"Actinic Reticuloid": A Chronic Dkhmatosis Associated With Severe Photosensitivity and the Histological Resemblance to Lymphoma

Abstract

Ten elderly male patients with severe persistent photosensitivity of unknown cause are described. The clinical presentation was that of an intense eczematous eruption affecting exposed sites but spreading elsewhere. Frequent episodes of erythroderma were characteristic and in some cases the marked thickening and ridging of the exposed skin simulated a lymphoma. In contrast to most other photodermatoses the photosensitivity extended through the u.v. to the visible spectrum. A wide range of histological changes were noted, in several instances closely resembling lymphoma because of the intensity and pleomorphisni of the infiltrate.OUR purpose is to describe a group of elderly male patients wlio developed chronic ])hotosensitivit3^ which, when the clinical changes were severe, suggested lymphoma. Additional features were the severity and wide spectral range of the photosensitivity and the intense dermal intiltrate whieh often showed a histologieal resemblance to retieulosis.Similar instances of photosensitivity inducing lymphoma-Iike reactions do not seem to have been described in detail previously and are not mentioned among the eommon patterns of ])hotosensitivity reviewed by Kesten and Slatkin (1953). However. Lamb and colleagues (1057) recorded 3 eases of photosensitivity in which the histological intiltrate showed retieular eells, plasma cells and eosinoi)hils and simulated '' lymplioblastoma ". Andrews and Domonkos (1963) also noted a similar instance. Wiskemann (196S) has kindly drawn our attention to 2 patients whom he has studied. Tliey, it seems, bear a elose resemblance to the patients we describe here and bad reticulosis-like reactions provoked by longwave u.v.r. and visible light (Meinhof, 1962; Wiskemann, 19r>5).

Development of Cutaneous Pseudolymphoma Following Ciclosporin Therapy of Actinic Reticuloid

“…Actinic reticuloid (AR) is a rare, chronic dermatosis characterized by redness and pronounced edema of light-exposed skin ac companied by severe itching [10]. This case report shows a dramatic clinical effect of CS in AR, but an ensuing development of a pseudolymphoma in the skin and later lym phoma.…”

Histologic mimickers of mycosis fungoides: a review

“…Cases of chronic actinic dermatitis have been reported which show very little spongiosis, Pautrier-like microabscesses and possible atypical hyperchromatic cells with cerebriform nuclei, thus resembling lymphoma. 17,18 Ultimately, acanthosis, papillary dermal changes similar to lichen simplex chronicus (thickened papillary dermis with vertically oriented coarse collagen bundles parallel to the rete ridges), stellate multinucleated fibroblasts and thickened and increased blood vessels aid in differentiation from CD81 variants of MF and aid in making the correct diagnosis of actinic reticuloid. The lymphocytes are most often CD81, 19 allowing for distinction from MF, which is generally CD41.…”

Successful Treatment of Recalcitrant Chronic Actinic Dermatitis with Tacrolimus

“…In 1961, Wilkinson [10]introduced the expression ‘persistent light reaction’ for photo-allergic contact dermatitis persisting without further allergen exposure. Ive et al [11]introduced the term ‘actinic reticuloid’ in 1967, describing a severe photo-induced dermatitis of older men with reduced thresholds for UVA, UVB and visible light associated with multiple type IV sensitizations. However, avoidance of allergens does not result in clearance of skin eruptions if UV exposure continues.…”