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. 2022 Sep 1;158(9):1022-1030.
doi: 10.1001/jamadermatol.2022.2823.

Clinicophotobiological Characterization of Photoaggravated Atopic Dermatitis

Kirsty J Rutter  1   2 , Mark D Farrar  1   2 , Elizabeth J Marjanovic  1   2 , Lesley E Rhodes  1   2
Affiliations

Clinicophotobiological Characterization of Photoaggravated Atopic Dermatitis

Kirsty J Rutter et al. JAMA Dermatol. .

Abstract

Importance: Photoaggravated atopic dermatitis (PAD) is estimated to affect 1.4% to 16% of patients with AD but remains poorly characterized with limited published data.

Objective: To provide detailed clinical and photobiological characterization of PAD.

Design, setting, and participants: This case series study used cross-sectional data collected from 120 consecutive patients diagnosed with PAD from January 2015 to October 2019 at a tertiary center referral unit for photobiology.

Main outcomes and measures: Routinely collected standardized clinical and photobiological data were analyzed using descriptive statistics, and regression analysis explored associations between demographic and clinical data.

Results: Of 869 patients who underwent photoinvestigation, 120 (14%) were diagnosed with PAD (69 female [58%]; median age, 45 [IQR, 31-61] years; range, 5-83 years; skin phototypes [SPTs] I-VI). Of these patients, 104 (87%) were adults. All patients had a history of AD, and most (62 of 104 [60%]) presented with sunlight-provoked or photodistributed eczema; median age at photosensitivity onset was 37 years (range, 1-72 years). Past-year Dermatology Life Quality Index score was greater than 10 for 80 of 103 adults (78%), and 82 of 119 (69%) had vitamin D (25-hydroxyvitamin D) level insufficiency or deficiency (<20 ng/mL; to convert ng/mL to nmol/L, multiply by 2.496). Broadband UV radiation provocation test results were positive for 112 patients (93%). In 28 patients (23%) with abnormal monochromator phototest findings, sensitivity occurred to UV-A, UV-B, and/or visible light, and UV-A of 350 ± 10 nm was the most prevalent wavelength. Photopatch test reactions were positive for 18 patients (15%). Patients with SPTs V to VI (31 [26%]) vs SPTs I to IV (89 [74%]) were younger at photosensitivity onset (median age, 24 years [IQR, 15-37 years] vs 40 years [IQR, 25-55 years]; P = .003), were more likely to be female (23 [74%] vs 46 [52%]; P = .03), and had a lower vitamin D status and a higher frequency of abnormal monochromator phototest findings.

Conclusions and relevance: In this case series study, PAD affected patients with different ages and SPTs and was associated with substantially impaired quality of life. The findings suggest that confirming PAD through phototesting may provide better personalized care for patients through identification of provoking wavelengths, relevant photocontact allergies, and appropriate photoprotection advice.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rutter reported receiving grants from the NIHR Manchester Biomedical Research Centre during the conduct of the study. Dr Marjanovic reported receiving grants from the NIHR Manchester Biomedical Research Centre during the conduct of the study. Prof Rhodes reported receiving grants from the NIHR Manchester Biomedical Research Centre during the conduct of the study, receiving clinical trial funding and grants from Mitsubishi Tanabe Pharma Inc and Clinuvel Ltd outside the submitted work, and serving as the NIHR Manchester Biomedical Research Centre Photodermatoses Programme lead. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Box Plots of Dermatology Life Quality Index (DLQI) and Children’s DLQI (CDLQI) Scores for Past Week and Past Year
DLQI and CDLQI scores range from 0 to 30, with higher scores indicating a more impaired quality of life. Horizontal lines inside boxes indicate medians; outer horizontal box lines, IQRs; and whiskers, ranges. Dashed lines represent boundaries for very large or extremely large effect on quality of life (top line, CDLQI; bottom line, DLQI). SPT indicates skin phototype. aP < .001. bP < .05.
Figure 2.
Figure 2.. Patients With Reduced Minimal Erythema Doses (MEDs) on Monochromator Testing
Wavelengths included UV-A, UV-B, and visible light. SPT indicates skin phototype. aP = .009. bP = .03.
See this image and copyright information in PMC

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