Studies from europe reported that most patients also have allergic contact dermatitis, 36 although this has been detected in a lower proportion. Treatment is not standardized and involves topical corticosteroids and immunomodulators, and systemic immunosuppressive agents. It is characterized by persistent redness of the face and other exposed areas. It is not well recognised that chronic actinic dermatitis may be exacerbated by light in the visible spectrum. Rarely, spread of the exanthema to uvprotected areas of skin and even erythroderma with palmoplantar hyperkeratosis occurs.
Efficacy and safety of azathioprine in chronic actinic dermatitis j pak assoc dermatol 2010. The prognosis for the associated contact allergic dermatitis is even worse, with some predicting chronic actinic dermatitis. Chronic actinic dermatitis associated with adult tcell leukemia. Chronic actinic dermatitis cad is an idiopathic photodermatosis defined as a persistent eruption of generally eczematous rash possibly associated with infiltrated papules and plaques predominantly affecting the exposed skin and a histopathology consistent with chronic eczema with or without lymphoma like changes associated with a reduction in minimal erythema dose. Chronic actinic dermatitis also known as actinic reticuloid, chronic photosensitivity dermatitis, persistent light reactivity, and photosensitive eczema. Chronic actinic dermatitis cad, one of the immune mediated photodermatoses, comprises a spectrum of conditions including persistent light reactivity, photosensitive eczema and actinic reticuloid. In our previous study period 19871992, the most prominent contact allergen was the sesquiterpene lactone mix 36% of patients with. Chronic actinic dermatitis website was set up to provide quality information about all the aspects of cad, with highly informative articles. What is chronic actinic dermatitis chronic actinic dermatitis is a rare skin condition that mainly affects men over the age of 50 years. Chronic actinic dermatitis is being increasingly diagnosed at this large urban medical center. Chronic actinic dermatitis cad is an uncommon photosensitive disorder, which occurs predominantly in elderly men. It is characterised by severely itchy, red, inflamed, and thickened dry skin, mainly in areas that have been exposed to sunlight or artificial light.
Cad is chronic, that is to say it typically persists for a number of years. Chronic actinic dermatitis definition of chronic actinic. Surgical management of chronic actinic dermatitis journal of. Chronic actinic dermatitis cad is persistent light reactivity encompassing actinic reticu loid and photosensitive eczema. Chronic actinic dermatitis is a chronic photodermatosis that occurs most commonly in men in their 60s and 70s. Patients with chronic actinic dermatitis cad, 1 also known as the photosensitivity dermatitis and actinic reticuloid syndrome, 2 are abnormally photosensitive to uv uvb and uva and often visible wavelengths. We describe an unusual case of chronic actinic dermatitis exacerbated by a tungsten lamp, which emits light in the visible spectrum. Perelman department of dermatology, new york university abstract. Chronic actinic dermatitis lesley clarkloeser md dermatology online journal 94. A 71yearold man presented with a sixyear history of a pruritic, erythematous, blistering eruption of the face, chest, and arms.
Its appearance resembles severe allergic contact dermatitis acd with pruritic, eczematous papules and. The term chronic actinic dermatitis or cad is used to describe a particularly severe form of eczema in which sensitivity to light is the main feature photosensitivity. Chronic actinic dermatitis cad, one of the immune mediated. Abnormal photosensitivity to ultraviolet uv and often visible radiation is a feature. Azathioprine as corticosteroid sparing drug in chronic actinic dermatitis. In addition to extreme sensitivity to uvb, uva andor visible light, about. Chronic actinic dermatitis primary care dermatology.
Chronic actinic dermatitis alexandria v booth md, stephanie mengden md, nicholas a soter md, david cohen md, mph dermatology online journal 14 5. The intellectual artifact termed chronic actinic dermatitis cad based on the unifying concept of a hypothetical endogenous photoallergen 1 denies the essentially clinical nature of history taking, physical examination, and patch testing in the diagnosis and prevention of contact dermatitis. Diagnosis and treatment of chronic actinic dermatitis dawe 2003. Patients often suffer from other related conditions of the skin that cause dermatitis in response to a variety of stimuli e. Chronic actinic dermatitis canadian medical association. Actinic dermatitis definition of actinic dermatitis by. Lecture 6 actinic keratosis and atopic dermatitis meyers cs. Diagnosis is based on clinical, histopathologic, and photobiologic features. In addition to extreme sensitivity to uvb, uva andor visible light.
Chronic actinic dermatitis cad, an immune mediated photodermatosis, comprises of persistent light reactivity, actinic reticuloid, photosensitive eczema and. Chronic actinic dermatitis journal of cutaneous medicine and. However, evidence from recent studies suggests that some demographics of cad patients may be changing. A clinical study of 15 cases in northern taiwan tzulin hsiao, chiayu chu department of dermatology, national taiwan university hospital and national taiwan university college of medicine, taipei, taiwan. Chronic actinic dermatitis actinic reticuloid cadar is an eczematous hypersensitivity reaction to ultraviolet rays that can vary from mild eczematous cases to ar, the most severe cases which may resemble cutaneous tcell lymphoma. Chronic actinic dermatitis cad is a persistent, ultraviolet uv radiationinduced eczema by either uva, uvb or visible. Chronic actinic dermatitis cad is an immunologically mediated photodermatosis characterized by pruritic eczematous and lichenified plaques located. Objectiveto determine the prognosis for resolution of abnormal cutaneous photosensitivity in patients with chronic actinic dermatitis also known as the photose.
