By switaschek, 4 May, 2020

ADAC

(BMJ)—A 6-yo boy presented w/ a 2-yr hx of recurrent painful vesicles and erythema affecting his face, ears, and neck, occurring during spring and summer months and only on sun-exposed areas. Healing led to residual scarring. Epstein-Barr virus (EBV) IgG was positive. Connective tissue dz and porphyria screens were negative. What is the dx?
Hydroa vacciniforme
Polymorphous light eruption
Pseudoporphyria
Actinic prurigo
Dystrophic epidermolysis bullosa
You are correct. Hydroa vacciniforme is a childhood photosensitivity disorder of unknown etiology that leads to painful vesicular eruptions affecting sun-exposed sites, settling w/ hemorrhagic crusting. It tends to resolve in adolescence but can leave permanent pox-like, depressed scarring. Hydroa vacciniforme can be assoc w/ latent EBV infxn. Management includes careful photoprotection w/ broad-spectrum sunscreens, sun-protective clothing, and UV films for windows. Vitamin D replacement should be offered.

Archives of Disease in Childhood 2020;105:302-303.