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.
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Forum for Nord Derm Ven 2016, Vol. 21, No. 4