Sun allergy

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mum23children
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by mum23children on Wed Feb 01, 2017 5:30 pm

Sun allergy

Hi,

My 7 year old has eczema and has had problems with the sun in the summer months for a number of years but last year was the worst so far. After time in the sun, even with factor 50 suncream she will come out with various rashes, generally hives on her legs which often go down overnight and a pink spotty rash on her top half and face which takes much longer to fade. The rash then triggers an eczema flare which sometimes leads to skin infections. The GP said its a sun allergy but wasn't specific and said we should just keep her in long sleeves and leggings plus wide brim hat throughout the summer which we did. She takes antihistimine daily from May to September and has doublebase and eumovate all year round to manage the eczema. We also use viscopaste bandages to manage flares. She has once had prednisolone to calm the reaction. I'm already worrying about how this summer will go and, as the GP seems a bit vague, I don't know where to go to get more information on how to manage it and what to try? Would be grateful for any advice offered.

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Dr Chris Rutkowski
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Joined: Tue Jan 24, 2017 2:04 pm
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by Dr Chris Rutkowski on Fri Feb 03, 2017 9:12 am

Re: Sun allergy

usually sunshine improves eczema, but not in everyone. Solar urticaria (hives to sun) is rare but can be a true nuisance. High dose antihistamines, high SPF and light protective clothes are important. A dermatology review might be needed
Dr Chris Rutkowski
Consultant Allergist, MD, MRCP

http://www.talkhealthpartnership.com/on ... kowski.php

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Dr Anton Alexandroff
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by Dr Anton Alexandroff on Fri Feb 03, 2017 11:59 pm

Re: Sun allergy

Thank you very much for your question. I am sorry to hear about the trouble your daughter experiences.

I agree with Dr Rutkowski. I was also wondering about polymorphic light eruption or sun-light aggravated eczema.

Could you tell us a little more if you can remember - how soon does rash come up? How long does it take to resolve? Do anti-histamines help with this sun induced rash?

with best wishes,

Dr Anton Alexandroff FRCP(UK) PhD CCT(Derm) FRSM FAAD
Consultant Dermatologist and Honorary Senior Lecturer
Member of the British Association of Dermatologists
Cambridge Nuffield Health Hospital
Bedford BMI Manor Hospital
Leicester Nuffield Health Hospital
Leicester Spire Hospital

www.alexandroff.org.uk
Dr Anton Alexandroff
Consultant Dermatologist, Honorary Senior Lecturer & BSF spokesperson - FRCP, CCT (Derm), PhD, FRSM, FAAD

http://www.talkhealthpartnership.com/on ... ndroff.php

mum23children
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Joined: Fri Jan 20, 2017 5:46 pm
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by mum23children on Mon Feb 06, 2017 7:12 pm

Re: Sun allergy

Hi, thanks for your responses. With the rashes, the hives come up the same day - so if we've been out in the afternoon, even if she's partially covered up, by the time we get home her skin is angry and itchy. It also seems to go down pretty quickly overnight. We were advised to give her loratidine daily as a preventative so its hard to know if the rash responds directly to it. The pink spotty rash that comes up on her neck and trunk and sometimes behind her ears takes a lot longer to go away, sometimes more than a week. It's also slower to come up and tends to be when there's been a few sunny days in a row. Wearing long sleeved clothing definitely seems to help with that kind. She's generally unaffected in winter though one day recently when it was sunny, the side of her face that was nearest the window at school came up very pink and itchy which made me wonder if she's affected even through glass. I'm not sure if that answers your questions? I had wondered about asking the doctor for a stronger antihistimine. Thanks again

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Dr Faheem Latheef
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by Dr Faheem Latheef on Fri Feb 17, 2017 7:22 pm

Re: Sun allergy

Based on your very clear description of these two different rashes it does sound like your daughter is suffering from two distinct problems- 1)solar urticaria which is the hives type rash that comes on immediately and which then settles down very quickly 2) Polymorphic light eruption which is the rash that takes a few days to come on and then lasts for a week. Polymorphic implies that the rash can take on many different forms as you clearly describe and it can in turn flare up her eczema. Some patients with eczema can also have photo-sensitive eczema whereby their eczema gets worse in the sun rather than better which is more common.

Solar urticaria can generally be controlled with anti-histamines and it may be that you need to increase the dose of anti-histamines if it is still happening whilst on the anti-histamines.

Polymorphic light eruption can be more tricky to manage. In some people they only get a reaction when they are abroad in the sun on holidays and as a short term (not ideal) option they take a few days worth of prednisolone starting the day before a planned holiday or in milder cases just use topical steroids. Ultraviolet A light can pass through window glass and could therefore be setting things off. Using a high factor sunscreen SPF 50 with at least 4-5 star rating (star rating refers to the ultraviolet A protection offered) regularly would certainly help. Paradoxically we also can manage this condition in the hospital with whats called desensitisation treatment whereby the body is exposed to ultraviolet light artificially to prevent this reaction from happening. This needs to be done before the summer months. There is also an anti-malarial tablet that can be used but wouldn't be the first choice in a child.

I think given the degree of problems your daughter is experiencing she should be referred to a Dermatologist for a review including potentially undergoing formal light testing where they can confirm the diagnosis and wavelengths of light which she is reacting to. If she is experiencing problems with sunscreens they may also recommend patch testing and photo-patch testing.

Hope that helps and wish your daughter all the very best.
Dr Faheem Latheef
Consultant Dermatologist and Honorary Senior Lecturer, MBCHB, MRCP (London), MRCP (Dermatology), MBA

http://www.talkhealthpartnership.com/on ... atheef.php

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