UNKNOWN CASE: PHOTOSENSITIVITY ---------------------------------------------------- 55 y.o. male who I have treated for 15 years. Recently he retired and moved to a ranch where he rides horses daily. Over past four months he c/o a rash on backs of hands only when he goes riding. He describes "small blisters" which burn and itch. If he rides with gloves he has no problems. I have seen him now 3-4 times over the past 2 months and have never seen an intact bulla, but he does have shallow, crusted erosions on the backs of his hands. He has no face or chest complaints or symptoms. He has milia, but has had these for the past 15 years. No hypertrichosis or hyperpigmentation. Urinary and blood porphyrin studies are all WNL. Medications are Zocor, Xantac, Daypro, Prosom. He denies having hay mites in his storage barn. Any other ideas. Jeff Marmelzat, M.D. -------------------- What is being used to groom the horse? Any powders? How long after he rides does he get the rash? Does the rash occur if he handles the horse but does not ride? Does the rash occur if he rides at night? Art Huntley MD -------------- For the gentleman with hand blisters, see if he is taking any NSAIDS, or other meds which could cause a pseudoporphyria. William Liss MD --------------- Re porphyria, pseudoporhyria. I would biopsy a lesion to see if it is porphyria, contact, pmle etc. Has this lab given positive quantitative urinary porhyrins in other patients ? Some patients don't quite understand how to obtain a 24 hour urine. Diane Thaler MD --------------- Could he have a photocontact to a soap or moisturizer or Bag Balm at the stable? Diane Thaler MD --------------- Several NSAID drugs are photosensitizers. Could Daypro be one? Check out his drugs in Litt's DERM reference. Jerry Eisner MD --------------- I'm sure you're considering various types of light related problems, Pct, and of course EBA Aquisita. Elliot Puritz MD ---------------- My first guess would be a photo rxn to daypro, especially if he rides wearing a hat. Guy Webster MD -------------- Photo induced drug eruption to daypro. Goldin/Kaplan ------------------------------ Have you checked all his medications for photosensitization? Barbara R. Reed, MD -------------------