PHOTOTOXIC REACTION DUE TO SOLAR RADIATION EXPOSURE IN A PSORIATIC PATIENT TREATED WITH PUVA THERAPY/ REAKCJA FOTOTOKSYCZNA PO EKSPOZYCJI NA PROMIENIOWANIE SLONECZNE U PACJENTKI LECZONEJ METODA PUVA Z POWODU LUSZCZYCY

• Published in: Medycyna pracy 2019-11, p.763
• Main Authors: Salinska, Magdalena, Kowalska, Hanna, Torzecka, Jolanta Dorota, Waszczykowska, Elzbieta, Wozniacka, Anna
• Format: Article
• Language: English
• Subjects: Antihistamines; Bullous pemphigoid; Care and treatment; Corticosteroid drugs; Coumarins; Hypertension; Itching; Medical examination; Patient education; Pemphigus; Photochemotherapy; Phototherapy; Psoriasis; Radiation (Physics); Radiation exposure; Skin
• ISSN: 0465-5893
• DOI: 10.13075/mp.5893.00881

Background: A phototoxic reaction may be induced by additional exposure to solar radiation during photochemotherapy (psoralen, ultra-violet A--PUVA treatment). A woman was admitted to Dermatology and Venereology Clinic in Lodz as an emergency case due to extensive erythematous-vesicular lesions on the skin of the lower limbs, accompanied by pain, itching and burning of the skin. The interview found that the patient was undergoing PUVA phototherapy for psoriatic lesions, with hypertension and nicotine dependence. Physical examination revealed large blisters, filled with serum and congestive erythematous lesions located on the lateral surfaces of the thighs and backs of the feet, as well as marked swelling of the lower limbs. Also, discs coated with thin scales were found on the upper and lower limbs and on the trunk. The entire body was intensely tanned. The patient was diagnosed with acute phototoxic reaction and general corticosteroids, antihistamine drugs, an antibiotic, antihypertensive drugs and topical treatment were introduced. Immunological tests were performed during the first days of hospitalization following the emergence of new blisters. Negative results ruled out bullous pemphigoid and pemphigus. Gradual clinical improvement was observed. To avoid the occurrence of acute phototoxicity during phototherapy, patients require education about the need to avoid UV exposure and to use photoprotection, when receiving UV-sensitizing treatment. Key words: psoriasis, blister, PUVA, phototoxic reaction, psoralens, photochemotherapy Reakcja fototoksyczna moze bye wywolana ekspozyj na promieniowanie sloneczne w trakcie leczenia fotochemioterapia (psoralen-ultraviolet A--PUVA). Pacjentka zostala przyjeta do Kliniki Dermatologii i Wenerologii w todzi w trybie pilnym z powodu rozleglych zmian rumieniowo-pecherzowych na skorze konczyn dolnych, ktorym towarzyszyly bol, swiad i pieczenie skory. W wywiadzie wskazano zmiany luszczycowe w trakcie terapii PUVA, nadcisnienie tetnicze i nikotynizm. W badaniu przedmiotowym stwierdzono rozlegle wypelnione trescia surowicza pecherze, zlewne zmiany rumieniowe zlokalizowane na bocznych powierzchniach ud i grzbietach stop oraz nasilone obrzeki podudzi i grzbietow stop. Na konczynach gornych i dolnych oraz na brzuchu obecne tarczki pokryte niewielka iloscia luski. Skora calego ciala intensywnie opalona. Rozpoznano ostra reakcje fototoksyczna i zastosowano ogolnie preparaty kortykosteroidowe, leki przeciwhistaminowe, antybiotyk