Atypical photosensitivity associated with triflusal

An 87-year-old man was referred to our photobiology unit in August 2015 for the diagnosis and treatment of eczematous lesions involving the sun-exposed areas (face, dorsal aspects of hands, and feet) that he had suffered from for >5 years. He had suffered from hypertension, and had experienced a cerebrovascular accident 10 years previously. Since then, triflusal (300 mg twice daily) has been prescribed (as the only therapy). On examination, facial erythema with non-adhering desquamation, marked ectropion, loss of skin folds and microstomia was noted (Fig. 1). The dorsa of the hands and feet showed discrete erythema only in photo-exposed areas. A lesional skin biopsy showed marked actinic elastosis, fibrosis of the superficial dermis, and a discrete chronic perivascular infiltrate with hyperkeratosis. A blood test was performed to rule out diet-related deficiency and autoimmune diseases, and we consulted with the patient’s general physician concerning possible triflusal replacement. Phototesting was performed on the first visit with a 150-W xenon solar simulator. The doses used were 7–33.3 mJ/cm2 ultraviolet (UV) B, and 5–10 J/cm2 UVA, respectively. There was no immediate response to either UVB or UVA. Twenty-four hours later, the minimal erythema dose (MED) for UVB (UVB-MED) was 7 mJ/cm2 [corresponding to Fitzpatrick skin phototype II, pathological value <19 mJ/cm2 (1)], and there was no response to UVA.