What is the management approach for patients with solar urticaria?

From the Guidelines

The most effective management approach for patients with solar urticaria involves a combination of photoprotection, antihistamines, and phototherapy, with PUVA being a beneficial option as evidenced by its ability to increase the minimum urticarial dose (MUD) and improve sun tolerance 1. When considering treatment options, it's essential to prioritize photoprotection, including strict sun avoidance, broad-spectrum sunscreens (SPF 50+), protective clothing, wide-brimmed hats, and sunglasses.

• First-line pharmacological treatment includes non-sedating H1-antihistamines such as cetirizine (10mg daily), loratadine (10mg daily), or fexofenadine (180mg daily) 1.
• For inadequate response, antihistamine doses can be increased up to fourfold (e.g., cetirizine 40mg daily).
• Phototherapy with narrowband UVB or PUVA can induce tolerance in some patients through desensitization, typically administered 2-3 times weekly for several weeks, with PUVA showing promising results in increasing MUD and sun tolerance 1. Some key points to consider when managing solar urticaria include:
• The use of UVA alone may be considered for patients with a very low MUD for UVA, where PUVA is thought to be unsafe, as it has the advantage of reduced risk of acute phototoxic reaction and long-term side-effects such as skin cancers 1.
• Combination therapy with PUVA and plasmapheresis or IVIg may be beneficial in some cases, although evidence is limited to small case reports 1.
• Patients should be advised to carry emergency medications such as epinephrine auto-injectors if they have experienced severe reactions. Overall, a comprehensive management approach that incorporates photoprotection, antihistamines, and phototherapy, with consideration of individual patient needs and responses, is crucial for effectively managing solar urticaria and improving quality of life 1.

From the Research

Management Approach for Solar Urticaria

The management approach for patients with solar urticaria involves a combination of treatments tailored to the disease severity.

• Antihistamines and leukotriene receptor antagonists are commonly used to treat solar urticaria, as seen in studies 2, 3, 4.
• Photoprovocation tests are used to determine the action spectra and minimal urticaria dose (MUD), which helps in tailoring the treatment regimen 2, 3.
• In cases where antihistamines and leukotriene receptor antagonists are not effective, omalizumab can be used as an alternative treatment option 3, 5, 6.
• Sun avoidance is also an important aspect of managing solar urticaria, as it helps to prevent symptoms from occurring in the first place 6, 4.

Treatment Options

Different treatment options are available for solar urticaria, including:

• Antihistamines such as desloratidine, fexofenadine, and cetirizine HCl 2, 4
• Leukotriene receptor antagonists such as montelukast 2, 3
• Omalizumab, which has been shown to be effective in treating recalcitrant solar urticaria 3, 5, 6
• High-dose antihistamines, which can help to improve tolerance to sunlight exposure 4

Disease Characteristics

Solar urticaria is a rare form of urticaria that can affect all skin types and can be difficult to diagnose and manage.

• The disease is characterized by erythema, whealing, and/or pruritus occurring minutes after sun exposure 2, 6, 4.
• The pathogenesis of solar urticaria is poorly understood, but it is thought to involve an immune-mediated response to sunlight 6, 4.
• The disease can have a significant impact on a patient's quality of life, making effective treatment essential 3, 5, 6, 4.