Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 61666

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : WC01 - WC05 Full Version

Clinical Characteristics of Photodermatoses in Indian Patients and their Phototesting Findings: A Cross-sectional Study

Published: January 1, 2023 | DOI:
Aishwaria Suresh, TP Thankappan

1. Assistant Professor, Department of Dermatology, KMCT Medical College, Calicut, Kerala, India. 2. Professor, Department of Dermatology, Pushpagiri Medical College, Thiruvalla, Kerala, India.

Correspondence Address :
Dr. Aishwaria Suresh,
Assistant Professor, Department of Dermatology, KMCT Medical College, Calicut-673602, Kerala, India.


Introduction: Phototesting helps to confirm photosensitivity, identify the action spectra, reproduce lesions by photo provocation for biopsy, calculate starting dose of desensitisation therapy, assess the severity of the photodermatoses, and monitor response to treatment. The effect of sunlight on darker skin has only been sparingly studied and hence, this study was undertaken in our population.

Aim: To identify the spectrum of photodermatoses, with their clinical characteristics and phototesting findings.

Materials and Methods: A cross-sectional study was conducted in Outpatient Department (OPD) of the Department of Dermatology, Pushpagiri Medical College, Tiruvalla, Kerala, India from January to December 2015. A total of 30 patients clinically diagnosed as photodermatoses were subjected to phototesting using the whole body phototherapy unit with Ultraviolet A (UVA) and UVB exposure. After 24 hours the UV-exposed areas were examined for the Minimal Erythema Dose (MED), and for the reoccurrence of skin lesions to determine the action spectra for the disorder, and the values were expressed in mean, frequency, and percentage.

Results: Polymorphic Light Eruption (PLE) remains the most common photodermatosis (n=25) with a definite female preponderance (n=19). The mean MED-UVB for type IV skin with photodermatoses was found to be 766 mj/cm2 and for type V skin was found to be 900 mj/cm2. MED-UVA was not observed in the majority of patients (n=24). Among the 25 patients with PLE, 16 patients had normal MED values to both UVA and UVB, four had reduced MED-UVB alone, one patient to UVA alone, and three patients had reduced MED to both. MED-UVB was not observed in one patient. MED-UVA was not observed in 21 patients (normal). Of the three patients with photoallergic dermatitis, one patient had reduced MED-UVB and MED-UVA. The other two patients had normal MEDs. The chronic actinic dermatitis patient had reduced MED to UVB and UVA and the actinic lichen planus patient had normal MEDs.

Conclusion: Phototesting remains a very useful tool in the evaluation and management of photodermatoses and PLE was the most common photodermatoses in studied population.


Polymorphic light eruption, Photosensitivity, Phototherapy

Photodermatoses are disorders of the skin characterised by an abnormal cutaneous response to ordinary light exposure (1). Erythema is the most visually apparent indicator of UV-induced skin inflammation. Erythema has been used as the endpoint for measuring the relative effects of UVB and sometimes of UVA, usually expressed as the action spectrum (2). The effect of sunlight on darker skin has only been sparingly studied (3),(4). The effect of sunlight does depend on the skin colour, skin type, and type of melanin in the skin (4). Photodermatoses are common in the Indian population despite the better natural photoprotection offered by melanin (4). Phototesting helps to confirm photosensitivity (5), identify the action spectra, reproduce lesions by photoprovocation for biopsy (3), calculate starting dose of desensitisation therapy, assess the severity of the photodermatoses and monitor response to treatment (5).

In India, the incidence of photodermatoses is high in view of the tropical weather, lack of knowledge regarding sun protection, and inadvertent consumption of phototoxic drugs (6). Identification of the cause and avoidance of triggering factors will help in reducing the incidence of photodermatoses (6). This study intends to identify the spectrum of photodermatoses with their clinical characteristics and phototesting findings and to find out the minimal erythema dose in these patients by UVA and UVB irradiation.

