Acute Polymorphous Light Eruption
David Elpern MD,
Williamstown, MA, USA
on July 17, 2001
M.R. is a 74-year-old woman who presented with a four day history
of a very pruritic eruption on the anterior thighs. This followed
an excursion to the beach with her grandchildren. It was the first
visit to the beach this year. About 10 years ago, the patient had
a similar, but more extensive eruption, while vacationing at Cancun.
is in good general health, her only medication is an occasional ibuprofen,
and she was using sunscreen. At the beach, she was wearing shorts and a
There are discrete and confluent juicy erythematous papules and
papulovesicles on the anterior thighs and knees in sun-exposed areas.
A few lesions are present on the mid upper chest. The remainder
of the cutaneous exam is unremarkable.
Acute Polymorphous Light Eruption
In 1985, along with Morison and Hood, I reported on this entity
which we also call "papulovesicular light eruption or PVLE. PVLE
is the most common type of PMLE - seen in up to 10% of individuals.
It occurs early in the season before a susceptible individuals skin
has had time to "harden." It occurs when such a person gets a large
dose of ultraviolet light and it is not prevented by sunscreens.
Eighty-five percent of the 150 patients we reported from Hawaii
from Hawaii were using sunscreens during the putative exposures.
Over 90% were tourists to the islands. The reason M.R.'s eruption
was limited to the thighs and knees is because her face, arms and
lower extremities had been hardened by mid June from outdoor exposures
through the Spring, but her thighs and knees had been protected
until her recent visit to the beach. Acute PVLE is self-limited.
With repeated sun-exposures it gradually disappears. It can be prevented
by getting graded and gradual exposures. Tanning booths should help
to prevent PVLE if used with care. Treatment is symptomatic. Wet
dressings and a potent corticosteroid cream or ointment for a few
days along with hydroxizine 10 - 50 mg h.s. are often helpful. For
severe cases, or when quick improvement is mandatory, 40 - 60 mg
of prednisone in divided doses for 4-5 days will provide relief.
1. Elpern DJ, Morison WL, Hood AF Papulovesicular light eruption.
A defined subset of polymorphous light eruption.Arch Dermatol 1985
A distinctive photodermatitis is seen commonly in tourists visiting
Hawaii. Analysis of 150 cases revealed that the eruption is acute
in onset following exposure to sunlight, is confined to exposed
areas, and mainly affects young to middle-aged white women. The
clinical presentation is remarkably uniform, consisting of papules,
papulovesicles, or vesicles. These findings are consistent with
a diagnosis of polymorphous light eruption (PMLE) and the histologic
picture supports this diagnosis. Other clinical variants of PMLE
were not seen in our patients, however, which suggests that this
condition is more monomorphous than polymorphous. We suggest papulovesicular
light eruption as a suitable name for this common and distinctive
subset of PMLE
2. Morison WL, Stern RS. Polymorphous light eruption: a common reaction
uncommonly recognized. Acta Derm Venereol 1982;62(3):237-40
Polymorphous light eruption (PMLE) is usually considered to be an
uncommon complaint, although the prevalence in the general population
has not been studied. In a survey of 271 apparently healthy subjects,
10% gave a history consistent with a diagnosis of PMLE. The clinical
characteristics in the survey cases of PMLE were similar in most
respects to those of patients presenting to a clinic with this disorder.
However, there was one notable exception, in that there was a striking
difference between the clinic and survey cases in the amount of
sunlight required to trigger the eruption. Clinic patients required
a mean exposure of 30 min as compared with over 3 h in the survey
cases. These findings suggest that PMLE is a common disorder but
that many individuals have a high threshold of response to sunlight
Dr. Elizabeth Rosenthal's Comments (7/18/01):
I think this is rather a common entity but is often less severe than
the case presented and often only mentioned after the fact by patients
coming in for another problem.
Dr. Foong's Comments (7/18/01):
recently saw a young lady who presented with a 2 day history of
pruritic eruption on the cheeks following prolonged sun exposure
at the farm in Cameron Highlands. She had similar episodes of photosensitive
skin eruption several months ago. She was investigated for lupus
erythematosus but was
negative. The lesions cleared with topical eumovate ointment.
contrast to western experience, PMLE is quite uncommon here, probably
because of chronic exposure to UV. It tends to be more persistent
Patient's Perspective (7/26/01):
I e-mailed and spoke with you prior to my trip to Hawaii, requesting
any new treatments for PMLE. Thanks so much for all your advice.
I told you I would let you know how it worked out...
I was so thrilled to find that I did not get one bit of PMLE, and
felt so comfortable for the first time in a tropical climate. Of
course, I opt for the shade whenever possible, but in the past that
has not even helped.
This was what I did:
Went to a tanning parlor for 2 weeks prior to trip. Went about every
other day, starting at 8 minutes, and gradually increasing to 12
minutes. I think this was the most important factor, as you had
Took 25,000 IU of beta carotene (1 tablet) for 2 weeks prior to
trip and during trip.
Applied Biosun sunscreen SPF45 to entire body once a day upon waking
or showering. Sometimes re-applied during the day if in the pool
or at a beach.
I did bring prednizone and hydroxizine, prescribed by my doctor
prior to the trip, but did not need to take it. I did not get any
sunburn or even a hint of PMLE. I can't tell you how good it felt,
since we were gone for 2 weeks and in the past it has almost ruined
my tropical vacations. Thanks so much for your advice!
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