Die idiopathischen Photodermatosen (IPD) stellen eine heterogene Gruppe von Erkrankungsbildern dar, die durch pathologische Hautreaktionen in Erscheinung treten, welche durch optische Strahlung insbesondere im Ultraviolett-A-Wellenlängenbereich ausgelöst werden. Die Ätiopathogenese der IPD ist unklar. Die polymorphe Lichtdermatose, die Hidroa vacciniformia, die solare Urtikaria, die aktinische Prurigo und die chronische aktinische Dermatitis sind die wichtigsten Erkrankungen, die zu den IPD gehören. Aufgrund der oft störenden Symptomatik führen die IPD häufig zu einer deutlichen Beeinträchtigung der Lebensqualität der betroffenen Personen. Zur exakten Bestimmung der Aktionsspektren sowie Klärung des Ausmaßes der Photosensitivität sind photodiagnostische Testverfahren unentbehrlich. Die Photoprovokationsprotokolle, Light-Hardening-Verfahren und medikamentösen Behandlungsformen der IPD sind jedoch kaum standardisiert. In diesem Übersichtsartikel werden die klinischen Charakteristika, diagnostischen Maßnahmen und Therapieoptionen der oben genannten IPD kurz diskutiert.
Abstract
The idiopathic photodermatoses (IPD) represent a heterogenous group of conditions appearing with pathological skin reactions that are triggered by optical radiation, particularly in the ultraviolet A wavelength region. The pathogenesis of IPD is obscure. Polymorphic light eruption, hydroa vacciniformia, solar urticaria, and chronic actinic dermatitis are the most important conditions that belong to the IPD. Due to bothersome symptoms such as intractable itch, the IPD frequently result in a significant reduction in quality of life of affected individuals. Photodiagnostic procedures are mandatory for the exact determination of action spectra and degree of photosensitivity. However, photoprovocation tests, light hardening regimens, and drug therapy of IPD are hardly standardized. In this review, the characteristic clinical features, diagnostic measures, and treatment options of IPD are briefly discussed.
Literatur
1 Ferguson J, Dover J S (eds). Photodermatology. London; Manson Publishing 2006
3
Stratigos A J, Antoniou C, Papathanakou E, Daboudi M, Tranaka K, Tsara K, Katsambas A D.
Spectrum of idiopathic photodermatoses in a Mediterranean country.
Int J Dermatol.
2003;
42
449-454
12
Van de Pas C B, Hawk J L, Young A R, Walker S L.
An optimal method for experimental provocation of polymorphic light eruption.
Arch Dermatol.
2004;
140
286-292
14
Ling T C, Richards H L, Janssens A S, Anastassopoulou L, Antoniou C, Aubin F, Diepgen T L, Fazakerley R, de Gruijl F R, Jansen C T, Pavel S, Smedley A, Stratigos A J, Webb A R, Gibbs N K, Rhodes L E.
Seasonal and latitudinal impact of polymorphic light eruption on quality of life.
J Invest Dermatol.
2006;
126
1648-1651
15
Boonstra H E, van Weelden H, Toonstra J, van Vloten W A.
Polymorphous light eruption: a clinical, photobiologic and follow-up study of 110 patients.
J Am Acad Dermatol.
2000;
42
199-207
17
Kolgen W, van Meurs M, Jongsma M, van Weelden H, Bruijnzeel-Koomen C A, Knol E F, van Vloten W A, Laman J, de Gruijl F R.
Differential expression of cytokines in UV-B-exposed skin of patients with polymorphous light eruption: correlation with Langerhans cell migration and immunosuppression.
Arch Dermatol.
2004;
140
295-230
22
Demachi A. et al .
Characterization of Epstein-Barr Virus (EBV)-positive NK cells isolated from hydroa vacciniforme-like eruptions.
Microbiol Immunol.
2003;
47
543-552
23
Iwatsuki K, Xu Z G, Takata M. et al .
The association of latent Epstein-Barr virus infection with hydroa vacciniforme.
Br J Dermatol.
1999;
140
715-721
24
Iwatsuki K. et al .
Pathogenic link between hydroa vacciniforme and Epstein-Barr virus-associated hematologic disorders.
Arch Dermatol.
2006;
142
587-595
29
Fukunaga A, Horikawa T, Yamamoto A, Yamada Y, Nishigori C.
The inhibition spectrum of solar urticaria suppresses the wheal-flare response follwing intradermal injection with photo-activated autologous serum but not with compound 48/80. Photodermatol Photoimmunol.
Photomed.
2006;
22
129-132
35
Yap L M, Foley P, Crouch R, Baker C.
Chronic actinic dermatitis: a retrospective analysis of 44 cases referred to an Australian photobiology unit.
