Solar Urticaria Clinical Presentation

  • Author: Ani L Tajirian, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 11, 2012
 

History

An accurate history is important for the diagnosis of solar urticaria because of the transient nature of the eruption. Patients often have no obvious lesions.

  • Patients may report pruritus, erythema, and wheal formation of varying degrees after a short period (< 30 min) of sun exposure.
    • As with most other photodermatoses, skin lesions in solar urticaria may occur on any exposed area, even if skin was covered with thin clothing.
    • The face and the dorsal aspect of the hands, which are chronically exposed to the sun, are less severely affected than other parts of the body, perhaps owing to acclimatization and "hardening."
  • Mucosal involvement (eg, tongue and/or lip swelling) has been reported.
  • Other symptoms, such as headache, nausea, vomiting, bronchospasm, and syncope, have been reported but are considered rare.
  • Upon cessation of sun exposure, the rash begins to disappear within several minutes to a few hours and rarely lasts beyond 24 hours. Rapid disappearance of the rash upon cessation of further sun exposure is essential to the diagnosis of solar urticaria.
  • Ascertain the following aspects of history to exclude other differential diagnoses:
    • Oral medication intake (eg, chlorpromazine), which may cause a similar photo-induced reaction
    • Currently used topical agents (eg, sunscreen, fragrance), which can cause photocontact dermatitis
    • Family history of photosensitivity (as may occur in some porphyrias)
    • Medical history regarding other body systems in order to detect other underlying causes of photosensitivity (eg, connective-tissue disorders)
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Physical

In most cases of solar urticaria, physical examination findings will be normal.

  • During an acute episode of solar urticaria, vital signs are usually unaffected; however, systemic symptoms accompanying the cutaneous eruption have been reported.
    • In rare cases, cardiac and respiratory rates increase and blood pressure decreases.
    • Wheezing may be heard upon auscultation of the chest when bronchospasm is present.
  • Examination of the skin during an acute solar urticaria episode may reveal lesions in the form of erythematous macules to distinct wheals, the morphology of which may be no different from that of lesions found in acute urticaria secondary to other causes.
    • Eruption follows a photodistribution modified by the type of clothing worn by the affected individual at the time of exposure.
    • Lesions may be present in areas covered with thin clothing, depending on the causative light wavelength and sheerness of the fabric.
    • Mucosal areas, such as the tongue and lips, may be swollen or edematous.
    • The reaction leaves no residual skin changes. Consequently, examination of the skin after the acute eruption reveals no evidence of the condition.
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Causes

Solar urticaria may be caused by an antigen-antibody reaction. Solar irradiation may induce an antigen in the serum or plasma of affected individuals. Intradermal injection of serum from a solar urticaria patient passively, but not consistently, transfers the condition to a healthy individual.

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Contributor Information and Disclosures
Author

Ani L Tajirian, MD  Resident Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Disclosure: Nothing to disclose.

Coauthor(s)

Philip J Cohen, MD  Chief, Section of Dermatology, New Jersey Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Donald Belsito, MD  Professor of Clinical Dermatology, Department of Dermatology, Columbia University Medical Center

Donald Belsito, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Dermatology Foundation, New York County Medical Society, New York Dermatological Society, Noah Worcester Dermatological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Elma Baron, MD, and Charles Taylor, MD, to the development and writing of this article.

References

  1. Miyauchi H, Horio T. Detection of action, inhibition and augmentation spectra in solar urticaria. Dermatology. 1995;191(4):286-91. [Medline].

  2. Fukunaga A, Horikawa T, Yamamoto A, Yamada Y, Nishigori C. The inhibition spectrum of solar urticaria suppresses the wheal-flare response following intradermal injection with photo-activated autologous serum but not with compound 48/80. Photodermatol Photoimmunol Photomed. Jun 2006;22(3):129-32. [Medline].

  3. Harris A, Burge SM, George SA. Solar urticaria in an infant. Br J Dermatol. Jan 1997;136(1):105-7. [Medline].

  4. Lecha M, Puy H, Deybach JC. Erythropoietic protoporphyria. Orphanet J Rare Dis. Sep 10 2009;4:19. [Medline].

  5. Hughes R, Cusack C, Murphy GM, Kirby B. Solar urticaria successfully treated with intravenous immunoglobulin. Clin Exp Dermatol. Jun 17 2009;[Medline].

  6. Maksimovic L, Fremont G, Jeanmougin M, Dubertret L, Viguier M. Solar urticaria successfully treated with intravenous immunoglobulins. Dermatology. 2009;218(3):252-4. [Medline].

  7. Adamski H, Bedane C, Bonnevalle A, Thomas P, Peyron JL, Rouchouse B, et al. Solar urticaria treated with intravenous immunoglobulins. J Am Acad Dermatol. Aug 2011;65(2):336-40. [Medline].

  8. Dawe RS, Ferguson J. Prolonged benefit following ultraviolet A phototherapy for solar urticaria. Br J Dermatol. Jul 1997;137(1):144-8. [Medline].

  9. Calzavara-Pinton P, Zane C, Rossi M, Sala R, Venturini M. Narrowband ultraviolet B phototherapy is a suitable treatment option for solar urticaria. J Am Acad Dermatol. May 25 2011;[Medline].

  10. Collins P, Ahamat R, Green C, Ferguson J. Plasma exchange therapy for solar urticaria. Br J Dermatol. Jun 1996;134(6):1093-7. [Medline].

  11. Fotiades J, Soter NA, Lim HW. Results of evaluation of 203 patients for photosensitivity in a 7.3-year period. J Am Acad Dermatol. Oct 1995;33(4):597-602. [Medline].

  12. Khoo SW, Tay YK, Tham SN. Photodermatoses in a Singapore skin referral centre. Clin Exp Dermatol. Jul 1996;21(4):263-8. [Medline].

  13. Roelandts R. Diagnosis and treatment of solar urticaria. Dermatol Ther. 2003;16(1):52-6. [Medline].

  14. Roelandts R, Ryckaert S. Solar urticaria: the annoying photodermatosis. Int J Dermatol. Jun 1999;38(6):411-8. [Medline].

  15. Ryckaert S, Roelandts R. Solar urticaria. A report of 25 cases and difficulties in phototesting. Arch Dermatol. Jan 1998;134(1):71-4. [Medline].

  16. Shimauchi T, Kabashima K, Tokura Y. Solar urticaria as a manifestation of Churg-Strauss syndrome. Clin Exp Dermatol. Mar 2007;32(2):209-10. [Medline].

 
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