Recurrent Photosensitive Pustular Eruption in a Young Woman

Abstract

A woman in her 20s was referred for evaluation of a 4-year history of recurrent pustular eruptions on her face, which initially presented while she was vacationing in Florida. She noted mild associated pruritus but denied burning sensation. The eruptions occurred intermittently, appearing as erythematous papules with prominent pustules, and were exacerbated by sunlight. On average, her lesions would resolve in 3 to 4 days with only mild background erythema by 5 to 7 days. Even mild sun exposure would induce the eruption, leading to frequent recurrences in summer months but long periods of remission in the fall through spring. Trials with various broad-spectrum sunscreens in combination with topical and oral antibiotics and topical ivermectin did not prevent flares or mitigate severity of eruptions when they occurred. She denied joint pain, fever, fatigue, changes in urine color, use of other topical or systemic medications, or presence of rashes elsewhere. She was otherwise healthy without other medical history.On physical examination, she was well appearing with numerous 1-to 2-mm monomorphous pustules over background erythema on the medial cheeks, chin, and nose (Figure , A). No nail fold capillary changes or mucosal lesions were observed. Serum analysis results for antinuclear, anti-SSA/Ro, and anti-SSB/La antibodies were negative. A 4-mm punch biopsy was taken from a representative lesion along the right jawline (Figure , B-D).

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

“…A small but growing number of cases that share these attributes are being reported, such as the case in a recent Journal of the American Medical Association Dermatology clinicopathological challenge. 2 As they accumulate, we feel it is imperative that the parameters of this entity be identified and a designation developed that consolidates the prior reports and allows for better identification and diagnosis of future cases.…”