Urticária solar refratária ao tratamento padrão: relato de caso e breve revisão da literatura
Solar urticaria refractory to standard therapy: a case report and brief literature review
Nicole Dominique Schayman Pino; Cláudia Soïdo Falcão Do Amaral; Kleiser Aparecida Mendes; Rejane Martins De Freitas Oliveira; Elaine Silva Oliveira; Maria Teresa Grabowsky Seiler; Janete Raad Rigolon; Mônica Ribeiro Oliveira; Bianca Victória De Oliveira Martins
Resumo
A urticária solar é uma urticária crônica induzida, física e rara, que causa lesões cutâneas e sensação de prurido, ardência ou ambos, minutos após a exposição solar, interferindo sobremaneira na qualidade de vida dos pacientes. O mecanismo fisiopatológico provável é a ativação e degranulação de mastócitos por ligação de IgE específica a um fotoalérgeno ativado por um determinado comprimento de onda do espectro luminoso. O quadro clínico persiste enquanto a exposição for mantida, e, na dependência da intensidade e duração da exposição, ele pode ser leve e localizado, ou grave e generalizado, como anafilaxia. O tratamento da urticária solar baseia-se na prevenção à exposição à luz solar, (roupas protetoras e uso de fotoprotetores), anti-histamínicos H1 de segunda geração e, em determinados casos, fototerapia, imunossupressores ou imunobiológicos. O anticorpo monoclonal anti-IgE omalizumabe, aprovado para tratamento da urticária crônica espontânea, tem sido indicado para o tratamento de urticárias induzidas, como a urticária solar, refratárias às terapias de primeira e segunda linhas. Relatamos o caso de uma paciente com urticária solar que não respondeu ao uso de anti-histamínicos H1 em doses quadruplicadas e a evolução favorável com o uso de omalizumabe, assim como uma breve revisão da literatura.
Palavras-chave
Abstract
Solar urticaria is a rare, physically induced chronic urticaria that causes skin lesions and a sensation of itching, burning, or both within minutes of sun exposure, greatly interfering with patients’ quality of life. The probable pathophysiological mechanism involves mast cell activation and degranulation by the binding of specific IgE to a photoallergen activated by a particular wavelength of the light spectrum. Clinical manifestations persist as long as exposure continues and may range from mild, localized reactions to severe, generalized presentations, such as anaphylaxis, depending on the intensity and duration of exposure. The treatment of solar urticaria is based on avoidance of sun exposure (protective clothing and sunscreen use), administration of second-generation H1 antihistamines, and, in selected cases, phototherapy, immunosuppressant agents, or biologic therapies. The anti-IgE monoclonal antibody omalizumab, approved for the treatment of chronic spontaneous urticaria, has been indicated in cases of inducible urticaria, such as solar urticaria, refractory to first- and second-line treatments. We report the case of a patient with solar urticaria who did not respond to quadruple-dosed H1 antihistamines and showed a favorable clinical response to omalizumab, followed by a brief review of the literature.
Keywords
References
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Submitted date:
05/29/2025
Accepted date:
07/28/2025
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