Material and Methods

A cross-sectional study was conducted in the Department of Dermatology, Pushpagiri Medical College, Kerala, India from January to December 2015. A total of 30 patients attending OPD with photodermatoses during the stipulated period of study duration were included in the study, after obtaining ethical committee clearance (PIMSRC/E1/388A/12/2015) and patient consent.

Inclusion criteria: Patients clinically diagnosed to have photodermatoses based on distribution of skin lesions on or predominantly on sun exposed areas, and patients willing to undergo the phototesting procedure, which takes about an hour in the phototherapy unit were included in the study.

Exclusion criteria: Patients with severe photosensitivity with dissemination of lesions to large areas and pregnant women were excluded from the study.

Study Procedure

The patient’s clinical characteristics and Fitzpatrick’s skin types, (Table/Fig 1) (7) were recorded and they were then subjected to phototesting in the active stage before initiation of the treatment.

‘Daavlin 3 series SPTM and 3 series PCTM Full body phototherapy device with smart touch control system, model number 311/350-24/24’ was used for the purpose of phototesting. The device is equipped with 24 lamps that emit UVA (peak 350 nm) and 24 Narrow Band UVB/TL-01 lamps (peak 311 nm). A full length gown with full sleeves was worn by the patient (Table/Fig 2). 4 cm2 openings were put on the back of the gown, six on each side, for UVA and UVB exposure (Table/Fig 3). Eyes were protected with UV blocking goggles and the face was covered with a cloth. Areas to be exposed were marked with a marker pen (Table/Fig 4).

Patients were then subjected to sequentially higher doses of UV light exposure on 4 cm2 area of the upper back. UVA was exposed at doses of 2,4,8,12,16 and 20 j/cm2 (Table/Fig 5). UVA dose of 2 j/cm2 was initially applied on the back. The first opening on the back of the gown was then closed. 2 j/cm2 was applied again, so that, a total of 4 j/cm2 is received at the second opening, which was then closed, and the process was repeated till all the openings received the required doses. UVB was also similarly exposed at doses of 200, 400, 600, 800, 1000 and 1200 mj/cm2.

After 24 hours the UV exposed areas were examined for the minimal erythema dose, and for reoccurrence of skin lesions to determine the action spectra for the disorder.

Statistical Analysis

Statistical analysis was done using epi info 7 software. The continuous variables like age, duration of disease, time from sun exposure to development of lesions etc were summarised as mean and standard deviation. The type of photodermatoses and sensitivity to UVA or UVB was expressed in frequency and percentage.


A total of 23 females and 7 males were included in the study. Majority of the participants were in 41-50 years of age (Table/Fig 6). The mean age was 43 years.

PLE remains the most common photodermatoses (n=25), with a definite female preponderance [Table/Fig-7,8]. None of the patients had a family history of PLE. About 14 patients with PLE had recurrent episodes of the disease. Most of the patients (n=26,86.6%) diagnosed to have photodermatoses were involved in indoor works. They were incidentally exposed to sunlight for different purposes like hanging clothes, travel to work place etc. Only four patients were involved in regular outdoor works. Sixteen patients developed lesions after exposure to afternoon sun, nine after exposure in the morning, four in the evening and one patient after exposure to a newly installed CFL in the office (Table/Fig 9). Most patients (n=18) developed the disease within 7-24 hours of exposure to light, six patients within six hours, five patients after 24 hours and time of onset was unnoticed by one patient. The patient with chronic actinic dermatitis had a history of parthenium dermatitis earlier while residing in North India. There was a definite seasonal exacerbation in summer for 66.7% patients (Table/Fig 10).

