Summary:
The article tells the story of a man who develops an unusual reaction to sunlight, known as solar urticaria. Previously enjoying the sun, he now turns red and itches when exposed to it. After consulting with his dermatologist, he discovers that his reaction is triggered by UVA light, which can even penetrate through windows. Solar urticaria is a rare and poorly understood disorder, and the man must now take precautions such as wearing protective clothing and using sunscreen with a high SPF. While his condition is manageable with medication and sun protection, prolonged exposure to sunlight can lead to severe reactions and potentially life-threatening situations.
Engaging Additional Piece:
The story of the man with solar urticaria sheds light on the complex and often unpredictable nature of allergic reactions. While most people are familiar with common allergies to things like pollen or pet dander, allergies to sunlight may seem extraordinary. Yet, the human body is capable of developing allergic reactions to almost anything, even something as fundamental as the sun.
This case also emphasizes the importance of understanding and acknowledging changes in our bodies. The man initially brushed off his symptoms as a mere inconvenience, not realizing the potential severity of his condition. It was his wife’s observation and concern that prompted him to seek medical help and eventually led to a diagnosis.
Moreover, the story underscores the significance of proper medical evaluation and diagnosis. Initially misdiagnosed as a photoallergic reaction and later as solar urticaria, the man’s journey highlights the importance of consulting with knowledgeable professionals who can accurately identify and treat unique medical conditions.
In a world where much of our lives revolve around exposure to various environmental elements, the idea of developing an allergy to sunlight may seem daunting. However, this story serves as a reminder that there is still much to learn about the intricacies of the human body and the potential interactions it can have with its surroundings. As medical research continues to advance, we can hope for better understanding and management of unusual conditions like solar urticaria. Until then, let us remain vigilant and receptive to the signals our bodies send us, ensuring our health and well-being even under the unlikeliest of circumstances.
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“Get out of the sun,” the woman yelled at her 80-year-old husband. “You’re turning red!” The man reluctantly walked towards the house. It was late afternoon, the end of a glorious summer day in Orange, Conn. But when he looked at her exposed arms, he could see that she was right. She was a bright pink, and he soon knew that her arms and probably the back of her neck would be red and itchy. It was time to go in.
He suspected his wife was getting a bit of a kick to suddenly become as sensitive to the sun as she’d always been. He loved the sun and until recently he thought he loved it too, turning his olive skin a dark brown that seemed to her a sign of health. But that spring he began to turn red where he hit the sun. It wasn’t exactly a sunburn, or at least not the kind of burn his wife used to get that made his skin red, peeling, and sore for days.
His sunburn was itchy, painless, and lasted an hour or two, sometimes a little longer. It certainly never lasted long enough for his dermatologist, Dr. Jeffrey M. Cohen, to see it. He told his doctor about the rash that spring when he went in for his annual skin exam. Cohen said he might be allergic to the sun and suggested an antihistamine and strong sunscreen. He took the pills whenever he felt like it and slathered on sunscreen sometimes, but he wasn’t sure it would do much good. Also, who ever heard of being allergic to the sun?
Clearly not a sunburn
She made an appointment with her dermatologist just before Christmas. It was one of those warm, sunny days in December, before winter really sets in, so she decided to make sure his doctor had a chance to see the rash. He arrived early and parked in the parking lot. He took off his jacket and stood in the sunlight that fell weakly on the building. After about 10 minutes, he could see that he was blushing, so he headed to the office.
“I have something to show you,” he told Cohen with a smile as the doctor entered the well-lit exam room. He unbuttoned his shirt to reveal his chest. Now it was bright red. The only places on his torso that seemed his normal color were the ones covered in a double layer of cloth: the placket strip below the shirt buttons, the corners of the collar, the double folds of cloth over the shoulders. Palest of all was the area under the left breast pocket where his cell phone had been.
