Acne aestivalis also called as acne mallorca, is a special kind of

polymorphous light eruption Polymorphous light eruption (PLE) presents with itchy red small bumps on sun-exposed skin, particularly face, neck, forearms and legs. It generally appears 30 minutes to a few hours after sun exposure and may last between one and 14 days. The b ...

induced by ultra violet A radiation. This condition is said to be seasonal, usually affecting people in

springtime Springtime may refer to: * Spring (season), one of the four temperate seasons Film and television * ''Springtime'' (1920 film), an American silent comedy starring Oliver Hardy * ''Springtime'' (1929 film), a ''Silly Symphonies'' animated Disney ...

and goes away in

autumn Autumn, also known as fall in American English and Canadian English, is one of the four temperate seasons on Earth. Outside the tropics, autumn marks the transition from summer to winter, in September ( Northern Hemisphere) or March ( Sou ...

when there is less sun light. This photo induced skin reaction leads to a mono-morphous eruption that consists of multiple, uniform, red, papular lesions. This

skin reaction A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this ...

is classified as a delayed-type hypersensitivity because the onset is 24–72 hours after sun exposure. The condition equally affects men and women between the ages of 20–40 years old with no prior history of

acne vulgaris Acne, also known as ''acne vulgaris'', is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and po ...

. The eruption is unusual because it spares the face but it affects the lateral aspects of the upper arms,

shoulder girdle The shoulder girdle or pectoral girdle is the set of bones in the appendicular skeleton which connects to the arm on each side. In humans it consists of the clavicle and scapula; in those species with three bones in the shoulder, it consists of ...

, back, and chest. This condition's

pathogenesis Pathogenesis is the process by which a disease or disorder develops. It can include factors which contribute not only to the onset of the disease or disorder, but also to its progression and maintenance. The word comes from Greek πάθος ''pat ...

is not very well understood but scientists believe it an unfortunate side effect that results from a strong immune response to potentially cancer-causing cell damage.

Signs and Symptoms

Patients present numerous lesions of small

papule A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some h ...

s that are dull red, dome shaped, hard, and usually not more than 2–4 mm in diameter. These

lesion A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

s do not affect the face but affect lateral aspects of upper arms, shoulder girdle, back, and chest. The papules have an onset of 1–3 days after sun exposure and may last for many weeks.

Comedo A comedo is a clogged hair follicle (pore) in the skin. Keratin (skin debris) combines with oil to block the follicle. A comedo can be open (blackhead) or closed by skin (whitehead) and occur with or without acne. The word "comedo" comes from the ...

nes are not present in this type of skin reaction.

Cause

The main cause of this condition is sun exposure.

Hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. They are usually referred to as an over-reaction of the immune s ...

to the sun may be experienced due to genetic predisposition. It is also speculated that

cosmetics Cosmetics are constituted mixtures of chemical compounds derived from either natural sources, or synthetically created ones. Cosmetics have various purposes. Those designed for personal care and skin care can be used to cleanse or protect ...

and sun care products containing hydroxyl peroxides may trigger this condition through free radical and ultra violet A radiation photo-toxic reactions.

Mechanism/pathophysiology

The actual mechanism of disease is not very well understood but there are a few speculations. It is believed that ''acne'' ''aestivalis'' has a genetic predisposition involved in which people who show acne aestivalis have lower expression of

apoptosis Apoptosis (from grc, ἀπόπτωσις, apóptōsis, 'falling off') is a form of programmed cell death that occurs in multicellular organisms. Biochemical events lead to characteristic cell changes (morphology) and death. These changes incl ...

inducing genes which leads to inflammation.

Inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

is believed to be triggered by circulating ultra violet radiation damaged cells that could not go through apoptosis and the cell fragments they release. Also, it is speculated that this sun induced acne form is caused by a photo allergic reaction between sunscreen, skin, and the sun. A photo-toxic reaction pathogenesis is also possible through

free radical A daughter category of ''Ageing'', this category deals only with the biological aspects of ageing. Ageing Ailments of unknown cause Biogerontology Biological processes Causes of death Cellular processes Gerontology Life extension Metabo ...

release in sun screen

oxidation Redox (reduction–oxidation, , ) is a type of chemical reaction in which the oxidation states of substrate change. Oxidation is the loss of electrons or an increase in the oxidation state, while reduction is the gain of electrons or a d ...

by ultra violet radiation.

Diagnosis

The

diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...

is by visual examination of skin lesions and sun exposure

history History (derived ) is the systematic study and the documentation of the human activity. The time period of event before the History of writing#Inventions of writing, invention of writing systems is considered prehistory. "History" is an umbr ...

. A diagnosis of ''acne aestivalis'' is made once the patient reports the onset of papules was 1–3 days after sun exposure.

Treatment

The treatment for this condition is topical

tretinoin Tretinoin, also known as all-''trans'' retinoic acid (ATRA), is a medication used for the treatment of acne and acute promyelocytic leukemia. For acne, it is applied to the skin as a cream, gel or ointment. For leukemia, it is taken by mouth ...

or benzoyl peroxide applied to the skin. The use of

topical steroid Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. Topical steroids have anti-inflammatory properties and are classifie ...

s should be avoided. Currently, there is no systemic treatment for ''acne aestivalis''.

Prognosis

This condition is alleviated during the fall season when there is less sun light available. The papules do not leave a

scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...

on the affected person's skin.

Epidemiology

There is limited information on the epidemiology of this condition. This disease was first noticed in Scandinavian men and women between the ages of 20 and 40 years old. The skin eruption would present in this population after sunbathing in Mallorca beach after a long and dark winter season.

Research

In 2001, a study was conducted to test a

prophylaxis Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...

regimen containing alpha-glucosylrutin, a strong plant-derived

antioxidant Antioxidants are compounds that inhibit oxidation, a chemical reaction that can produce free radicals. This can lead to polymerization and other chain reactions. They are frequently added to industrial products, such as fuels and lubricant ...

. The focus of the experiment was to evaluate the effects of alpha-glucosylrutin on polymorphous light eruption and ''acne aestivalis'' development. The study demonstrated that applying alpha-glucosylrutin along with SPF 15 sunscreen decreases severe polymorphous light eruption cases from 96.2% to 7.4%.The study included 20 people with polymorphous light eruption and 3 people with acne aestivalis. In this study, 2 out of the 3 people with acne aestivalis did not have an episode of lesions after being prophylactically treated with alpha-glucosylrutin and SPF 15.

References

External links

{{Radiation-related disorders Acneiform eruptions