Buildup of excessive keratin due to chronic exposure to sunlight on sunexposed sites face, arms, dorsum of hands called actinic cheilitis in lips may become invasive with only a single layer of atypical keratinocytes risk factors. A 52yearold man experienced a pruritic and erythematous eruption on his face, neck, upper chest, and arms. Many patients also have multiple contact allergens. Jul 31, 20 dermatopathology reference describes actinic reticuloid histopathology including histologic features and provides links to additional medical references. Objective abnormal photosensitivity to ultraviolet b uvb and often uva and visible light is an essential component of the syndrome.
Chronic actinic dermatitis an overview sciencedirect topics. Chronic actinic dermatitis article about chronic actinic. Actinic means caused by sun and dermatitis which is. In the meantime, i have been reading about this condition and i do not have the rash. It is characterised by severely itchy, red, inflamed, and thickened dry skin, mainly in areas that have been exposed to sunlight or artificial light. Histopathology, patch testing and photoaggravation testing were also performed. Clinical features and histological findings of 17 patients with chronic actinic dermatitis. Diagnostic criteria were laid down about 20 years back, but clinical features are the mainstay in diagnosis.
Chronic actinic dermatitis cad comprises a broad range of abnormal reactions of the skin to ultra violet or other visible light radiation. 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. 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. The natural history of chronic actinic dermatitis allergy and. Chronic actinic dermatitis definition of chronic actinic. The reactions cause inflammation, sunburns and occur on sensitized skin, where the sensitizers could be both external and internal agents.
Based on clinical examination histology chronic eczema with or without lymphoma like changes. The lesions of cad are characterized as a widespread eczematous eruption with scale, lichenification, and infiltrated plaques occurring on sunexposed skin. Chronic actinic dermatitis with leonine facies and iatrogenic. The histopathologic features in the early stages are comparable to contact dermatitis. My doctors have declared a working diagnosis meaning guess of chronic actinic dermatitis, although i do not fit the typical profile of middleaged to elderly male. The term chronic actinic dermatitis is being used increasingly for this group of chronic photodermatoses. Photobiologic reduction in med of uvb, uva on normal skin.
Reduction in the minimal erythema dose med to both uvb and. Provide a patient information leaflet on chronic actinic dermatitis. Chronic actinic dermatitis is a chronic photodermatosis that occurs most commonly in men in their 60s and 70s. Patients often suffer from other related conditions of the skin that cause dermatitis in response to a variety of stimuli e. The term actinic keratosis can be literally understood as a disorder of epidermal keratinocytes that is induced by ultraviolet uv light exposure. Chronic actinic dermatitis is a persistent photodermatitis, likely resulting from a delayed hypersensitivity reaction. Chronic actinic dermatitis is a rare skin condition that mainly affects men over the age of 50 years. Photosensitive atopic dermatitis exacerbated by uvb exposure. What is chronic actinic dermatitis chronic actinic dermatitis is a rare skin condition that mainly affects men over the age of 50 years.
Chronic acquired dyskeratotic papulosis of the face mdedge. The skin becomes photosensitive and reacts after the exposure of light. Photosensitive atopic dermatitis exacerbated by uvb. Chronic actinic dermatitis a study of clinical features somani vk. A variety of skin responses to ultraviolet irradiation in patients with atopic dermatitis. Chronic actinic dermatitis primary care dermatology society. Results had been positive for spongiosis with exocytosis. In this study, we characterize the histopathologic and immunohistochemical. The characteristic atopic reaction to patch tests with human dander and the naturally occurring lesions of the disease atopic dermatitis resemble each other grossly in the occurrence of papules, papulovesicles, redness and slight desquamation and in their chronologic development and retrogression. 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.
It is characterised by severely itchy, red, inflamed, and thickened dry skin due to exposure to ultraviolet radiation and frequently also visible light from the sun or artificial lighting. Diagnosis and treatment of chronic actinic dermatitis. Chronic actinic dermatitis primary care dermatology. Abnormal photosensitivity to ultraviolet uv and often visible radiation is a feature. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology. Radiation dermatitis is most directly related to increased dose inhomogeneity, which itself is a function of increasing breast size or chest wall diameter. Older men appear to be most susceptible, and the condition leads to marked photosensitivity, with signs demonstrable after exposure to ultraviolet light even lower than the minimal erythema dose. A vietnam veteran who had been exposed to agent orange presented with a 28year history of a papulonodular disease mainly affecting the face. Chronic actinic dermatitis an overview sciencedirect. Chronic actinic dermatitis a study of clinical features. The condition is also known as chronic photosensitivity. Results from two biopsies will be available next week. Actinic reticuloid persistent light reactors photosensitivity dermatitis and eczema diagnosis.
