para>Limit use of fluorinated steroids on face; use hydrocortisone cream or ointment for short period.
- NSAIDs (ibuprofen 600 mg QID, indomethacin 25 mg PO TID, aspirin, others)
- Prednisone for severe reactions (0.5 to 1 mg/kg/day PO) for 3 to 10 days
- Antihistamines for pruritus (hydroxyzine 25 to 50 mg PO QID)
- Sunscreens (>30 SPF) for prevention: Use broad-spectrum sunscreen to block both UVA and UVB. PABA may aggravate photodermatitis in sensitized patients (due to the sulfa moiety).
- Aspirin or ibuprofen taken orally or NSAID applied topically (diclofenac) before sun exposure may modestly reduce erythema and pain of sunburn.
Geriatric Considerations
More likely to experience adverse reactions to causative drugs
COMPLEMENTARY & ALTERNATIVE MEDICINE
- PO ²-carotene seems to modestly reduce the risk of sunburn in individuals who are sensitive to sun exposure.
- Omega-3 fatty acid intake may decrease the sensitivity of skin to UV exposure (4).
- Compresses made from tea bags steeped in a small amount of water may reduce itching and burning of sunburn (5).
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
Avoid direct sunlight.
PATIENT EDUCATION
- Avoidance of direct sunlight exposure
- Avoidance of photosensitizing drugs
- Protective clothing (e.g., hats, long sleeves)
- Sunscreens >30 SPF
PROGNOSIS
Good with avoidance/protection measures
COMPLICATIONS
Rare (secondary bacterial infection)
REFERENCES
11 Smith E, Kiss F, Porter RM, et al. A review of UVA-mediated photosensitivity disorders. Photochem Photobiol Sci. 2012;11(1):199 " 206.22 Kalia S, Laurentiu Haiducu M. Sunscreen and sun protection: shedding light on recent advances. J Cutan Med Surg. 2011;15(Suppl 1):S382 " S386.33 Almutawa F, Buabbas H. Photoprotection: clothing and glass. Dermatol Clin. 2014;32(3):439 " 448.44 Glatz M, Hofbauer GF. Phototoxic and photoallergic cutaneous drug reactions. Chem Immunol Allergy. 2012;97:167 " 179.55 Pilkington SM, Watson RE, Nicolaou A, et al. Omega-3 polyunsaturated fatty acids: photoprotective macronutrients. Exp Dermatol. 2011;20(7):537 " 543.
ADDITIONAL READING
Saraf S, Gupta A, Kaur CD, et al. Dermatological consequences of photosensitization with an approach to treat them naturally. Pak J Biol Sci. 2014;17(2):167 " 172.
CODES
ICD10
- L56.8 Oth acute skin changes due to ultraviolet radiation
- L57.8 Oth skin changes due to chr expsr to nonionizing radiation
- L56.4 Polymorphous light eruption
- L59.8 Oth disrd of the skin, subcu related to radiation
ICD9
- 692.72 Acute dermatitis due to solar radiation
- 692.70 Unspecified dermatitis due to sun
- 692.74 Other chronic dermatitis due to solar radiation
- 692.79 Other dermatitis due to solar radiation
SNOMED
- photodermatitis (disorder)
- Photodermatitis due to sun
- Polymorphic light eruption (disorder)
- Contact dermatitis due to solar radiation
CLINICAL PEARLS
- Choose a sunscreen with an SPF of at least 30 with full-spectrum protection (UVA and UVB) for best efficacy.
- The most common medications that predispose to photosensitivity include tetracyclines and sulfonamide. However, many other medications may cause photosensitivity.