • Immunosupression with azathipurine plus glucocorticoids or oral cyclosporine may be required.
  • 25. Dermatoheliosis (Photoaging) • A syndrome of polymorphic response of various components of the skin • Cumulative effect of chronic sun exposure – UVA, UVB, VL, IR • More severe in fair skin individuals presenting after 40 years of age.
  • 26. Dermatoheliosis • Patient appears as wrinkled, wizened, leathery, “prematurely aged. • Other signs of chronic photodamage may be observed
  • 27.
  • 28.
  • 29. Dermatoheliosis • Tretinoin, 5-Fluorouracil and sun screens may help. • Generally has poor prognosis
  • 30. Solar Lentigo • A circumscribed brown macule resulting from a localized proliferation of melanocytes due to chronic exposure to sunlight • Again more common in fais skinned individuals • Cryosurgery and laser are effective means of treatment
  • 31.
  • 32.
  • 33.
  • 34.
  • 35. Porphyria Cutanea Tarda • A photo aggravating metabolic disorder that presents as “fragile skin” of the exposed areas and at times tense bullae • UROGEN decarboxylase deficiency
  • 36. Porphyria Cutanea Tarda • Aggravating by alcohol, estrogens, iron, polychlorinated hydrocarbons, high dose chloroquine, diabetes mellitus and hemodialysis
  • 37.
  • 38.
  • 39.
  • 40. Porphyria Cutanea Tarda • Avoid ethanol • Phlebotomy • Low dose chloroquine