Photosensitivity in Pediatrics

Photosensitivity encompasses a group of disorders characterized by abnormal cutaneous responses to ultraviolet (UV) and/or visible light exposure. These conditions can be inherited or acquired and may represent significant morbidity in the pediatric population.

Key Points:

• Affects approximately 1-4% of children
• Can be manifestation of underlying systemic disease
• Significant impact on quality of life
• Requires comprehensive management approach
• Early recognition crucial for optimal outcomes

Major Categories

1. Immunologically Mediated

• Polymorphic Light Eruption (PMLE)
• Juvenile Spring Eruption
• Solar Urticaria
• Chronic Actinic Dermatitis

2. Genetic/Inherited

• Xeroderma Pigmentosum
• Bloom Syndrome
• Rothmund-Thomson Syndrome
• Cockayne Syndrome
• Trichothiodystrophy

3. Phototoxic Reactions

• Drug-induced
• Plant-induced
• Chemical-induced

4. Photoaggravated Conditions

• Lupus Erythematosus
• Dermatomyositis
• Atopic Dermatitis
• Acne

General Presentation Patterns

• Distribution:
  • Sun-exposed areas
  • Face and dorsal hands
  • V-area of neck
  • Extensor surfaces
• Common Symptoms:
  • Burning sensation
  • Pruritus
  • Pain
  • Stinging
• Timing:
  • Immediate vs delayed onset
  • Seasonal variation
  • Duration of symptoms

Morphological Patterns

• Acute Changes:
  • Erythema
  • Edema
  • Vesiculation
  • Urticarial plaques
• Chronic Changes:
  • Lichenification
  • Hyperpigmentation
  • Scarring
  • Premature aging

1. Polymorphic Light Eruption (PMLE)

• Most common idiopathic photodermatosis
• Characteristics:
  • Delayed onset (hours to days)
  • Papules, vesicles, plaques
  • Pruritic eruption
  • Spring/summer predominance

2. Xeroderma Pigmentosum

• Inherited DNA repair defect
• Features:
  • Extreme UV sensitivity
  • Early skin cancer development
  • Progressive neurological problems
  • Ocular complications

3. Solar Urticaria

• Immediate-type hypersensitivity
• Characteristics:
  • Rapid onset (minutes)
  • Wheal and flare reaction
  • Resolution within hours
  • May be severe/anaphylactic

4. Drug-Induced Photosensitivity

• Common Culprits:
  • Tetracyclines
  • Fluoroquinolones
  • NSAIDs
  • Thiazide diuretics
• Mechanisms:
  • Phototoxic reactions
  • Photoallergic reactions

Diagnostic Approach

• Detailed History:
  • Age of onset
  • Pattern of exposure
  • Seasonal variation
  • Family history
  • Medication history
• Physical Examination:
  • Distribution pattern
  • Morphology assessment
  • Associated features
  • Systemic involvement

Specific Testing

• Photoprovocation Testing:
  • Monochromator testing
  • Solar simulator
  • MED determination
• Laboratory Studies:
  • ANA and other autoantibodies
  • Porphyrin levels
  • Genetic testing
  • DNA repair studies

General Principles

• Photoprotection:
  • Broad-spectrum sunscreens
  • Protective clothing
  • UV-protective films
  • Behavioral modification
• Acute Treatment:
  • Topical corticosteroids
  • Systemic antihistamines
  • Cool compresses
  • Pain management

Specific Treatments

• Prophylactic Measures:
  • Photohardening
  • PUVA therapy
  • Antimalarials
  • Beta-carotene
• Immunomodulators:
  • Systemic corticosteroids
  • Azathioprine
  • Cyclosporine
  • IVIG in severe cases

Preventive Strategies

• Sun Protection:
  • Physical barriers
  • Chemical photoprotection
  • Timing of outdoor activities
  • Environmental modifications
• Education:
  • UV index awareness
  • Proper sunscreen use
  • Recognition of triggers
  • Early warning signs

Lifestyle Modifications

• Activity Planning:
  • Indoor activities during peak hours
  • Gradual sun exposure
  • Regular monitoring
• Environmental Control:
  • Window films
  • Protective clothing
  • Indoor lighting modifications

High-Risk Groups

• Genetic Disorders:
  • Xeroderma pigmentosum
  • Bloom syndrome
  • Rothmund-Thomson
• Autoimmune Conditions:
  • Lupus patients
  • Dermatomyositis
  • Mixed connective tissue disease

Special Situations

• School Settings:
  • Educational plans
  • Protection measures
  • Emergency protocols
• Sports/Activities:
  • Modified participation
  • Protective equipment
  • Risk assessment

Acute Complications

• Physical:
  • Severe burns
  • Secondary infection
  • Dehydration
  • Anaphylaxis (in solar urticaria)
• Psychological:
  • Anxiety
  • Social isolation
  • Depression
  • School avoidance

Long-term Complications

• Medical:
  • Skin cancer risk
  • Scarring
  • Chronic photodamage
  • Systemic complications
• Quality of Life:
  • Activity limitations
  • Career impact
  • Social development
  • Educational challenges

Outcome Variables

• Disease-Specific:
  • Type of photosensitivity
  • Age of onset
  • Severity of disease
  • Associated conditions
• Treatment-Related:
  • Compliance with photoprotection
  • Access to care
  • Treatment response
  • Prevention effectiveness

Follow-up Care

• Monitoring Schedule:
  • Regular skin examinations
  • Photography documentation
  • Quality of life assessment
  • Complication screening
• Long-term Management:
  • Treatment adjustment
  • Prevention optimization
  • Psychosocial support
  • Transition planning