Majority of patients were of Fitzpatrick’s skin type IV (n=23), six patients were of skin type V and remaining one patient was of skin type III. The mean MED-UVB (minimal erythema dose to ultraviolet B) for type IV skin with photodermatoses was found to be 766 mj/cm2 and for type V skin was found to be 900 mj/cm2. MED-UVA was not observed in the majority of patients (n=24). Among the 25 patients with PLE, 16 patients had normal MED values to both UVA and UVB, four had reduced MED-UVB alone (Table/Fig 11), one patient to UVA alone, three patients had reduced MED to both. MED-UVB was not observed in one patient and MED-UVA was not observed in 21 patients (normal). In the three patients with photoallergic dermatitis, one patient had reduced MED-UVB and MED-UVA. Other two patients had normal MEDs.The chronic actinic dermatitis patient had reduced MED to UVB and UVA (Table/Fig 12) and the actinic lichen planus patient had normal MEDs.


The PLE was the most common photodermatosis observed in present study population (83.3%), followed by photoallergic dermatitis. In a study from India it has been found to be 0.56% in the plains and as high as 3.81% in hilly areas (8). PLE was the most common photodermatoses reported in previous studies also (1),(9),(10),(11). The mean age of PLE patients was 43 years in present study which was higher than a previous study from India (32.7 years) (1). The female predominance in PLE is well documented (12),(13),(14) as in present study (n=19,76%). About 14 (56%) of the patients with PLE had recurrent episodes of the disease in present study. None of the patients had a family history of PLE even though it is reported in upto one sixth of patients in literature (15). Most patients with PLE developed the disease after 6-24 hours of exposure to light, five patients within six hours, four patients after 24 hours and time of onset was unnoticed by one patient. One patient who developed the lesions after 6-24 hours had no history of sun exposure but developed after installation of a new CFL in office. PLE is a delayed type of hypersensitivty response and is reported to occur between 30 minutes to three days after exposure to sunlight (15). Flourescent lighting has been shown to induce lupus erythematosus lesions and chronic actinic dermatitis and has the potential to induce other idiopathic photodermatoses like PLE but to what extent is not yet clear (16). Two-third of patients (n=16) had disease onset in summer, followed by disease occurrence in summer and spring. Onset or worsening of PLE in summer and spring is reported. Among the patients with PLE 32% had low MED responses. Four had reduced MED-UVB alone, one patient had reduced MED-UVA alone and three patients had reduced MED to both. Around 15-30% abnormal MED responses have been documented in literature (17),(18) and the incidence was slightly higher in this study. MED-UVB was not observed in one patient. This could probably be due to a MED above the test ladder that was employed, that is, above 1200 mj/cm2. Higher than normal MED values have also been reported for PLE patients (19). Rest of the 16 patients (64% of patients) had normal minimal erythemal responses, the incidence was slightly lower than that in previous studies. Que SKT et al., reported 68% (n=216) of their PLE patients to have normal MED responses to UVB, UVA and visible light (10). Magnus IA (20) in 1964 and Frain-Bell W et al., (21) also had reported normal MED in PLE patients earlier.

Of the three PAD patients, one patient had reduced MED-UVA and UVB, other two patients had normal MEDs. The patient with systemic PAD due to Non Steroidal Anti-Inflammatory Drugs (NSAIDs) intake had the reduced MED. In the CAD patient MED to UVB and UVA was reduced as in previous studies (1),(17). In the absence of abnormal phototests a diagnosis of CAD cannot be made (18). Actinic lichen planus patient had normal MEDs as in a previous case (22). All the patients with PAD, and six patients with PLE were using different topical applications on the involved sites. Of these, four patients with PLE were using sandalwood soaps which is a known photosensitiser that might have predisposed them to development of disease (23). One patient with PAD probably had systemic photoallergic dermatitis due to NSAID use (the patient was also using medicated oils) and the other two had photocontact allergic dermatitis from face pack and fairness creams. The sunscreen incorporated in the fairness cream or fragrance in face pack might have induced photosensitivity in the patients here, but the exact composition could not be assessed. The most common lesions in this study were irregular papules and plaques with scaling and erythema.

