Pain, swelling and irritability in the sun: what is the diagnosis?
Sinead Mary McGlacken-Byrne1, Lisa Dann2, Annette Murphy3
1Department of Paediatrics, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland sineadmcglackenbyrne@gmail.com.
Insights
Children experiencing severe hand pain and swelling after sun exposure may have a rare condition. This reaction, often misdiagnosed, highlights the need for accurate diagnosis of sun-induced pediatric symptoms.
Area of Science:
- Pediatric Dermatology
- Environmental Medicine
Background:
- Recurrent episodes of swelling and pain in children following sun exposure are uncommon.
- Previous cases suggest a link between sunlight and these symptoms, but the exact cause remains unclear.
Observation:
- Two pediatric cases presented with severe burning pain and swelling of hands and face/upper limbs after sun exposure.
- Symptoms included hand swelling, facial edema, and limb edema, with a history of similar summer episodes since early childhood.
- Children exhibited distress, irritability, and hand-flapping behaviors during symptomatic periods.
Findings:
- Standard treatments like oral steroids and antihistamines were ineffective in both cases.
- Routine investigations and imaging (limb radiograph) showed no abnormalities, ruling out common causes of swelling.
- The consistent pattern of symptoms following sun exposure points towards a specific, likely non-inflammatory, reaction.
Implications:
- This suggests a potential diagnosis of a sun-induced, non-allergic reaction in children, possibly a form of solar urticaria or a related photodermatosis.
- Accurate diagnosis is crucial to avoid ineffective treatments and manage patient and parental anxiety.
- Further research is needed to understand the pathophysiology and develop targeted treatments for this condition.
Abstract:
A 7-year-old boy presented with a 24-hour history of severe burning pain affecting both hands that had started within minutes of playing outdoors. His mother reported that he had been running his hands under cold water and shaking his hands and head to try and relieve the pain. On examination, there was swelling of his hands, eyelids and cheeks. His parents mentioned that his hands and face had 'swollen in the sun' every summer from the age of 2 years.A 3-year-old girl presented with a 2-day history of left upper limb swelling following a day of prolonged sun exposure. Examination revealed non-pitting oedema extending from her left shoulder to hand with no associated tenderness, erythema or rash. Her mother reported six previous episodes of irritability following sun exposure during which she would cry and flap her hands 'for hours'.Oral steroids and antihistamines were prescribed in both cases with little effect. Findings of routine baseline investigations were normal in both cases. A radiograph of the upper limb in the second patient disclosed nothing abnormal.
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