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Ten elderly male patients with severe persistent photosensitivity of unknown cause are described. The clinical presentation was that of an intense eczematous eruption affecting exposed sites but spreading elsewhere. Frequent episodes of erythroderma were characteristic and in some cases the marked thickening and ridging of the exposed skin simulated a lymphoma. In contrast to most other photodermatoses the photosensitivity extended through the u.v. to the visible spectrum. A wide range of histological changes were noted, in several instances closely resembling lymphoma because of the intensity and pleomorphisni of the infiltrate.OUR purpose is to describe a group of elderly male patients wlio developed chronic ])hotosensitivit3^ which, when the clinical changes were severe, suggested lymphoma. Additional features were the severity and wide spectral range of the photosensitivity and the intense dermal intiltrate whieh often showed a histologieal resemblance to retieulosis.Similar instances of photosensitivity inducing lymphoma-Iike reactions do not seem to have been described in detail previously and are not mentioned among the eommon patterns of ])hotosensitivity reviewed by Kesten and Slatkin (1953). However. Lamb and colleagues (1057) recorded 3 eases of photosensitivity in which the histological intiltrate showed retieular eells, plasma cells and eosinoi)hils and simulated '' lymplioblastoma ". Andrews and Domonkos (1963) also noted a similar instance. Wiskemann (196S) has kindly drawn our attention to 2 patients whom he has studied. Tliey, it seems, bear a elose resemblance to the patients we describe here and bad reticulosis-like reactions provoked by longwave u.v.r. and visible light (Meinhof, 1962; Wiskemann, 19r>5).

Quantitative studies on sunburn cell (SBC) production in mouse epidermis are reported. Ultraviolet radiation (UVR), 260-300 nm, produced a dose related effect with respect to SBC formation. Maximal spectral reactivity was at wavelengths shorter than 300 nm. In 8-methoxypsoralen (8-MOP) photosensitization, SBCs were also produced and this response is dose related with respect to long wave UVR dose. In fluorescein photosensitization, provoked by 487 nm light, SBCs were not produced. The response in 8-MOP photosensitization and 254 nm UVR (given alone) differed in respect of time course, but it is considered that both may perhaps to initiated by a DNA lesion.

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Fourteen patients suffering from actinic prurigo were treated with thalidomide. Eleven patients showed lasting improvement on the drug and three of these remained symptom-free after discontinuing therapy. No major side-effects were observed. Thalidomide is an effective drug in the treatment of actinic prurigo but it must be used with adequate contraception in women of child-bearing age.

A double-blind controlled trial of low-dose prophylactic oral psoralen photochemotherapy (PUVA) and ultraviolet-B (UVB) irradiation therapy was undertaken from April to September 1983 in 42 patients with polymorphic light eruption (PLE). Patients were randomly allocated to three groups, PUVA with oral 8-methoxypsoralen (8-MOP), UVB with oral placebo, and control low-dose UVA with oral placebo. The initial dose given to each active treatment group was a third of the predetermined minimal phototoxic or erythema dose, followed three times weekly for 6 weeks by doses incremented by an eighth on each occasion in the PUVA group and by a seventh in the UVB group. Ultraviolet radiation exposure was monitored throughout with polysulphone film lapel badges. Patients recorded their symptoms on a visual analogue scale. Symptoms of rash and itch in patients treated with PUVA and UVB were significantly less affected by increasing exposure to ultraviolet radiation than were these symptoms in control patients.