Chronic actinic dermatitis is a difficult to treat photodermatitis. Chronic actinic dermatitis actinic reticuloid cadar is an eczematous hypersensitivity reaction to ultraviolet rays that can vary from mild eczematous cases to ar, the most severe cases which. In extreme cases exposure to light in as little as 30 seconds will cause a reaction. Pdf chronic actinic dermatitis with leonine facies and. Chronic actinic dermatitisactinic reticuloid cadar is an eczematous hypersensitivity reaction to ultraviolet rays that can vary from mild eczematous cases.
Chronic actinic dermatitis is often associated with sensitivity to uv light. Chronic actinic dermatitis cad is an uncommon inflammatory dermatosis characterized by dermatitis involving ultraviolet uv lightexposed skin with notable sparing of sunprotected areas. According to its creators, the conditions persistent light reactivity. We are a participant in the amazon services llc associates program, an affiliate. Chronic actinic dermatitis a study of clinical features. Chronic actinic dermatitis cad is a photosensitivity disorder defined by a persistent eczematous reaction of 3 months or greater duration on sunexposed body parts, abnormally low phototest. To update readers on the current understandings of chronic actinic dermatitis cad in regard to epidemiology, clinical findings, pathophysiology, treatment, and prognosis. Chronic actinic dermatitis cad, an idiopathic photosensitive dermatosis, is an eczema of the exposed areas induced by uvb, sometimes uva, and occasionally visible light. Contact and photocontact sensitization in chronic actinic. Tofacitinib citrate for the treatment of refractory. Lecture 6 actinic keratosis and atopic dermatitis meyers. In some patients, chronic actinic dermatitis clears after a long time, but it tends to remain unresolved in 80% patients, even 10 years after diagnosis.
The term chronic actinic dermatitis cad was first coined by hawk and magnus and is a unifying label encom passing the conditions of photosensitive eczema, photo sensitivity dermatitis, persistent light reaction, and actinic reticuloid. Chronic actinic dermatitis cad is one of the most frequently encountered photodermatoses in patients older than 50 years of age. Chronic actinic dermatitis cad is a persistent eczematous photodermatitis classically described in older, white men with contact allergy to plants. Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a dermatitis andor a pseudolymphomatous eruption. We report four cases of chronic actinic dermatitis cad occurring in middleaged men with significant outdoor exposure. It occurs in patients of all ethnic groups, but in the united states, it is more commonly seen in darkskinned individuals. The natural history of chronic actinic dermatitis allergy and. Chronic actinic dermatitisactinic reticuloid cadar is an eczematous hypersensitivity reaction to ultraviolet rays that can vary from mild eczematous cases to ar, the most severe cases which may resemble cutaneous tcell lymphoma. We present a case with partial response to dupilumab, a monoclonal antibody approved for atopic dermatitis. Chronic actinic dermatitis an overview sciencedirect. A 52yearold man experienced a pruritic and erythematous eruption on his face, neck, upper chest, and arms. A case report of therapeutically challenging chronic. Cad is considered a chronic complaint as it usually lasts for several years. Patients with chronic actinic dermatitis cad frequently have positive patch or photopatch tests.
Objective abnormal photosensitivity to ultraviolet b uvb and often uva and visible light is an essential component of the syndrome. Many patients also have multiple contact allergens. Chronic actinic dermatitisa study of clinical features. Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a.
Cad is classically thought to be primarily a disease of elderly caucasian males, though recent evidence suggests that in skin of color, the disease manifests more often in younger females. Chronic actinic dermatitis a study of clinical features somani vk. The term chronic actinic dermatitis or cad is used to describe an unusual type of eczema or dermatitis that is caused by abnormal skin sensitivity to sunlight photosensitivity. Chronic actinic dermatitis cad is one of the previously socalled idiopathic photodermatoses, now preferably called autoimmune photodermatoses. Diagnostic criteria were laid down about 20 years back, but clinical features are the mainstay in diagnosis. Chronic actinic dermatitis is an immunemediated reaction to sun or artificial light, often accompanied by contact allergies.
Chronic actinic dermatitis with leonine facies and iatrogenic adrenal insufficiency successfully treated with topical tacrolimus. Diagnosis and treatment of chronic actinic dermatitis. Chronic actinic dermatitis cad is a severe form of eczema in which either natural sunlight or artificial light uv is the main causal factor, thus individuals with cad are very sensitive to light. Chronic actinic dermatitis chronic actinic dermatitis cad is one of the most frequently encountered photodermatoses in patients older than 50 years of age. Chronic actinic dermatitis cad is classically described in older, white men, although increasing reports describe younger patients with darker skin types, particularly south asians. Cad is characterised by chronic eczema, which is usually severe, is accentuated in lightexposed sites, and persists all year but is worse in summertime. It primarily affects men older than 50 years and is characterized by pruritic eczematous and. Actinic dermatitis is dermatitis due to exposure to the sun.