Dermatology - Photoaggravated Eczema

This leaflet has been written to help answer some of your questions about photoaggravated eczema. You may have been given this leaflet because you have been diagnosed with photoaggravated eczema or because we think this might be the cause of your symptoms.

What is photoaggravated eczema?

Eczema is a dry, itchy, inflammation of the skin. Sometimes the word dermatitis is used which means the same thing as eczema. Eczema is most common in children who often “grow out of it”, but it can be persistent, come back, or start for the first time in adult life. Photoaggravated eczema is a type of eczema that is triggered or made worse by sunlight and occurs in about 1 in 10 cases of eczema.

Photoaggravated eczema must be diagnosed by tests in a specialist photobiology unit. This is because it can be confused with other skin disorders.

If you have photoaggravated eczema you might notice that your eczema is worse in spring/summer than winter or flares up on sunny holidays. You might find that areas of your body that are protected from sunlight, such as under watch straps or clothing, do not develop eczema.

Who suffers from photoaggravated eczema?

People with a history of eczema or atopic dermatitis are more likely to develop photoaggravated eczema. Eczema can run in families, but this does not appear to be the case for photoaggravated eczema. Photoaggravated eczema affects both sexes and can occur in all skin types.

Is photoaggravated eczema infectious?

No. There is no risk of other people catching photoaggravated eczema from you.

Can photoaggravated eczema be cured?

No treatment will get rid of photoaggravated eczema for ever, but, by careful sun avoidance and use of sunscreens, the rash can often be prevented from flaring, and there are treatments that can help (see below). When the condition occurs, it is treated with standard eczema treatments.

How will having photoaggravated eczema affect me?

If you have been diagnosed as having photoaggravated eczema you may have to make changes to your lifestyle. You should try to:

• Avoid the sun during conditions that provoke your photosensitivity and particularly when sunlight is intense. In the UK this is mainly between 11 and 3pm, although other times of day can be troublesome
• Wear protective clothing, with close/tightly woven fabrics, long sleeves and trousers, hats with broad brims. Glasses and sunglasses with wrap around lenses can also be helpful
• Use a sunscreen that is SPF 30 or above (high UVB protection) and also has high UVA protection. Remember to re-apply the sunscreen evenly and often

What about vitamin D?

Importantly, in order for people to make enough Vitamin D themselves, they need a certain amount of sun exposure. The sun protection measures needed for people with photoaggravated eczema mean Vitamin D deficiency is a real risk and this does require treatment with supplements if it occurs. This can be monitored through blood tests.

How can photoaggravated eczema be treated?

Sunscreens

Your doctor can provide you with certain sunscreens on prescription and these will help protect your skin. Sunscreen should be applied as thickly as possible and re-applied as often as possible.

Skin creams

Your doctor may prescribe corticosteroid creams or ointments to put on your skin. Steroid creams can be strong and should only be applied sparingly but when used carefully they can control the inflammation and help to ease the itch and tightness of your skin.

If you have a severe flare up of your rash you could use a strong steroid at first then as the rash eases you could switch to a lower strength one. Lower strength steroid creams are used on the face when necessary. More information about steroid creams and how they should be used can be accessed through the British Association of Dermatologists website at
https://www.bad.org.uk/pils/topical-corticosteroids/ and through the National Eczema Society website (see also below for contact information).
 
It is also important to apply moisturising creams or emollients. Emollients can help to combat the dryness of your skin.
Emollients should be applied half an hour after the steroid creams.

Some other creams or ointments may also be prescribed for eczema, such as calcineurin inhibitors. These work in a different way from corticosteroids.

Tablets

There are strong tablets that can help if your eczema is difficult to control or if you have a very bad flare up. These tablets affect the immune system, and can have side effects, so you and your doctor should weigh up the benefits against the side effects to decide whether they should be prescribed.

Desensitisation or UV Treatment

Occasionally the resistance of your skin to the effects of the sun can be increased. This is done in a hospital department and will involve visiting the hospital three times a week for about 5 weeks in the spring. It involves gradually exposing your skin to a little more ultraviolet light every visit to try to build up your skin’s resistance. The effects of desensitisation are lost in the winter so you will have to build up your resistance again in the spring.

Injection treatments

Some people with eczema are eligible for treatment with medication given by injection. They can cause some side effects, and so as with tablets the risks and benefits need to be carefully considered.

Hardening or Toughening

Occasionally people with photoaggravated eczema may be able to increase the resistance of their skin at home. This involves going outside for short periods in the spring to build up your resistance. You might find the time is as short as a few minutes at first, but you may be able to gradually build this up to longer times. You will have to be careful not to overdo it, but as you understand more about how much light triggers your rash you will be able to judge how long to stay out. The effects of hardening are lost in the winter so you will have to build up your resistance again in the spring. We have included an example of how you might try to toughen your skin in the spring.

Example:

Mrs Smith knows her rash usually appears in the evening if she has been out in the sun during the day. Mrs Smith has been toughening her skin in the spring and this is her diary on next page.

Contact us

The Photobiology Unit can be contacted on 0161 206 4081 or by email Photobiology.Salford@nca.nhs.uk

Further Information

The National Eczema Society provides advice and support for all types of eczema. They can be contacted at:

The National Eczema Society Hill House
Highgate Hill London, N19 5NA
Helpline 0800 089 1122 (Mon – Fri 8am – 8pm)
Email helpline@eczema.org or if you have internet access on their web site at www.eczema.org

Eczema Outreach Support is a charity to support children and young people with eczema. They help children aged 0-17 and their parents or carers. They can be contacted through:
Email: info@eos.org.uk Office Tel: 01506 840 395
Website: https://eos.org.uk/

The British Association of Dermatologists produces a series of patient information leaflets. They can be contacted at The British Association of Dermatologists, 4 Fitzroy Square, London or through their web site www.bad.org.uk