Only one patient had chronic actinic dermatitis and one had actinic lichen planus both of which are reported to be less common (12). The patient with chronic actinic dermatitis had a history of parthenium dermatitis earlier while residing in North India. There is a definite trend towards a change from an airborne pattern to a CAD pattern in the natural history of parthenium dermatitis (24). In actinic lichen planus, skin tests for ultraviolet sensitivity are reported to be negative in most cases. Therefore, the cause of the occurrence of eruptions exclusively on the light-exposed areas remains unclear (25).Verhagen AR and Koten JW hypothesised that light induces the Koebner phenomenon that progresses to actinic lichen planus in a certain population of patients who have a tendency to develop lichenoid eruptions (26).

There were no patients with idiopathic photodermatoses like actinic prurigo, hydroavacciniforme and solar urticaria as in other case series from India (1) as they are very rare in our country. There are no Indian studies on MED in patients with photodermatoses. Considering the two studies from India on normal skin by Pai GS et al., (27) and Tejasvi T et al., (28) an average value of 800 mj/cm2 for type IV skin and 925 mj/cm2 for type V skin was considered normal in present study. In present study, seven patients with type IV skin had a MED-UVB less than 800 mj/cm2 and two patients with type V skin had MED-UVB less than 925 mj/cm2 (600 mj/cm2 and 800 mj/cm2) which was low. Mehta RV et al., (3) from India could not demonstrate erythema to UVA in type IV and type V skin even after irradiation upto 700 j/cm2 with a solar simulator. Hence, it is proposed that the MED for UVA on Indian skin is probably greater than 700 j/cm2. In present study, six patients with photodermatoses had observable erythemal response to UVA at less than 20 j/cm2 which was abnormal.


Small sample size due to the prolonged time required for phototesting in the phototherapy unit.


Polymorphic Light Eruption (PLE) remains the most common photodermatoses and phototesting findings are normal in a majority of patients with PLE. This study emphasises the importance of using phototests in conjunction with a history and physical examination, in conforming the diagnosis, identify those wavelengths of light which are most detrimental to an individual patient, and hence to take adequate measures to prevent exposure to those wavelengths of light.


