Phototoxic Dermatitis
A 28-year-old woman presented with large areas of erythema on her face, with associated burning. These areas had developed on sun-exposed skin, with conspicuous sparing of a linear area on her nose and much of her forehead, areas that were covered by glasses and hair, respectively (Panels A and B). The symptoms developed within hours after a professional facial massage and subsequent sun exposure at her workplace in a newly designed all-glass office building. Cypress and geranium products that were used for the facial were thought to be responsible for the lesions, since careful questioning revealed no other likely contact with phototoxic substances. Phototoxic dermatitis is an inflammatory, photochemically evoked skin reaction caused by concomitant exposure to sun and photosensitizing substances (furocoumarins are one such group), which increase the reactivity of the skin to ultraviolet radiation. Areas that are protected against ultraviolet radiation are not affected. Typically, the acute sunburnlike lesions present with erythema, edema, and sometimes vesicles or bullae. This patient's lesions were treated topically with methylprednisolone 0.1% cream. Combined with meticulous sun protection, the treatment led to complete resolution within 10 days.
Porphyrins is associated with such cases and causes porphyria cutanea tarda.
