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December 27, 2016 00:07

Polymorphic photodermatosis .Causes.Symptoms .Diagnostics.Treatment

clinically polymorphic photodermatosis combines the features of solar prurigo and eczema, arising from exposure to the sun.The disease generally develops under the influence of UVB, UVA rays sometimes.The term "polymorphic photodermatosis" in 1900 suggested that the Danish dermatologist Rash.He observed 2 patients with clinical manifestations of the disease were very similar to the sun and solar eczema prurigo.However, some scientists believe these diseases are self-reliant.

term "polymorphic photodermatosis" scholars interpreted differently.For example, British dermatologists understand this disease as a disease occurring in young children, who appear rosy red papules hemispherical shape having a solid consistency, comprising on the surface of yellow bubble (rash located on the open and closed areas).Rash winter undergoes slight regression, but not disappear.In South America, the scientific literature polymorphic dermatosis included in the number of hereditary diseases.It occurs mostly in Indian fami

lies (80% of patients - a girl) and shows a high sensitivity to the sun.

Pathogenesis polymorphic photodermatosis.The pathogenesis of the disease is not fully understood.According to some scholars, in causing the disease are important in the immune system disorders.The patients had a blood increase total T-lymphocyte, increase in T helper skin compared with other cells.There is an increase in the blood of patients with B-lymphocyte content, and IgG-immunoglobulins of neutrophils and increased sensitization but with respect to the protein.The occurrence of the disease is very important endocrine and gastro-intestinal system.The simultaneous action of the above factors and high patient sensitivity to sunlight accelerate development of the disease.

Symptoms polymorphic photodermatosis.Disease occurs between 10-30 years of age or more often in women.It usually begins in the spring months.After 7-10 days after exposure beams develop symptoms characteristic of the disease.One sign is the appearance on the exposed skin (face, neck, hands) prurigiioznyh or vesicular rash accompanied by itching.Observed cheilitis and conjunctivitis.The disease occurs seasonally, a rash appears in spring and summer, the fall is reduced.Papules the size of 0.2-1 cm, pink and red, located on erythematous skin.Merging, they form plaques.As a result, severe itching of the skin, there are excoriations and hemorrhagic crusts.In 1/3 patients have papulovezikuleznaya rash, skin oozing, and clinical manifestation of the disease more closely resembles acute eczema.

for disease characterized by a change papular rash vezikulezioy.However, if the disease recurs and is manifested with such morphological elements, such as erythema, lichenoid-pruriginous papules, excoriation, crust, it is possible to diagnose "solar prurigo".With long-term course of the disease on the skin surface can be observed dipigmentnye scars.One patient may be seen as a pruriginous and eczematous lesions.

At the same time, on the patient's skin and urticaria may occur granulomatous rash.With the progression of the disease rash may spread to those areas of the body where you do not get sunlight.

in the diagnosis and differential diagnosis is important to define the minimal erythema dose, which is high for a polymorphic photodermatosis.

Histopathology.Morphological changes do not have a specific character.In the epidermis revealed acanthosis, spongiosis and in the dermis - infiltrate consisting of leukocytes.

differential diagnosis.Dermatoses cleduet distinguished from lupus erythematosus, erythropoietic protoporphyria, sarcoidosis, hydroa aestivalis.

Hereditary polymorphic photodermatosis American Indians have described A. R. Birt, R. A. Davis in 1975. The disease is common among Indians in North and South America;It begins in childhood.The ratio of female to male patients is 2: 1.Family cases are 75% and it is assumed that it is transmitted by dominant inheritance.

dermatoses begins in the spring months, the rash is located only in areas exposed to sunlight.In young children, the disease is as acute eczema on the face and is often associated with cheilitis (start time).

epidemiological survey of American Indians found that the dermatosis may contribute to the development of diseases such as streptococcal pyoderma, post-streptococcal glomerulonephritis.

Summer prurigo Hutchinson is a clinical form of polymorphic photodermatosis and very rare.Dermatoses begins in children and adolescence manifested rash of nodules, which are bubbles surface.The rash is observed not only in the open areas of the body, but also on the skin of the buttocks and legs.In winter, the morphological elements do not completely disappear.During the photo-UVB with 50% of patients showed the emergence of nodules observed in the polymorphic photodermatosis.Some dermatologists say that summer prurigo Hutchinson is a form hydroa aestivale, others attributed it to the polymorphic photodermatosis.However, the frequent occurrence at a young age, nodules on the surface of the bubble elements weakly expressed link between the rash and the action of sunlight, incomplete disappearance of the rash in the winter, the presence of morphological elements in areas not subjected to the influence of sunlight, set it apart from the polymorphic photodermatosis.

treatment.Recommended prevention patients from the sun, use sunscreen ointments and other means.Recommend vitamin therapy (Group B, C, PP), antioxidants (alpha-tocopherol), methionine tionikol.Using antifebrile drugs (delagil once a day to 0.25 g over 5 days) yields a good result.Use of beta-carotene with ksantaksantinom enhances the effectiveness of treatment.In order to prevent polymorphic photodermatosis early spring and during remission spend PUVA therapy or phototherapy with UVB rays, which give positive results.The use of prophylactic PUVA therapy with beta-carotene increases the effectiveness of treatment.