Solar Urticaria Workup

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

Laboratory Studies

  • Perform serologic tests for antinuclear antibody, Ro, and La antibodies to exclude connective-tissue disease (eg, lupus erythematosus).
  • Perform testing to exclude metabolic causes (eg, porphyrias).
    • Evaluate the plasma porphyrin level.
    • If abnormal results are found, follow with a quantitative 24-hour urinary and fecal porphyrin measurement, as well as erythrocyte porphyrin determination.
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Other Tests

  • Phototesting confirms the diagnosis, identifies the action spectrum, and establishes baseline data (eg, minimum urticarial dose [MUD]) for possible therapeutic interventions and monitoring in the future.
    • Solar urticaria has a wide action spectrum. Perform phototesting using broadband UV-B (290-320 nm), UV-A (320-400 nm), and visible light sources (400-800 nm). Most patients with solar urticaria have provocative wavelengths in the UV-A and visible ranges, especially green or blue.
    • Duration of exposure under visible light should be less than an hour. Typically, the light emitted by a slide projector is used. Measures must be taken to avoid excessive heat output from the light source in order to eliminate the possibility of cholinergic- or heat-induced urticaria, instead of actual solar urticaria. A water filter may be placed in front of the light source to absorb excess heat.
    • Phototesting with narrowband UV-B (311-313 nm) is recommended if therapy with this light source is being considered. Occasionally, these tests do not produce the expected reaction.
    • Phototesting with other light sources (eg, solar simulators, lasers) may be necessary in difficult-to-establish cases.
    • Provocation with natural sunlight may be performed if ambient conditions allow.
    • Many patients with solar urticaria have an inhibition spectrum. If their skin is first exposed to wavelengths known to induce solar urticaria and is then immediately afterward, or possibly concurrently, exposed to radiation within the inhibition spectrum, the urticarial reaction is either eliminated or diminished.
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Histologic Findings

Histologic changes are typically found in the dermis in the form of vasodilatation, increased permeability of the vascular endothelium, and edema. Eosinophil infiltration and deposition of eosinophil granule proteins in the dermis are prominent during early stages of the lesion. Neutrophils are found in increased numbers around the upper dermal vessels. Dermal mast cells may increase in number. After 24 hours, the dermal infiltrate is predominantly composed of mononuclear leukocytes.

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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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