Diagnosis and treatment of chronic actinic dermatitis

Abstract

Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a dermatitis and/or a pseudolymphomatous eruption. Abnormal photosensitivity to ultraviolet (UV) and often visible radiation is a feature. Many patients also have multiple contact allergens. Histopathologic features vary, with a spectrum from mild dermatitis to pseudolymphomatous (reticuloid) features. The essential tests to make the diagnosis and to guide advice on avoidance of the responsible wavelengths and any contact allergens are phototesting and patch testing. Chronic actinic dermatitis can be regarded as a disorder of increased susceptibility, for reasons that remain uncertain, to develop delayed-type allergic responses to both endogenous photoallergens and exogenous allergens. Treatment consists of detailed advice on sunlight and allergen avoidance (guided by the results of investigations), topical corticosteroids, and emollients. When these measures are insufficient alone, systemic immunosuppressives may be considered: systemic prednisolone for acute exacerbations or azathioprine if systemic treatment is required for more than a few weeks.

Azathioprine in dermatology: The past, the present, and the future

“…128,[145][146][147][148][149][150] Some consider it the first choice for long-term immunosuppression of this condition. 151 Azathioprine has also been reported to be helpful in severe polymorphous light eruption. 152 Other uses Azathioprine has been reported to be successful not only in immunobullous, photodermatotic, and eczematous diseases but also in a number of other severe or recalcitrant conditions.…”

Chronic Actinic Dermatitis/Actinic Reticuloid

“…22,32 Dawe et al 7 found that it is estimated that the probability of resolution is 10% over 5 years, 20% over 10 years, and 50% over 15 years. 22,32 Dawe et al 7 found that it is estimated that the probability of resolution is 10% over 5 years, 20% over 10 years, and 50% over 15 years.…”

Evaluation of narrow band ultraviolet B phototherapy in the treatment of chronic actinic dermatitis in Chinese patients

“…Many patients also have multiple contact allergens (Dawe, Crombie, & Ferguson, 2000). Current management for CAD includes broad-spectrum sunscreens, physical protection from sunlight, allergen avoidance, topical corticosteroids and tacrolimus, systemic corticosteroids and immunosuppressive agents such as azathioprine, cyclosporine, and mycophenolate mofetil, and photo(chemo)therapy (Dawe & Ferguson, 2003;Forsyth & Millard, 2010;Ma & Lu, 2010). Current management for CAD includes broad-spectrum sunscreens, physical protection from sunlight, allergen avoidance, topical corticosteroids and tacrolimus, systemic corticosteroids and immunosuppressive agents such as azathioprine, cyclosporine, and mycophenolate mofetil, and photo(chemo)therapy (Dawe & Ferguson, 2003;Forsyth & Millard, 2010;Ma & Lu, 2010).…”