Red & Spotty Face - Photosensitive Eruptions

Question 1

What 6 conditions are considered to be photosensitive eruptions?

Answer 1

1. Acute lupus erythematosus
2. Discoid lupus
3. Dermatomyositis
4. Drug-Induced Photosensitivity
5. Photoallergic Reaction
6. Acute Sunburn

Question 2

What are the key areas on the body affected by photosensitive reactions?

Answer 2

Sun exposed areas.

Question 3

Is SLE more common in males or females?

Answer 3

Females

Question 4

How does it present?

Answer 4

Facial redness which lasts a few hours or weeks after sun exposure.

The rash is a butterfly rash on malar erythema.

Question 5

How can you tell the difference between SLE and Rosacea?

Answer 5

SLE usually involves the nose whilst Rosacea spares the nose.

Question 6

What other cutaneous manifestations are related to SLE?

Answer 6

• Raynaud’s phenomenon
• Livedo Reticularis
• Panniculitis (Lupus Profundus)
• Bullous Lesions
• Vasculitic Purpura
• Telangiectasias
• Urticaria

Question 7

Is Discoid Lupus (a.k.a. Chronic Cutaneous lupus) more common in males or females?

Answer 7

Females

Question 8

Note the atrophic lesions with scars

Answer 8

They present with characteristic lesions on the face, scalp, and ear.

(Rarely mucosal lesions aswell)

Question 9

20% of patients with Discoid Lupus (DLE) end up being positive for what autoantibody?

Answer 9

ANA

Question 10

Do people that have DLE (Discoid Lupus) go on to develop SLE?

Answer 10

No.

DLE (Discoid Lupus) is a confusing nomenclature and will most likely have a change in terminology int he near future.

Question 11

What rash on the eyes is associated with dermatomyositis?

Answer 11

Heliotrope rash on eyelids.

Question 12

Dermatomyositis is associated with what manifestation on the fingers?

Answer 12

Gottron’s Papules

Question 13

What plant is the heliotropic rash named after?

(For Extra Points - what does Heliotrope stand for?)

Answer 13

Heliotrope plant which is red/purple.

Heliotrope means “turn towards the sun”

Question 14

If someone has dermatomyositis - one should always exclude cancer.

7-30% of cases of Dermatomyositis arise after cancer.

What are the common associated cancers?

Answer 14

Ovarian

Breast and Lung.

Question 15

What drugs cause phototoxic reactions on the skin (RED FACE)?

Answer 15

• Tetracyclines - especially doxycycline
• NSAIDS
• Fluoroquinlolones
• Amiodarone
• Methotrexate
• Phenothiazines
• Sulfonamides
• Retinoids

Question 16

What is the difference between a phototoxic reaction and a photoallergic reaction?

Answer 16

• Phototoxic reactions occur as a result of direct photochemical reaction occuring in the skin.
• Photoallergic reactions occur when UV converts the drug into a photoallergen which in turn triggers a cell-mediated hypersensitivity,.

Question 17

What are the common drugs that cause photoallergic reactions?

Answer 17

• Thiazide diuretics
• Sulfonamide antibiotics
• Phenothiazines
• NSAIDS
• Tricyclic antidepressants
• Antimalarials

Question 18

This man is feeling unwell in himself with fever and malaise.

What is this?

What causes it?

Answer 18

Erysipelas.

(Superficial infection whereas cellulitis is a deeper infection)

Cuased by Strep or Staph.

It differs from Contact Dermatitis because he is systemically unwell.