Australas J Dermatol.
2003;
44
256-262
36
Menage H duP, Sattar N K, Haskard D O, Hawk J LM, Breathnach S M.
A study of the kinetics and pattern of E-selectin, VCAM-1 and ICAM-1 expression in chronic actinic dermatitis.
Br J Dermatol.
1996;
134
262-268
37
Chu A C, Robinson D, Hawk J L, Meacham R, Spittle M F, Smith N P.
Immunologic differentiation of the Sezary syndrome due to cutaneous T-cell lymphoma and chronic actinic dermatitis.
J Invest Dermatol.
1986;
86
134-137
38
Bakels V, van Oostveen J W, Preesman A H, Meijer C JLM, Willemze R.
Differentiation between actinic reticuloid and cutaneous T cell lymphoma by T cell receptor y gene rearrangement analysis and immunophenotyping.
J Clin Pathol.
1998;
51
154-158
39
Bilsland D, Crombie I K, Ferguson J.
The photosensitivity dermatitis and actinic reticuloid syndrome: no association with lymphoreticular malignancy.
Br J Dermatol.
1994;
131
209-214
45
Das S, Lloyd J J, Walshaw D, Farr P M.
Provocation testing in polymorphic light eruption using fluorescent ultraviolet (UV) A and UVB lamps.
Br J Dermatol.
2004;
151
1066-1070
46
Bruynzeel D P, Ferguson J, Andersen K, Goncalo M, English J, Goosens A, Hölzle E, Ibbotson S H, Lecha M, Lehmann P, Leonard F, Moseley H, Pigatto O, Tanew A.
Photopatch testing: a consensus methodology for Europe.
J Eur Acad Dermatol Venereol.
2004;
18
679-682
48
Hampton P J, Farr P M, Diffey B L, Lloyd J J.
Implication for photosensitive patients of ultraviolet A exposure in vehicles.
Br J Dermatol.
2004;
151
873-876
50
Gambichler T, Laperre J, Altmeyer P, Hoffmann K.
UVA and UVB transmission of fabrics: critical wavelength based on absorbance and effective dose.
Exog Dermatol.
2002;
1
290-295
51 Peyron J L, Raison-Peyron N, Meynadier J, Moyal D, Rougier A, Hourseau C. Prevention of solar urticaria using a broadspectrum sunscreen and determination of a solar urticaria protection factor (SUP). In: Rougier A, Schaefer H (eds). Protection of the skin against ultraviolet radiation. Paris; John-Libbey Eurotext 1998: 201-205
52
Van den Keybus C, Laperre J, Roelandts R.
Protection from visible light by commonly used textiles is not predicted by ultraviolet protection.
J Am Acad Dermatol.
2006;
54
86-93
53 Schauder S, Schrader A, Ippen H. Göttinger Liste 1996. Sonnenschutzkosmetik in Deutschland. 4. neubearbeitete und erweiterte Auflage. Berlin; Blackwell 1996
59
Janssens A S, Pavel S, Out-Luiting J J, Willemze R, de Gruijl F R.
Normalized ultraviolet (UV) induction of Langerhans cell depletion and neutrophil infiltrates after artificial UVB hardening of patients with polymorphic light eruption.
Br J Dermatol.
2005;
152
1268-1274
60
Darras S, Segard M, Mortier L, Bonnevalle A, Thomas P.
Treatment of solar urticaria by intravenous immunoglobulins and PUVA therapy.
Ann Dermatol Venerol.
2004;
131
65-69
61
Jeanmougin M, Peyron J L, Thomas P, Beani J C, Guez E, Bachot N.
Polymorphic light eruption: prophylaxis using a topical combination of antioxidants and UVA protection formulations.
Ann Dermatol Venereol.
2006;
133
425-428
62
Patel D C, Bellaney G J, Seed P T, McGregor J M, Hawk J L.
Efficacy of short-course oral prednisolone in polymorphic light eruption: a randomised controlled trial.
Br J Dermatol.
2000;
142
112-114
63
Wu J J, Huang D B, Pang K R, Hsu S, Tyring S K.
Thalidomide: dermatological indications, mechanisms of action and side-effects.
Br J Dermatol.
2005;
153
254-273
66
Mang R, Stege H, Budde M A, Ruzicka T, Krutmann J.
Successful treatment of solar urticaria by extracorporeal photochemotherapy (photopheresis) - a case report. Photodermatol Photoimmunol.
Photomed.
2002;
18
196-198
69
Evans A V, Palmer R A, Hawk J L.
Erythrodermic chronic actinic dermatitis responding only to topical tacrolimus.
Photodermatol Photoimmunol Photomed.
2004;
20
59-61