Centre for Dermatology Research, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, England.
Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, Manchester, England.
JAMA Dermatol. 2022 Sep 1;158(9):1022-1030. doi: 10.1001/jamadermatol.2022.2823.
Photoaggravated atopic dermatitis (PAD) is estimated to affect 1.4% to 16% of patients with AD but remains poorly characterized with limited published data.
To provide detailed clinical and photobiological characterization of PAD.
DESIGN, SETTING, AND PARTICIPANTS: This case series study used cross-sectional data collected from 120 consecutive patients diagnosed with PAD from January 2015 to October 2019 at a tertiary center referral unit for photobiology.
Routinely collected standardized clinical and photobiological data were analyzed using descriptive statistics, and regression analysis explored associations between demographic and clinical data.
Of 869 patients who underwent photoinvestigation, 120 (14%) were diagnosed with PAD (69 female [58%]; median age, 45 [IQR, 31-61] years; range, 5-83 years; skin phototypes [SPTs] I-VI). Of these patients, 104 (87%) were adults. All patients had a history of AD, and most (62 of 104 [60%]) presented with sunlight-provoked or photodistributed eczema; median age at photosensitivity onset was 37 years (range, 1-72 years). Past-year Dermatology Life Quality Index score was greater than 10 for 80 of 103 adults (78%), and 82 of 119 (69%) had vitamin D (25-hydroxyvitamin D) level insufficiency or deficiency (<20 ng/mL; to convert ng/mL to nmol/L, multiply by 2.496). Broadband UV radiation provocation test results were positive for 112 patients (93%). In 28 patients (23%) with abnormal monochromator phototest findings, sensitivity occurred to UV-A, UV-B, and/or visible light, and UV-A of 350 ± 10 nm was the most prevalent wavelength. Photopatch test reactions were positive for 18 patients (15%). Patients with SPTs V to VI (31 [26%]) vs SPTs I to IV (89 [74%]) were younger at photosensitivity onset (median age, 24 years [IQR, 15-37 years] vs 40 years [IQR, 25-55 years]; P = .003), were more likely to be female (23 [74%] vs 46 [52%]; P = .03), and had a lower vitamin D status and a higher frequency of abnormal monochromator phototest findings.
In this case series study, PAD affected patients with different ages and SPTs and was associated with substantially impaired quality of life. The findings suggest that confirming PAD through phototesting may provide better personalized care for patients through identification of provoking wavelengths, relevant photocontact allergies, and appropriate photoprotection advice.
据估计，光加重特应性皮炎（PAD）影响 1.4%至 16%的 AD 患者，但由于数据有限，其特征描述仍很差。
提供 PAD 的详细临床和光生物学特征。
设计、设置和参与者：这项病例系列研究使用了 2015 年 1 月至 2019 年 10 月期间，在一家三级光生物学转诊中心从 120 名连续确诊 PAD 的患者中收集的横断面数据。
使用描述性统计分析了常规收集的标准化临床和光生物学数据，并进行了回归分析以探讨人口统计学和临床数据之间的关联。
在接受光调查的 869 名患者中，有 120 名（14%）被诊断为 PAD（69 名女性[58%]；中位年龄 45 [IQR，31-61]岁；范围，5-83 岁；皮肤光型[SPT]I-VI）。这些患者中，104 名（87%）为成年人。所有患者均有 AD 病史，大多数（104 名中的 62 名[60%]）表现为阳光诱发或光分布的湿疹；光敏性发病年龄的中位数为 37 岁（范围，1-72 岁）。过去一年的皮肤病生活质量指数评分大于 10 的成年人有 80 名（78%），119 名（69%）维生素 D（25-羟维生素 D）水平不足或缺乏（<20ng/ml；要将 ng/ml 转换为 nmol/L，请将其乘以 2.496）。112 名患者（93%）的宽谱 UV 辐射激发试验结果为阳性。在 28 名（23%）异常单色仪光试验结果的患者中，出现了对 UV-A、UV-B 和/或可见光的敏感性，而 350±10nm 的 UV-A 是最常见的波长。光斑贴试验反应阳性的有 18 名患者（15%）。SPT V 至 VI（31 [26%]）与 SPT I 至 IV（89 [74%]）的患者光敏性发病年龄更轻（中位数年龄，24 岁[IQR，15-37 岁]与 40 岁[IQR，25-55 岁]；P=0.003），女性更常见（23 [74%]与 46 [52%]；P=0.03），维生素 D 状态较低，异常单色仪光试验结果更常见。
在这项病例系列研究中，PAD 影响了不同年龄和 SPT 的患者，并与生活质量严重受损相关。研究结果表明，通过光测试确认 PAD 可能通过识别诱发波长、相关光接触过敏和适当的光保护建议，为患者提供更好的个性化护理。
