Solar urticaria

Hydroxychloroquine is approved for the treatment of both systemic and cutaneous lupus erythematosus. Both chloroquine and quinacrine (Atabrine) are also effective in this skin disease. Low-dose chloroquine is used for the therapy of porphyria cutanea tarda in patients in whom phlebotomy has failed or is contraindicated. Other skin diseases in which the drugs are useful (after sunscreens and avoidance of sun exposure) include polymorphous light eruption and solar urticaria. 

Solar urticaria has been attributed to repirinast in a 72-year-old woman who had taken it for 20 months (2). She developed urticaria immediately after irradiation with 1.5 J/cm of UVA, and a provocation test confirmed that repirinast was responsible for the urticarial reaction, with a spectrum of 320-350 nm. 

Kurumaji Y, Shomo M. Drug-induced solar urticaria due to repirinast. Dermatology 1994 188(2) 117-21. 

PUVA is used most commonly in the treatment of psoriasis, vitiligo, and cutaneous T-cell lymphoma. However, up to 30 other skin diseases have been reported to be responsive to PUVA therapy. The most common of these include palmarplantar pustulosis, polymorphous light eruption, dishydrotic eczema, atopic dermatitis, allergic contact dermatitis, actinic reticuloid, solar urticaria, pityriasis lichenoides, and graft versus host disease. 

THERAPEUTIC USES FDA-approved dermatological uses of hydroxychloroquine include treatment of discoid and systemic lupus erythematosus. Unapproved but first-line uses include treatment of dermatomyositis, porphyria cutanea tarda, polymorphous light eruption, sarcoidosis, eosinophilic fasciitis, lymphocytic infiltrate of Jessner, lymphocytoma cutis, solar urticaria, granuloma annulare, and some forms of panniculitis. 

UV-light Solar urticaria 2-15 min 0.25-3 Tests with UV-light of different wavelengths... 

There is an increased incidence of atopy (42%). An association with urticarial dermographism, cold urticaria, solar urticaria and aspirin intolerance has been reported for one patient each (Tennenbaum and Lowney 1973 Wise et al. 1978 Willis and Epstein 1974, unpublished own patient). 

The disease must be differentiated from solar urticaria and cholinergic urticaria (heat reflex urticaria) by appropriate testing (see above). 

Heat urticaria, polymorphous light reaction, photo-allergic contact eczema, phototoxic contact eczema, SLE and porphyria must be differentiated from solar urticaria by history, appearance of the lesions, skin testing and laboratory examinations. Reactions on exposure to infrared light should be classified as heat urticaria. 

Since serum factors apparently elicit solar urticaria in some patients, trials with plasmapheresis alone or in combination with PUVA have been done in a number of patients, with extended periods of remission in some and failure in others (Hudson-Peacock et al. 1993 Collins et al. 1996). This treatment can only be done in a hospital setting and with the necessary equipment and expertise. In patients diagnosed as suffering from secondary solar urticaria, any underlying disease should be treated. 

Symptomatic treatment of solar urticaria with antihistamines is generally disappointing (Willis and Epstein 1974 Hasei and Ichihashi 1982). A trial with Hi-blockers is nevertheless worthwhile (Baart de la Faille et al. 1975 Hudson-Peacock et al. 1993 Harris et al. 1997), particularly with the newer, non-sedating antihistamines. Some but not all patients respond also to anti-malarials (Willis and Epstein 1974 Ratanen and Sukonen 1980). 

Baart de la Faille H, Rottier PB, Baart de la Faille-Kuyper EH (1975) Solar urticaria. A case with possible increase of skin mast cells. Br J Dermatol 92 101-107... 

Collins P, Ahamat R, Green C, Ferguson J (1996) Plasma exchange therapy for solar urticaria. Br J Dermatol 134 1093-1097... 

Haas N, Toppe E, Henz BM (1998) Microscopic morphology in different types of urticaria. Arch Dermatol 133 41-46 Harris A, Burge SM, George SA (1997) Solar urticaria in an infant. Br J Dermatol 136 105-107... 

Hasei K, Ichihashi M (1982) Solar urticaria. Determinations of action and inhibition spectra. Arch Dermatol 118 346-350 Haustein UF, Kirchhoff B (1984) Die Behandlung der erworbenen K teurtikaria mit Ketotifen. Dermatol Wochenschr 170 ... 

Herd M, Merk HF (1994) Occurrence of cold urticaria in insect venom allergic individuals. Allergol J 3 379-381 Holzle E, Hadshiew IM (1996) Mechanisms of solar urticaria. Curr Opin Dermatol 3 185-189... 

Ive H, Lloyd J, Magnus lA (1965) Action spectra in idiopathic solar urticaria. A study of 17 cases with a monochromator. Br J Dermatol 77 229-243... 

Kojima M, Horiko T, Nakamura Y, Aoki T (1986) Solar urticaria. The relationship of photoallergen and action spectrum. Arch Dermatol 122 550-555... 

Kontou-Fili K, Maniatakou G, Demaka P, Gonianakis M, Palaiogolos G, Aroni K (1991) Therapeutic effects of cetirizine 2HCI in delayed pressure urticaria clinicopathologic findings. J Am Acad Dermatol 24 1090-1093 Laufer P, Laufer R (1983) Solar urticaria in cystic fibrosis. Cutis 31 665-666... 

Leenutaphong V (1993) Solar urticaria induced by UVA and inhibited by visible light. J Am Acad Dermatol 29 337-340 Lemanske RF, Bush RK (1982) Cold urticaria in infectious mononucleosis JAMA 247 1604... 

Solar urticaria is an idiopathic photodermatitis characterised by the appearance of wheals following exposure to sun or artificial sources of light. 

Polymorphous light eruption Hydroa vacciniforme Solar urticaria Persistent light reaction... 

Magnus, I. S., Jarrett, A., Prankerd, T. A. J., and Rimington, C., 1961, Erythropoietic protoporphyria A new porphyria syndrome with solar urticaria due to protopor-phyrinemia. Lancet 2 448. 

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