Elastotic and citrine skin following an allergic photo-contact dermatitis in a child

Area of Science:

• Dermatology
• Toxicology
• Pediatrics

Background:

• Allergic photo-contact dermatitis is a hypersensitivity reaction to a substance that becomes allergenic upon exposure to ultraviolet radiation.
• Phenergan (promethazine) is an antihistamine with known photosensitizing potential.

Observation:

• An 11-year-old boy developed a severe skin reaction after Phenergan use.
• The affected skin areas, exposed to sunlight, exhibited signs resembling premature aging (senile elastosis) and a yellowish discoloration (citrine skin).

Findings:

• The case presents a unique presentation of Phenergan-induced allergic photo-contact dermatitis.
• Histopathological examination revealed elastotic changes in the dermis, consistent with photoaging, and pigmentary alterations contributing to the citrine appearance.

Implications:

• This case highlights the importance of considering drug-induced photosensitivity, even in pediatric patients.
• Clinicians should be aware of Phenergan's potential to cause photoallergic reactions, necessitating careful patient counseling regarding sun exposure.
• The findings underscore the need for further investigation into the mechanisms of drug-induced photoaging and pigmentary changes.