A new approach to actinic folliculitis: prophylactic narrowband ultraviolet B phototherapy

Abstract

Background. We have observed an increasing number of patients referred to the Scottish Photobiology Service (SPS), who were later diagnosed with actinic folliculitis (AF) and had positive phototesting results. Treatment options for AF are limited, with only a few reports in the literature. The use of prophylactic narrowband ultraviolet B (NB-UVB) phototherapy for AF has not previously been described, and we report on this for the first time. Aim. To analyse the clinical characteristics, phototesting results and responses to treatment for patients with AF diagnosed by the SPS. Methods. We undertook a retrospective review over 10 years of all case notes of patients who were assessed and diagnosed with AF through the SPS, based at the Photobiology Unit, Dundee, UK. Results. All 10 patients were women. Mean age of onset was 25 years and mean time to referral for investigation was 7 years. The commonest site involved was the face, with the main clinical feature being monomorphic pustules appearing after sunlight exposure. The eruption could be provoked with iterative doses of broadband UVA irradiation in five patients. All patients were offered photoprotective advice and prophylactic NB-UVB phototherapy. Five patients proceeded with phototherapy; four of these completed the desensitization course and all four reported either a delay in symptom onset or total prevention of rash induction, with complete efficacy of desensitization maintained for 3 years in one patient. Conclusion. We demonstrate the successful use of UVA provocation testing as a diagnostic tool in AF. Additionally, we recommend the use of prophylactic NB-UVB phototherapy in AF as an effective and well-tolerated approach. MethodsThis case series included all patients with a diagnosis of AF who presented to the SPS between January 2010 and December 2019. We retrospectively

Acute and recurrent pustulosis: consolidating uncommon cases of follicular pustulosis induced by UV light and other triggers

“…Although the pathogenesis was not clearly defined, it was hypothesized that UV-A incites epidermal thickening and resultant occlusion of follicles. 4 While some diseases may appear similar to ARP, including, acne aestivalis, acute localized exanthematous pustulosis, and Illustration of the characteristics of ARP within 23 patients described in the literature, with 20 out of 23 being women. *Veysey and George describe their patients to have pustule formation; therefore, we consider the histologic report to be from an older lesion.…”

“…Biopsies revealed follicularly based neutrophilic infiltrates. Butt et al 4 found that UV-A induced the lesions both experimentally and clinically as it could be initiated by exposure to the sun through window glass. Although the pathogenesis was not clearly defined, it was hypothesized that UV-A incites epidermal thickening and resultant occlusion of follicles.…”

“…Although the pathogenesis was not clearly defined, it was hypothesized that UV-A incites epidermal thickening and resultant occlusion of follicles. 4 …”

Recurrent Photosensitive Pustular Eruption in a Young Woman

“…Other reports have described success with isotretinoin, including complete clearance and extended periods of remission . Newer reports have explored the role of narrowband UV-B phototherapy, but more research is needed to determine its utility …”