Treatment of solar urticaria by intravenous immunoglobulins and PUVA therapy].

Type:Uv phototherapy Time:2017-09-15 10:39:20

BACKGROUND:

Solar urticaria is a rare form of urticaria occurring a few minutes after solar exposure. It is particularly

incapaciting because it limits outdoor activities. Antihistamine and phototherapy are sometimes disappointing.

CASE REPORT:

A 32 Year-old woman had been suffering from severe solar urticaria since November 2000, which was confirmed by

photobiological data. High-dose antihistamine treatment (fexofenadine 180 mg twice a day) was inefficient. Despite a

first UVA desensitization, PUVAtherapy produced only a partial improvement and short lasting for protection, with an

important handicap in daily life. In March 2002, among the others treatments, we chose intravenous immunoglobulins:

0.5 g/kg the first day then 1 g/kg the second and the third days. The minimal urticaria dose was raised from 1 J/cm2

in UVA before perfusion up to 15.6 J/cm2 48 hours later and in UVB from 100 mJ/cm2 up to 2,200 mJ/cm2. Clinically the

improvement was significant but partial in daily activities. It was possible to reintroduce PUVAtherapy without UVA-

desensitization and, for the first time, to obtain complete remission for more than 2 Months with an association of

intravenous immunoglobulins, PUVAtherapy and antihistamine treatment. In July 2002, treatment was successfully

repeated.

DISCUSSION:

First intention treatments (antihistamine and PUVAtherapy) are sometimes inefficient. Others treatments

(plasmapheresis, ciclosporin, doxepin, cimetidine) are restrictive, not always efficient and can induce severe side-

effects. We report the second case of solar urticaria improved by intravenous immunoglobulins. In spite of the cost,

intravenous immunoglobulins seem to be an interesting treatment, at least by avoiding UVA-desensitization in severe

cases of solar urticaria.

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