September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 24-year old woman presented with an itchy rash that started each year in March or April. The problem commenced in her teens but had become progressively worse and as such she was no longer able to go abroad for holidays where the symptoms had become intolerable. Each episode came on 1-2 days after a sunny spell and lasted approximately one week. The patient was otherwise well taking no medications, there was no relevant family history.
There were many small ill-defined papules, mainly on UV-exposed sites, but with some involvement of the trunk.
1) What is the diagnosis?
2) How would you manage this patient?
The diagnosis is polymorphic light eruption (PLE) ie prickly heat.
PLE can affect any age but is more common in teenagers and young adults. Symptoms commonly develop 24 hours after UV exposure but can occur anywhere between two hours and five days after. Sunbeds usually trigger the rash. Patients usually complain of a moderate itch, symptoms usually settle within a week.
Clinical findings:
In most cases investigations are not needed but in more florid cases (such as this lady) it is important to exclude lupus by checking bloods for ANA and ENA levels (particularly Ro and La autoantibodies). ENA levels can be positive even if the ANA screen is negative.
This patient should be considered for referral for further assessment and possible graduated phototherapy beginning in late winter/early spring of each year to help increase the patients tolerance to UV exposure.
Please refer to the chapter on photodermatoses to learn more about skin conditions caused or aggravated by UV radiation.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
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Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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