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Management of the photodermatoses *

In the management ofthe photodermatoses it is important that the diagnosis is correct, i.e. that photosensitivity is in fact present. Often this can be suspected on clinical grounds alone but, except in those instances where the abnormal reaction to light is short-term, confirmation by phototesting is necessary. In this way the responsible wavelengths will be determined and the action spectrum defined. This will allow for the selection of an appropriate photodermatosis label and may also direct attention to specific causal factors. In reactions of exposed skin to external agents, light sensitivity is only one possible explanation and less likely to be responsible for the reaction than external irritants or allergic sensitizers. Although certain distribution characteristics strongly suggest photosensitivity, such as the involvement of the edge of the pinnae and of the mastoid area in the male, and the sparing of exposed sites partially protected by variation of hair styles in the female, other features of cutaneous photosensitivity may become obscured, particularly in photosensitivity dermatitis. The expectation that all exposed skin will react is often not fulfilled, especially in the female with polymorphic light eruption in whom the skin ofthe face may not be involved for reasons which have yet to be satisfactorily explained. Also, in those photodermatoses where the photosensitivity is marked, covered skin will react following penetration of certain modern fabrics by the responsible wavelengths. Similar involvement away from the exposed skin will occur as part of the response to contact allergens and other features of a dermatitis; once again this aspect is of particular relevance in the photosensitivity dermatitis and actinic reticuloid syndrome. Also, the eruption may not always be confined to the sunshine months atid in the photosensitivity dermatitis and actinic reticuloid syndrome in particular those affected may not show any obvious worsening during these months on account of the broad action spectrum involving UVR and light which is present all the year round. Perhaps more important still is the added