P H O T O C O N TA C T D E R M AT I T I S

Done by : khetam fuad mohammed

THE SUPERVISOR : DR. AYMAN AL-SHAMI
FACULTY OF MEDICINE AND HEALTH SCIENES
DEPARTMENT OF HUMAN MEDICINE

9/30/16

Taiz University, YEMEN

Photodermatology :
Study the interaction
between human skin and
UV&visible radiation
Transform the energy of
radiation to an absovable
response (photobiolofic
response )
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Taiz University, YEMEN

General mechanism of
photosensitivity
Normal skin ha several molecules that are
activated upon sun exposure and undergo
chemical reactions that chromophores , which
are important for our survival under the sun
and necessary for our life ..an example is 7dehydrocholestrol which upon activation by
UVB forms provitamin D3 necessary for Vit
D synthesis .
Photosensitivity develops when an abnormal
chromopore , is present in the skin .
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Taiz University, YEMEN

General mechanism of
photosensitivity
When excited by a photon , these molecules
suffer from changes with in te molecule it
self >>result in skin damage and
inflammation .
Chromofores >>> (photochemical
reaction) >> photoproducts >> Stimulate
cellular signal transduction pathway)*
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Taiz University, YEMEN

In some patients photosensitivity

develops because of:

A deficiency in the capacity to repair UV-1

aggression , due to a genetic problem
.(xeroderma pigmentosum , Blooms syndrome)
Transiant imbalance of antioxidant skin-2
defense (in pellagra due to reduced levels of
niacin in diet or alcohol consumption )
Natural mechanisms of skin protection are- 3
deficient (Vitiligo , albinism )
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Taiz University, YEMEN

Skin Reactions To Sun Light

photosensitivity
An abnormal response to light, usually sunlight, occurring
within minutes, hours, or days of exposure & lasting up to

.weeks, months, and even longer

Cutaneous photosensitivity reactions require
absorption of photon energy by molecules
:that can be

Exogenous agents applied topically or systemically

Endogenous molecules either present in skin or produced by
abnormal metabolism

A combination of exogenous and endogenous

molecules

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Taiz University, YEMEN

:Basics Of Clinical Photomedicine

The main culprit of solar radiation-induced skin pathology
is the UV portion of the solar spectrum.
UVR spectrum:
UVA (long wave-1
radiation)
Range from 320
400 nm
Erythrogenic
activity is weak;
however
penetrates the
dermis
Responsible for
development of
slow natural tan
UVA may
augment the
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effects of UVB

UVB-2
(middlewave
radiation
Range from 290
.320 nm
Erythrogenic
activity is the
highest
Produces new
pigment
formation,
sunburn, vit.D
synthesis
Responsible for
inducing
Taiz
University,skin
YEMEN
cancer

UVC (shortwave-3
or Germicidal
Radiation)
Range from 100
290 nm
Does not reach
the surface of
the earth
Emitted from
artificial sources
and used in
sterilization of
operative rooms
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Basics Of Clinical Photomedicine:

UV activation of an endogenous or an
exogenous
skin chromophore can induce an
inflammatory
reaction (phototoxicity) or a T-cell-mediated
.reaction (photoallergy)

9/30/16

Taiz University, YEMEN

Classification of skin
:reaction to sunlight
Phototoxicity*
.Sunburn
.Drug-/chemical-induced
Plant-induced.
Photoallergy*
.Drug-/chemical-induced
.Chronic actininc dermatitis
.Solar urticarial
9/30/16

Taiz University, YEMEN

Phototoxicity :
is more frequent and considered to develop in every
individual, as long as enough photosensitizer
and sun exposure are present; occurs even
on a first and single contact, with no flare-ups or cross
;reactions
and appears mainly as well-demarcated erythema
exclusively on sun-exposed areas (mimicking
sunburn); and on histology, apoptotic keratinocytes
.sunburn cells) are abundant

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Taiz University, YEMEN

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Classification of skin reaction

to sunlight:
Idiopathic*
Metabolic and
nutritional
.Porphyria cutanea tarda
Pellagra
DNA-deficient*
photodermatoses
Photoexacerbated*
dermatoses

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Chronic photodamage:*
Dermatoheliosis
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Classification of skin
reaction to sunlight:

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Taiz University, YEMEN

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Classification of skin
reaction to sunlight:

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Taiz University, YEMEN

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:Acute Sun Damage (Sunburn)

Is an acute, delayed, and transient inflammatory response of normal

skin after exposure to UVR from sunlight or artificial sources
It is a phototoxic reaction
It depends on the amount of UVR energy & the susceptibility of the
patient

very young children & elderly persons (reduced capacity to ): Age(

.sunburn)
:Pathogenesis
-Damage to DNA => excision of pyrimidine dimers => protective tanning
response

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Taiz University, YEMEN

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The main mediator of sunburn reaction is IL-6

:Management
:Prevention*

with SPT I or II should avoid sunbathing, especially between 11 A.M an

.Clothing: UV-screening cloth garments- 2

unscreens: reduce the induction of solar keratosis and squamous cell ca

:Moderate sunburn*
.Topical: Cool wet dressing, topical glucocorticoids
Systemic: Acetylsalicylic acid, Indomethacin
:Severe sunburn*
.Bed rest. If very severe toxic patient, hospitalization is required.Topical: Cool wet dressing, topical glucocorticoids.Systemic: Oral glucocorticoids, Indomethacin-

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Taiz University, YEMEN

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Drug/Chemical-Induced
Photosensitivity

Describes the interaction of UVR with a chemical/drug within the skin

Two mechanism :

Phototoxic reactions : manifests like irritant contact dermatitis

Photoallergic reactions : Photoallergen initiates an immunologic
response (type IV immunologic reaction) manifests like
allergic eczematous contact dermatitis

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Taiz University, YEMEN

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Phototoxic Drug-/ChemicalInduced Photosensitivity

Describes an adverse reaction of the skin that results from
simultaneous exposure to certain drugs (via ingestion,
injection, or topical application) and to UVR or visible
light .
Phototoxic drug reactions are more frequent than
photoallergic drug sensitivity .
Two types of reactions :
Systemic phototoxic dermatitis .
Local phototoxic dermatitis .

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Taiz University, YEMEN

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Systemic Phototoxic - 1
:Dermatitis
Occurs in individuals systemically exposed
to a photosensitizing agent and subsequent
UVR .
All ages, both sexes, all races and all types
of skin color .
Drugs eliciting systemic phototoxic
dermatitis are listed in the following table :

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Taiz University, YEMEN

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1- Systemic Phototoxic
Dermatitis:

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Taiz University, YEMEN

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1- Systemic Phototoxic
Dermatitis:
Nails: subungual hemorrhage and photoonycholysis .
Pigmentation:Marked
brown
epidermal
melanin
pigmentation .
Treatment :
As for sunburn

9/30/16

Taiz University, YEMEN

Topical Phototoxic - 2
:Dermatitis
There is therapeutic application of photosensitizer,
followed by UVA irradiation .
The most common topical phototoxic agents :

Taiz University, YEMEN

2- Topical Phototoxic Dermatitis:

The most common and important topical

phototoxic dermatitis is
phytophotodermatitis (plant + light =
dermatitis) which is an inflammation of the
skin due to contact with plants during
occupational exposure to sunlight

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Taiz University, YEMEN

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Other Clinical Patterns:

Telangiectasia: as a manifestation of
photosensitivity has
been reported with calcium channel
blockers [52] and
the telangiectatic pattern of photoaging
with lesions
.mainly in the lateral folds of the neck

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Taiz University, YEMEN

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Taiz University, YEMEN

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