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Photosensitivity Disorders in Children SIRIRAJ MEDICAL LIBRARY CONTINUING MEDICAL EDUCATION Photosensitivity disorders in children Part I Rattanavalai Chantorn, MD,a HenryW.Lim,MD,b and Tor A. Shwayder, MDb Bangkok, Thailand, and Detroit, Michigan CME INSTRUCTIONS The following is a journal-based CME activity presented by the American Academy of delineate the appropriate diagnostic and management steps for each of these Dermatology and is made up of four phases: disorders. 1. Reading of the CME Information (delineated below) Date of release: December 2012 2. Reading of the Source Article Expiration date: December 2015 3. Achievement of a 70% or higher on the online Case-based Post Test Ó 4. 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After completing this learning activity, participants should be able to recognize the clinical characteristics of immunologically mediated photodermatoses, drug- and Elsevier: http://www.elsevier.com/wps/find/privacypolicy.cws_home/ chemical-induced photodermatoses, and cutaneous porphyrias in children; and privacypolicy 1093.e1 1093.e2 Chantorn, Lim, and Shwayder JAM ACAD DERMATOL DECEMBER 2012 Photosensitivity disorders in children encompass a diverse group of diseases. Compared to adult patients, underlying systemic disorders, including genetic or metabolic defects, are common causes in pediatric photosensitivity disorders. Photosensitivity in a child should be suspected if the child develops a sunburn reaction in sun-exposed sites after limited sun exposure. Diagnosis of a photodermatosis is made based on careful history taking and a physical examination. Early recognition and prompt diagnosis are essential to minimize long-term complications associated with inadequate photoprotection. In part I of this continuing medical education article, immunologically mediated photodermatoses, photodermatoses caused by exogenous photosensitizers, and the cutaneous porphyrias will be covered. ( J Am Acad Dermatol 2012;67:1093.e1-18.) Key words: children; photodermatoses; photosensitivity; phototesting; polymorphous light eruption; porphyrias. Ultraviolet (UV) radiation Photodermatoses have their and visible light are portions CAPSULE SUMMARY action spectrum in the UVA of the spectrum of electro- and/or UVB and/or visible magnetic radiation, which is d Photodermatoses in children are much light range. UVA light is in- classified by wavelength less common than those in adults. volved in the majority of drug- induced photosensitivity (Table I). Ultraviolet C d The most common pediatric (UVC) light or germicidal ra- photodermatosis is polymorphous light reactions. diation (200-290 nm) is ab- eruption, followed by erythropoietic Photosensitivity can be sorbed completely by the protoporphyria. defined as an abnormal or ozone layer and does not adverse reaction of the skin d Photoprotection is the mainstay of reach the earth’s surface at to UV or visible radiation. It management, although for some, there sea level. Ultraviolet A (UVA) usually follows exposure to are additional specific treatment options. light has been divided into sunlight, but rarely artificial UVAI (340-400 nm) and light sources may be also UVAII (320-340 nm). Because responsible. Similar to of the proximity of the wavelength range of UVAII adults, photosensitivity in children encompasses a to ultraviolet B (UVB) light, as compared to UVAI, the diverse group of diseases. Many of them are the biologic properties of UVAII are closer to that of UVB. result of genetic or metabolic defects, and others may The depth of penetration of UV radiation into the indicate an underlying systemic disorder. skin depends on the wavelength. The longer wave- Photosensitivity in a child should be suspected if length UVA easily reaches the reticular dermis; shorter the child develops a sunburn reaction, swelling, or wavelength UVB light is absorbed in the epidermis and intense pruritus after limited sun exposure or de- little reaches the papillary dermis. Even though only velops an eruption, skin fragility, or
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