Patricia L . Danielsen et al . – Recurrent UVA photosensitive erythema multiforme
Fig . 2 . Histopathology showing : ( A ) a central subepidermal bulla , with ( B ) dermal lymphocytic infiltrate and many apoptotic cells in the lower epidermis .
In this case recurrent EM was provoked by UVA . The distinction between PEM and an EM variant of polymorphous light eruption has been described previously ( 3 ), and recurrent EM following sun-induced PLE has also been reported ( 4 , 5 ). In these 3 cases there was a delay of 2 weeks between initial PLE eruption and development of EM .
The involvement of mucosa and non-sun-exposed areas , a confirmatory biopsy , a positive UVA provocation test without delay , and the absence of pruritus and HSV infection substantiate the diagnosis of recurrent PEM . Drug-photo-induced EM and UVB-induced EM have been reported previously , but , to our knowledge , recurrent vesiculobullous EM induced by UVA has not been described previously ( 6 – 9 ). Phototesting might be indicated in recurrent PEM and appropriate sun behaviour alone may be sufficient to prevent attacks .
References
1 . Wetter DA , Davis MDP . Recurrent erythema multiforme : clinical characteristics , etiologic associations , and treatment in a series of 48 patients at Mayo Clinic , 2000 to 2007 . J Am Acad Dermatol 2010 : 62 : 45 – 53 .
2 . Wolf R , Lipozencic J . Shape and configuration of skin lesions : Targetoid lesions . Clin Dermatol 2011 : 29 : 504 – 508 .
3 . Akarsu S , Ilknur T , Fetil E , Lebe B , Günes AT . Erythema multiforme-like eruption localized to a sun-exposed area . Photodermatol Photo 2010 : 26 : 101 – 103 .
4 . Fraser-Andrews EA , Morris-Jones R , Novakovic L , Hawk JL . Erythema multiforme following polymorphic light eruption : a report of two cases . Clin Exp Dermatol 2005 : 30 : 232 – 234 .
5 . da Costa JB , Duarte Reis M , Soares de Almeida L , Mayer-da-Silva A , Marques Gones M . Erythema multiforme on exposed and non-exposed skin following polymorphic light eruption : a case report . Photodermatol Photo 2008 : 24 : 150 – 151 .
6 . Fitzpatrick JE , Thompson PB , Aeling JL , Huff C . Photosensitive recurrent erythema multiforme . J Am Acad Dermatol 1983 : 9 : 419 – 422 .
7 . Calzavara Pinton PG , Venturini M , Capezzera R , Zane C , Facchetti F . Photosensitive erythema multiforme and erythema multiforme-like polymorphous light eruption . Photodermatol Photo 2003 : 19 : 157 – 159 .
8 . Rodríguez-Pazos L , Sánchez-Aquilar D , Rodríguez-Granados MT , Pereiro-Ferreirós MM , Toribio J . Erythema multiforme photoinduced by statins . Photodermatol Photo 2010 : 26 : 216 – 218 .
9 . Rodríguez-Pazos L , Gómez-Bernal S , Montero I , Rodríguez-Granados M , Toribio J . Erythema multiforme photoinduced by paroxetine and herpes simplex virus . Photodermatol Photo 2011 : 27 : 219 – 221 .
104 Case Report
Forum for Nord Derm Ven 2016 , Vol . 21 , No . 4