Cohen was amazed. This was clearly not a sunburn. To Cohen, it looked like a classic presentation of what’s called photodermatitis, an inflammatory skin reaction triggered by sunlight. Most of these unusual rashes fall into one of two classes. The first is a phototoxic reaction, which is often seen with certain antibiotics such as tetracycline. When someone is taking these medications, the sun can cause an immediate and painful sunburn-like rash that, like a normal sunburn, can last for days, causing blisters and even scarring. Clearly, this patient had an immediate reaction to the sun, but he insisted that his rash didn’t hurt. He just itched like crazy. And he was gone in a matter of hours. His reaction was more like photoallergic dermatitis, in which sunlight causes hives, raised red patches that itch intensely and last less than 24 hours. But that didn’t quite fit either; Photoallergic reactions are not immediate. They usually take a day or two to erupt after exposure to light.
Each reaction is triggered by drugs. Cohen reviewed the patient’s extensive list of medications. Amlodipine, an antihypertensive drug, was known to cause this type of photosensitivity, but the patient had recently started taking this drug, months after he first mentioned the rash. Hydrochlorothiazide, another of his blood pressure medications, could sometimes do this. The patient had been on this drug for years and was doing fine, but at least in theory, this unusual type of reaction could start at any time.
Cohen explained his thinking to the patient. A biopsy would have to be done to confirm the diagnosis. Pathology would help you distinguish the inflammation of urticaria from the more destructive phototoxic reaction, which destroys skin cells. And it would help you rule out other possibilities, like systemic lupus erythematosus, an autoimmune disease that’s more common in middle-aged women but can occur in men and women of any age.
A couple of days later, Cohen had his answer. She was hives, medically known as urticaria. This was a photoallergic reaction. And it was probably triggered by her hydrochlorothiazide. You should ask your primary care doctor to stop the medication, Cohen told his patient, and after a few weeks the rash should stop.
Through the window
The man returned to Cohen’s office three months later. The eruption did not change. After a few minutes in the sun, he itched and flushed, even in the dead of winter. Cohen went back to the patient’s medical list. None of the others had been linked to this type of reaction. “Tell me about this rash again,” he said. The patient went over his history one more time. Every time the sun hit his skin, even if he came in through the window, he would turn red. When he drove, the warm touch of the sun on his arm caused an aggravated itch. And by the time he got to his destination, that skin would be a bright red. Hearing this description, Cohen suddenly realized that he had got it right the first time. The patient had developed an allergy to sunlight, a condition known as solar urticaria.
Cohen explained that it was not a sunburn. Sunburns are caused by light at shorter wavelengths known as ultraviolet B or UVB. That form of light cannot penetrate glass. The fact that he could get this redness through his window indicated that his reaction was triggered by light with a longer wavelength, known as UVA. This is the form of light that causes skin to tan and age, the form used in tanning salons.
Solar urticaria, he explained, is a rare and poorly understood disorder. When sunlight penetrates the skin, it interacts in different ways with different cells. The most familiar are those cells that, when exposed, produce a pigment known as melanin, which tans the skin and offers some protection against other effects of the sun. In those with solar urticaria, the body develops an immediate allergic reaction to one of the cellular components changed by sunlight. It is not yet known how or why this change occurs. The allergy can start in early adulthood and can last a lifetime. And it’s hard to deal with.
Sunscreen, Cohen told her, is a must, even indoors. He would also have to take a higher dose of the antihistamine he was prescribed, at least double the usual recommended dose. Patients are also advised to wear protective clothing. Solar urticaria can be dangerous. Prolonged exposure to sunlight can trigger severe reactions and, rarely, a life-threatening anaphylactic event.
The patient was diagnosed a little over a year ago and has been using sunscreen with an SPF of 50 ever since. He doubled the dose of his antihistamine. And most of the time, medication plus long pants and sleeves and a hat keep you safe. Most of the time. And when he forgets, he knows he can count on his wife to let him know that he’s starting to turn red again.
Lisa Sanders, MD, is a contributing writer for the magazine. Her latest book is “Diagnosis: Solving the Most Perplexing Medical Mysteries.” If you have a solved case to share, please write to Lisa.Sandersmdnyt@gmail.com.
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