Photosensitivity skin disorders in childhood

Abstract

SummaryPhotosensitivity in childhood is caused by a diverse group of diseases. It usually indicates idiopathic photodermatoses, first of all polymorphic light eruption. It may be an early symptom of genetic disorders such as porphyria or very rare genophotodermatoses. Photosensitivity secondary to topical or systemic external agents as well as photoexacerbated dermatoses is not so frequent in childhood. Here we present our experience with childhood photosensitivity skin diseases collected over a 40-year period. L ight-induced skin eruptions are not a common problem in pediatric dermatology. However, the condition often causes trouble and discomfort to the affected child and the parents.The literature on childhood photodermatoses (PDs) is relatively scanty. The incidence of PDs in childhood is much lower than in adults (1). According to the paper published by Jansén (2), photosensitivity started at the age of 15 years or earlier in 26% of the cases out of a total of 370 PD patients. There is also a shortage of primary data on the prevalence of PDs classified recently by Yashar and Lim (3) such as (i) idiopathic PD: polymorphic light eruption (PLE), juvenile spring eruption of the ears (JSE), solar urticaria (SU), hydroa vacciniforme (HV), (ii) photosensitivity secondary to exogenous agents, (iii) cutaneous porphyrias, (iv) genophotodermatoses and (v) photoexacerbated/aggravated disorders. The paper presents experience with PDs in childhood (83 cases) collected at the Department of Dermatology, Debrecen, between 1967 and 2006.The diagnosis in the vast majority of PD cases in children is PLE, whereas the order of other diseases is quite variable depending on geographic and genetic conditions. In the Finnish report (2) mentioned before, PLE was followed by xeroderma pigmentosum (XP) and then erythropoietic protoporphyria (EPP), while no cases were recorded from external photosensitizers. According to other literary data, phototoxic dermatitis occurs relatively often besides idiopathic PDs during childhood (4). Similar to these findings the most frequent diagnosis at our Department of Dermatology was also PLE. However, we recorded a rather high number of EPP cases and some porphyria cutanea tarda (PCT) as well, but only a few cases of XP (Table 1).Diagnosis of PD in childhood is not as easy as in adulthood (5). In the history occasionally (mostly in EPP) a family history is noted, such as in our patient material (6). The clinical picture is featured by various kinds of eruptions localized typically on the sun-exposed skin. The diagnosis in childhood can also be confirmed by phototests. Most informative is the provocation test used to reproduce lesions of idiopathic PDs (5). We perform it with ultraviolet (UV)B and UVA separately (Multitester SBB LT 400; Saalmann, Herford, Germany) (7) according to the protocol of Lehmann et al. (8). Photopatch testing for identifying external photosensitizer(s) is not performed commonly in children. We have not used it in our practice. Concerning laboratory tests, in porphyrias spect...

Photosensitivity testing in children

“…P hotosensitivity disorders in children can be classified into 4 groups: (1) idiopathic, (2) secondary to endogenous agents, (3) photoexacerbated dermatoses, and (4) secondary to exogenous agents (Table I). 1 Polymorphic light eruption (PLE) is the most common photodermatosis.…”

Photosensitivity disorders in children

“…2 before 5 years of age and 10% between 6 and 14 years of age. In a study from Scotland, 20% of the patients presented before 10 years of age, 4 whereas in Finland, approximately 25% of the cases occurred before 15 years of age. 3 Clinical manifestation.…”

“…[3][4][5] It is caused by partial deficiency of the ferrochelatase (FECH) enzyme; clinical presentations appear only when FECH activity is \50% of normal function. EPP is an inherited disorder; however, the mode of inheritance is complex.…”

“…A study by Horkay et al 4 collected 83 childhood-onset photodermatosis patients evaluated between 1967 and 2006 in Debrecen, Hungary, and found that the vast majority of photosensitivity cases in children were PMLEs, similar to the result of the previous report. However, Horkay et al 4 found that the second most common cause was EPP. The latest literature in pediatric photodermatoses, published by Ten Berge et al, 5 also reported that PMLE was the most common diagnosis (39% of patients).…”

“…2 The incidence of photodermatoses in the pediatric population is much lower than in adults. [3][4][5] A summary of the distribution of photosensitivity disorders in children as reported in the literature [3][4][5] is shown in Table III. Jansen 3 reported 95 (26%) cases of a total 370 patients with photosensitivity disorders started before 15 years of age.…”