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Solar Urticaria

  • Author: Ani L Tajirian, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 11, 2014
 

Background

Solar urticaria is a rare photodermatosis characterized by pruritus, stinging, erythema, and wheal formation after a brief period of exposure to natural sunlight or an artificial light source emitting the appropriate wavelength. (See Presentation.)

Initially described by Merklen in 1904, solar urticaria is localized to exposed areas of the skin, although it can occur through thin clothing. Solar urticaria disappears within several minutes to a few hours, without pigmentary change if further sun exposure is avoided. The condition can be quite disabling and difficult to manage. It often has a sudden, dramatic onset, and little information is available regarding its duration and eventual outcome. (See Prognosis, Presentation, DDx, Treatment, and Medication.)

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Epidemiology

Solar urticaria accounts for only 4% of patients in the United States with photosensitive disorders and for 5.3% of cases of photosensitive dermatoses worldwide.

A slight female predilection is noted for solar urticaria. Regarding age, the disease has a wide range of onset (10-70y). The mean age of onset for solar urticaria is 35 years, but it has been reported to occur in infancy.[1, 2]

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Patient Education

Educate patients that, despite its persistent and chronic nature, solar urticaria is a benign disorder that is usually localized to the skin without affecting general health. Emphasize that response to treatment is generally unpredictable and that prevention by avoidance may ultimately be the key to the management of this condition. (See Prognosis, Treatment, and Medication.)

For patient education information, see the Allergies Center and the Skin Conditions and Beauty Center, as well as Hives and Angioedema.

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Etiology

Solar urticaria is possibly 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.

The following types of solar urticaria have been proposed:

  • Type I - This type is characterized by an immunoglobulin E (IgE)–mediated hypersensitivity to specific photoallergens generated only in solar urticaria patients
  • Type II - This type is characterized by an IgE-mediated hypersensitivity to nonspecific photoallergens found in solar urticaria patients and in healthy individuals

Passive-transfer test findings are positive in patients with type II solar urticaria, but they may be positive or negative in those with type I.

The wide action spectrum (290-800 nm) implicated for solar urticaria may be related to the specific photoallergen and its molecular weight. Diversity in the reported action spectra for the disease may be due to differences in photoallergens. In addition, spectra believed to be responsible for either inhibition or augmentation of the reaction have been detected.[3]

Complex interactions occur between the various wavelengths and the photoallergen.

The result of these interactions is mast cell degranulation with subsequent histamine release. Mediators other than histamines may also be involved.

Inhibition of solar urticaria with light suppresses the wheal-flare response following intradermal injection of photoactivated autologous serum but does not suppress the wheal and flare associated with compound 48/80.[4]

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Prognosis

Solar urticaria is usually a chronic condition; few patients experience spontaneous remission. Continued intake of oral antihistamines may prevent the whealing to a degree, thus allowing some tolerance to sunlight. Significant and more long-lasting improvement is observed in patients who undergo phototherapy or photochemotherapy. Some patients find that following preventive measures makes their condition manageable.

In some cases, skin eruption is accompanied by symptoms such as headache, nausea, vomiting, bronchospasm, and syncope. The mortality rate for solar urticaria has not been determined.

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Contributor Information and Disclosures
Author

Ani L Tajirian, MD Procedural Fellow, Division of Dermatology, University of Vermont College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

Elma D Baron, MD Assistant Professor of Dermatology, Case Western Reserve University, University Hospitals of Cleveland; Director of Skin Study Center, University Hospitals Research Institute; Acting Chief of Dermatology, Veterans Affairs Medical Center, Cleveland

Elma Baron, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Photobiology, Photomedicine Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

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.

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.

Charles R Taylor, MD Associate Professor of Dermatology, Harvard Medical School; Director of Phototherapy Unit, Department of Dermatology, Massachusetts General Hospital

Charles Taylor, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Laser Medicine and Surgery, Massachusetts Medical Society, New England Dermatological Society, and Society for Investigative Dermatology

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.

References
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  2. Hochstadter EF, Ben-Shoshan M. Solar urticaria in a 1-year-old infant: diagnosis and management. BMJ Case Rep. 2014 Apr 17. 2014:[Medline].

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

  4. 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. 2006 Jun. 22(3):129-32. [Medline].

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

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

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

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

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

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

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

  12. 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. 2011 May 25. [Medline].

 
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