Polymorphic light dermatosis

Last Updated: 2020-11-19

Author(s): Anzengruber F., Navarini A.

ICD11: EJ30.0

  • Bateman 1817
  • Hutchinson 1878
  • Rasch 1900
  • Hausmann und Haxthausen 1929

Sun allergy, light eczema, polymorphic light eruption, PMLE, Prurigo aestivalis, summer prurigo, lupus erythematosus-like light dermatosis, eczema solare

Most frequent light dermatosis, which is characterized by its severe itching. The appearance is monomorphic within the type of PLD (see below: papules, vesicles, plaques, cocardial lesions, etc.).

  • Prevalence (depending on data situation) up to 20%.
  • Seasonal accumulation March - June (exception: during holidays in warm countries)
  • Independent of age
  • Women : Men = 9:1
  • More common among Caucasians, but also possible among Africans.
  • Family accumulation in at least 20%.

  • Triggered by sunlight, exact etiology is not known.
  • Probably a genetic disposition plays a role.
  • Proinflammatory cytokines are induced by UVA (sometimes also UVB) radiation.
  • A cell-mediated immunological reaction of the delayed type occurs through previously unknown photo-induced antigens.
  • Disruption of UV-induced immunosuppression.

Only in sun-exposed areas, individual predilection sites are described.

The skin symptoms are polymorphic and can often be divided into different types.


  • Papular type
  • Hemorrhagic type
  • Plaque type
  • Erythema exudative multiforme type
  • Papules (Acne aestivalis Hjorth)
  • Erythema-exsudative-multiform-type type
  • Papulo-vesicular type
  • Ictus type
  • Vesiculo-bullous type
  • Lichenoid type (described in the colored population)
  • Special forms: family variant, found in Indians. Juvenile spring eruption (especially ear helices, hands or nose in young men and children in spring).
  • The first symptoms appear hours to days later. However, a manifestation is also possible after several days (cumulative dose). Often there is a familiarisation effect (hardening). In most cases there is a pronounced itching.

  • Typical medical history
  • Time course (continuous? intermittent? Depending on the season? Age of first manifestation? - e.g. Hidroa vacciniformia or spring perniosis), duration of efflorescence? Medication intake? Family history?
  • Do skin changes also occur behind glass? Indication of triggers by UV-A.
  • Do they occur outdoors, but not behind glass? Indication of triggers by UV-B.
  • In room light? Triggered by visible light.
  • After which exposure period do the efflorescences occur?
  • Light diagnostics

    • light staircase
  • Photo provocation 

    • MED is mostly normal
    • UVA provocation more effective than UVB
    • Photopatch test
  • Biopsy if necessary

  • Laboratory
    • ANAs (to search for lupus erythematosus) (if necessary, plasma fluorescence scan in case of justified suspicion of porphyria).

Different patterns depending on the type. In most cases, cuff-shaped, perivascular lymphohistiocytic cell infiltrates are visible over the entire dermis. In addition, subepidermal oedema, exocytosis and spongiosis can occur.

  • Regular UV hardening in spring (costly)
  • Sun protection, sufficient in the trigger light spectrum

  • Under light-care, the patient heals independently without residuals.
  • Chronic recurrent course.

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