Solar urticaria is an uncommon condition characterized by erythema and whealing shortly after exposure to ultraviolet (UV) and/or visible light. We report a 25-year-old woman with an erythematous, edematous, pruritic reaction minutes after sun exposure while she was taking terbinafine for onychomycosis. Phototesting revealed a UVB-sensitive urticarial reaction, confirming the diagnosis of solar urticaria. This report describes the first patient with possible terbinafine-associated solar urticaria.

Excessive sun exposure is known to be the leading cause of skin cancer. The direct cellular damage inflicted by the ultraviolet (UV) radiation from the sun results in premature aging, DNA damage, and mutations that ultimately lead to skin cancer. Sunscreens are highly recommended to protect against UV radiation. However, little research has been conducted on the economic burden of sunscreen use. In this study, we aimed to evaluate the annual cost of sunscreen under both ideal and actual use conditions while stratifying for the sun protection factor (SPF) and by the name brand or equivalent store brand sunscreen. Pricing data was collected for sunscreens of SPF 30, 50, 70, and 100. For each type of sunscreen, the size and price of the container were recorded. Our results demonstrated that sunscreen prices increased with SPF but purchasing a generic sunscreen resulted in savings of 40%-50%. Our estimates reveal that sunscreens are affordable with annual expenditures ranging from $30.21 to $61.94, depending on brand, for SPF 50 sunscreens used with minimal application density for the average person.

We present a 17-year-old boy who developed a generalized urticarial eruption, malar rash, fever, and arthralgia within one week of initiating minocycline therapy for acne. His workup showed positive antinuclearand anti-histone antibodies. His symptoms quickly resolved after discontinuing minocycline and starting oral prednisone. We believe the constellation of his symptoms, laboratory findings, and temporalassociation of minocycline initiation was suggestive of minocycline-induced lupus. Unique to this case is that his urticarial presentation was so striking that it could have been initially regarded as drug induced urticaria without considering drug-induced lupus. Since minocycline is so widely prescribed for acne among the dermatology community, we believe that it is important for dermatologists to be aware of this alternative clinical presentation of minocyclineinduced lupus.