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‘Spring, summer eruption of elbows’ indicated polymorphous light eruption, not lupus erythematosus

Seasonal, recurrent eruption of patients’ elbows represented a localized version of polymorphous light eruption and not cutaneous lupus erythematosus, according to study results.

Researchers conducted a retrospective analysis of nine patients in Spain (mean age, 44.7 years; five men) who presented with recurrent spring eruption of their elbows from April 1989 to June 2012. Lesions consisted of pruriginous, erythematous-edematous papules and plaques. Eruption occurred in spring and early summer and recurred seasonally (ranging annually from 2 and 6 years) after the first week of sunlight exposure. Within 1 to 2 weeks, eruption resolved spontaneously or with topical corticosteroids; no associated symptoms were present.

Lesions — with varying degrees of edema and papillary dermis, and a papillary and reticular dermal perivascular infiltrate primarily containing small lymphocytes — showed features that were typical of polymorphous light eruption (PLE).

“Immunohistochemical studies demonstrated strong immunoreactivity for CD2, CD4 and CD*, revealing the infiltrate was composed predominantly of T lymphocytes, with a predominance of T-helper over T-cytotoxic lymphocytes,” the researchers reported.

The absence of plasmacytoid dendritic cells was highlighted by negative immunostaining for CD123. Other negative T- and B-cell markers included CD30, PD-1, CXCL13, FoxP3, CD79a and CD56.

“We believe this recurrent eruption of the elbows represents a distinctive and localized version of PLE rather than a peculiar manifestation of cutaneous lupus erythematosus and suggest the term ‘spring and summer eruption of the elbows,’ ” the researchers concluded. “This is based on its distinct epidemiologic and clinical features, such as the occurrence in spring and summer, the delayed appearance of the lesions several hours or days after exposure to sunlight, and the transient and often recurrent course of eruption. The striking localization of the eruption, exquisitely affecting the elbows, remains unexplained.”