Wadhwani AR, Sharma VK, Ramam M, Khaitan BK. A clinical study of the spectrum of photodermatoses in dark-skinned populations. Clin Exp Dermatol. 2013;38 (8):823-29. [crossref] [PubMed]
Kochevar IE, Taylor CR, Krutmann J. Fundamentals of cutaneous photobiology and photoimmunology. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K, editors. Fitzpatrick’s dermatology in general medicine. 8th edition. Vol 1. New York: Mc Graw Hill; 2012;1031-65.
Mehta RV, Shenoi SD, Balachandran C, Pai S. Minimal erythema response (MED) to solar simulated irradiation in normal Indian skin. Indian J Dermatol Venereol Leprol. 2004;70(5):277-79.
Sharma VK, Sahni K, Wadhwani AR. Photodermatoses in pigmented skin. Photochem Photobiol Sci. 2013;12(1):65-77. [crossref] [PubMed]
De Argila D, Aguilera J, Sánchez J, García-Díez A. Study of idiopathic, exogenous photodermatoses, part II: photobiologic testing. Actas Dermosifiliogr. 2014;105(3):233-42. [crossref] [PubMed]
Srinivas CR, Sekar CS, Jayashree R. Photodermatoses in India. Indian J Dermatol Venereol Leprol. 2012;78,Suppl S1:01-08. [crossref] [PubMed]
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124(6):869-71. [crossref] [PubMed]
Sharma L, Basnet A. A clinicoepidemiological study of polymorphic light eruption. Indian J Dermatol Venereol Leprol. 2008;74(1):15-17. [crossref] [PubMed]
Morison WL, Stern RS. Polymorphous light eruption: A common reaction uncommonly recognized. Acta Derm Venereol. 1982;62(3):237-40.
Que SKT, Brauer JA, Soter NA, Cohen DE. Normal minimal erythema dose responses in patients with suspected photosensitivity disorders. Photodermatol Photoimmunol Photomed. 2012;28(6):320-21. [crossref] [PubMed]
Hönigsmann H. Polymorphous light eruption. Photodermatol Photoimmunol Photomed. 2008;24(3):155-61. [crossref] [PubMed]
Stratigos AJ, Antoniou C, Papathanakou E, Daboudi M, Tranaka K, Tsara K, et al. Spectrum of idiopathic photodermatoses in a Mediterranean country. Int J Dermatol. 2003;42(6):449-54. [crossref] [PubMed]
Karthikeyan K, Aishwarya M. Polymorphous light eruption- An indian scenario. Indian Dermatol Online J. 2021;12(2):211-19. [crossref] [PubMed]
Boonstra HE, van Weelden H, Toonstra J, van Vloten WA. Polymorphous light eruption: A clinical, photobiologic, and follow-up study of 110 patients. J Am Acad Dermatol. 2000;42(2 Pt 1):199-07. [crossref] [PubMed]
Honigsmann H, Hojyo-Tomoka MT. Polymorphous light eruption, hydroavacciniforme and actinic prurigo. In: Lim HW, Honigsmann H, Hawk JLM, editors. Photodermatology. New York: Informa healthcare. 2007;149-67. [crossref]
Moseley H, Ferguson J. The risk to normal and photosensitive individuals from exposure to light from compact fluorescent lamps. Photodermatol Photoimmunol Photomed. 2011;27(3):131-37. [crossref] [PubMed]
Farr PM, Dawe RS. Phototesting. In: Lim HW, Honigsmann H, Hawk JLM, editors. Photodermatology. New York: Informa healthcare. 2007;433-40.
Murphy GM. Investigation of photosensitive disorders. Photodermatol Photoimmunol Photomed. 2004;20(6):305-11. [crossref] [PubMed]
Diffey BL, Farr PM. The erythemal response to ultraviolet radiation in subjects with polymorphic light eruption. Br J Dermatol. 1986;114(1):103-08. [crossref] [PubMed]
Magnus IA. Studies with a monochromator in the common idiopathic photodermatoses. Br J Dermatol. 1964;76:245-64. [crossref] [PubMed]
Frain-Bell W, Dickson A, Herd J, Sturrock I. The action spectrum in polymorphic light eruption. Br J Dermatol. 1973;89(3):243-49. [crossref] [PubMed]
Werth VP, Honigsmann H. Photoaggravated dermatoses. In: Lim HW, Honigsmann H, Hawk JLM, editors. Photodermatology. New York: Informa healthcare. 2007;250-66. [crossref]
Starke JC. Photoallergy to sandalwood oil. Arch Dermatol. 1967;96(1):62-63. [crossref] [PubMed]
Sharma VK, Verma P, Maharaja K. Parthenium dermatitis. Photochem Photobiol Sci Off J Eu rPhotochem Assoc Eur Soc Photobiol. 2013;12(1):85-94. [crossref] [PubMed]
Dekio I, Matsuki S, Furumura M, Morita E, Morita A. Actinic lichen planus in a Japanese man: first case in the East Asian population. Photodermatol Photoimmunol Photomed. 2010;26(6):333-35. [crossref] [PubMed]
Verhagen AR, Koten JW. Lichenoid melanodermatitis. A clinicopathological study of fifty-one Kenyan patients with so-called tropical lichen planus. Br J Dermatol. 1979;101(6):651-58. [crossref] [PubMed]
Pai GS, Vinod V, Krishna V. Med estimation for narrow band UV-B on type IV and type V skin in India. Indian J Dermatol Venereol Leprol. 2002;68(3):140-41.
Tejasvi T, Sharma VK, Kaur J. Determination of minimal erythemal dose for narrow band-ultraviolet B radiation in north Indian patients: Comparison of visual and Dermaspectrometer readings. Indian J Dermatol Venereol Leprol. 2007;73(2):97-99. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/59819.17295

Date of Submission: Aug 26, 2022
Date of Peer Review: Sep 23, 2022
Date of Acceptance: Nov 12, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Sep 05, 2022
• Manual Googling: Nov 05, 2022
• iThenticate Software: Nov 11, 2022 (8%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)