In Vivo Phototesting
The term photosensitivity is used to describe the acute reaction of skin to UV radiation (UVR) and is considered abnormal if the reaction of skin to UVR is either quantitatively or qualitatively outwith that of the normal population.
Photosensitivity diseases are a heterogeneous group of conditions for which detailed clinical assessment is vital.
A further category of abnormal photosensitivity disease are seen in those induced by drugs and chemicals.
These include antibiotics (e.g. fluoroquinolones and doxycycline), diuretics (e.g. thiazides) and non-steroidal anti-inflammatory drugs.
|Metabolic photodermatoses||Photoexacerbated dermatoses||Genetic photodermatoses||Primary photodermatoses||Exogenous photodermatoses|
|Porphyria cutanea tarda||Lupus erythematosus||Xeroderma pigmentosum||Polymorphic light eruption||Drug-induced photosensitivity|
|Erythropoeitic protoporphyria||Dermatomyositis||Bloom syndrome||Juvenile spring eruption||Photocontact dematitis|
|Variegate porphyria||Darier disease||Rothmund Thomson syndrome||Actinic folliculitis||Pseudoporphyria|
|Erythropoeitic porphyria (Gunther disease)||Rosacea||Cockayne syndrome||Actinic prurigo|
|Pemphigus vulgaris||Solar urticaria|
|Pemphigus foliaceus||Chronic actinic/ photosensitivity dermatitis|
|Atopic dermatitis||Hydroa vacciniforme (Epstein Barr virus)|
For routine screening, a xenon arc solar simulator can be used for MED testing.
- UVA/ UVB sources used to determine wavelength band giving rise to photosensitivity
- For a full and precise investigation, the PhotoTest450 must be employed
Minimal erythema dose (MED) in Photosensitive skin
- The induced erythema is graded 22-26 hours following the dosage, based on an established 5-point scale
- Polymorphic light eruption typically requires 2 hours of exposure to trigger a reaction, which may not develop for up to 24 hours and lasting up to 48 hours
|0||No difference from surrounding skin|
|(+)||Just perceptible erythema (diffuse mild erythema without defined borders)|
|+||Uniform erythema with sharply defined borders|
|++||Bright red colour and slight induration (edema) on palpation|
|+++||Bright red colour and pronounced induration (edema) raised above the surrounding skin|
- In solar urticaria where immediate photosensitivity is the problem, the MUD (i.e. the dose of irradiation required to elicit just detectible urticaria) is used as the main outcome measure
- 5—point scale used when testing patients suffering from idiopathic solar urticaria
- Solar urticaria is usually triggered within just a few minutes of exposure, with lesions appearing within as little as an hour
|(+)||Just perceptible erythema (minimal urticaria dose; MUD)|
|+||Erythema localised to irradiated area|
|++||Erythema spreading beyond the irradiated area|
|+++||Wheal in some parts of irradiated area|