Solar urticaria: clinical characteristics, treatment effectiveness, long-term prognosis, and QOL status in 29 patients

Shinya Imamura; Yoshiko Oda; Takeshi Fukumoto; Mayuko Mizuno; Mariko Suzuki; Ken Washio; Chikako Nishigori; Atsushi Fukunaga

doi:10.3389/fmed.2024.1328765

Solar urticaria: clinical characteristics, treatment effectiveness, long-term prognosis, and QOL status in 29 patients

Front Med (Lausanne). 2024 Feb 16:11:1328765. doi: 10.3389/fmed.2024.1328765. eCollection 2024.

Authors

Shinya Imamura^#^{1

2}, Yoshiko Oda^#¹, Takeshi Fukumoto^#¹, Mayuko Mizuno^#¹, Mariko Suzuki^#¹, Ken Washio^#¹, Chikako Nishigori^#¹, Atsushi Fukunaga^#^{1

3}

Affiliations

¹ Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.
² Department of Dermatology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, Kobe, Japan.
³ Department of Dermatology, Osaka Medical and Pharmaceutical University, Osaka, Japan.

^# Contributed equally.

Abstract

Introduction: Solar urticaria (SU), a relatively rare skin inflammatory and photosensitivity disease, is often resistant to standard urticaria treatment. Quality of life (QOL) among SU patients has not been extensively explored. This study was performed to clarify the clinical features and effectiveness of therapies (e.g., hardening therapy) for SU and to determine QOL among SU patients.

Methods: The authors examined the characteristics, treatments, and QOL statuses of 29 Japanese SU patients using medical records and a questionnaire approach.

Results: Among 29 patients, H1 antihistamine therapy (H1) was effective in 22 (75.8%) patients. H2 antihistamine therapy (H2) was effective in three of seven (42.9%) patients. Ultraviolet radiation A (UVA) hardening therapy was effective in eight of nine (88.9%) patients. Visible light (VL) hardening therapy was ineffective in three of three patients. In one patient who underwent both UVA and VL hardening therapy, only UVA hardening therapy was effective. In the questionnaire, 18 patients (90%) reported some improvement compared with disease onset (four had complete remission, six had completed treatment although mild symptoms persisted, and eight were receiving treatment with moderate symptoms), whereas two patients reported exacerbation. Patients in complete remission had a mean disease duration of 4 years, whereas patients not in remission had a mean disease duration of 8.8 years. The mean Dermatology Life Quality Index (DLQI) score for the current status was 7.4. There was a correlation between DLQI and symptom/treatment status. However, neither DLQI and action spectra nor DLQI and treatments exhibited significant differences.

Discussion: The questionnaire revealed current QOL status and long-term prognosis in SU patients. Compared with disease onset, most patients showed improvement when assessed for this study. Both H1 and H2 should be attempted for all SU patients. UVA hardening therapy may be an option for SU patients with an action spectrum that includes UVA.

Keywords: DLQI; IIT; MUD; UVA; UVB; VL; rush hardening therapy; solar urticaria.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported in part by a Grant-in-Aid for Scientific Research (C) (JSPS KAKENHI Grant No. 20 K08651) to AF and a Grant-in-Aid for Early-Career Scientists (JSPS KAKENHI Grant No. 23 K15268) to SI from the Ministry of Education, Culture, Sports, Science, and Technology, Japan.