Chronic actinic dermatitis cad, an idiopathic photosensitive dermatosis, is an eczema of the exposed areas induced by uvb. Actinic dermatitis definition of actinic dermatitis by. It occurs in patients of all ethnic groups, but in the united states, it is more commonly seen in darkskinned individuals. The photosensitivity dermatitis and actinic reticuloid syndrome chronic actinic dermatitis occurring in seven young atopic dermatitis patients. Chronic actinic dermatitisa study of clinical features.
Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology reference and guide. Chronic radiation dermatitis shows dermal sclerosis, elastosis and vascular ectasia overlying an epidermis which is often hyperkeratotic figure 1. Actinic dermatitis article about actinic dermatitis by. Chronic actinic dermatitis cad is a condition in which the skin becomes inflamed, particularly in areas that have been exposed to sunlight or artificial light. These growths are more common in fairskinned people and those who are frequently in the sun. Chronic actinic dermatitis cad, previously photosensitivity dermatitisactinic reticuloid pdar syndrome, is a chronic dermatitis sometimes with pseudoreticuloid features predominantly of photoexposed sites. Radiation dermatitis presents at the site of previous radiotherapy for cancer or following accidental exposure to radiation. Chronic actinic dermatitis cad is a severe, socially disabling and intractable photosensitive disorder particularly affecting elderly men. 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. Patients one hundred seventyeight patients with chronic actinic dermatitis.
Histopathological findings usually show eczematous appearance but. Perelman department of dermatology, new york university abstract. Chronic actinic dermatitis has been described in european, american, and asian populations. Chronic actinic dermatitis a study of clinical features core. Histopathology four patients had skin biopsies taken from areas of existing dermatitis. The lesions of cad are characterized as a widespread eczematous eruption with scale, lichenification, and. Results had been positive for spongiosis with exocytosis, acanthosis, dyskeratotic keratinocytes, and marked incontinence of pigment, which together are suggestive of a previously unreported clinical entity that we. Chronic actinic dermatitis also known as actinic reticuloid, chronic photosensitivity dermatitis, persistent light reactivity, and photosensitive eczema. 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. Actinic dermatitis is dermatitis due to exposure to the sun. It affects both genders and most often affects elderly men.
Patients often suffer from other related conditions of the skin that. Lumican as a novel marker for differential diagnosis of bowen disease and actinic keratosis. Comparison of demographic and photobiological features of chronic actinic dermatitis in patients with lighter vs darker skin types. 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. 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. Chronic acquired dyskeratotic papulosis of the face. Multiple biopsies of both fresh and mature papulonodules had been performed for routine histopathology and electron microscopy. Older men appear to be most susceptible, and the condition leads to marked photosensitivity, with signs demonstrable after exposure to ultraviolet light even lower than the.
Acute, subacute or chronic spongiotic dermatitis in acute lesions, there is focal, usually mild, spongiosis with overlying scale crust containing a few neutrophils. Chronic actinic dermatitis cad is a severe photosensitivity disease. Cad must be differentiated from photocontact allergy and airborne dermatitis. The natural history of chronic actinic dermatitis allergy. Chronic actinic dermatitis is a rare skin disease that mainly affects middleaged and elderly men. Chronic actinic dermatitis lesley clarkloeser md dermatology online journal 94.
Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a dermatitis andor a pseudolymphomatous eruption. For phototesting, and possibly patch testing some of these patients will have an airbourne. Ten patients had acute dermatitis and six had chronic dermatitis. It occurs mostly in people who are allergic to sensitizers, such. Chronic actinic dermatitis cad, one of the immune mediated photodermatoses, comprises a spectrum of conditions including persistent light reactivity, photosensitive eczema and actinic reticuloid. Chronic actinic dermatitis cad is a chronic photodermatosis commonly affecting patients with skin of color.
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. Clinical findings, histopathologic features, and phototests were consistent with a diagnosis of chronic actinic dermatitis. Spongiotic dermatitis may be a feature of eczema, atopic dermatitis, seborrheic dermatitis, and other allergic skin reactions. Chronic actinic dermatitis cad is a photosensitivity disorder defined by a persistent eczematous reaction of 3 months or greater duration on sun. Cad is considered a chronic complaint as it usually lasts for several years. Actinic keratosis ak, sometimes called solar keratosis or senile keratosis, is a precancerous area of thick, scaly, or crusty skin. Histopathology consistent with chronic eczema with or without lymphoma like changes, and. Chronic actinic dermatitis cad is the term first proposed in 1979 by hawk and magnus to unify the conditions known as persistent light reactivity described by wilkinson in 1961, actinic reticuloid described by ive et al. The histologies of acute ap and polymorphous light eruption ple. Key differences identified between actinic keratosis and cutaneous squamous cell carcinoma by transcriptome profiling. Provide a patient information leaflet on uv protection for more information on sunscreen, including the dundee formulation, refer to the related chapter on photodermatoses. Fair skin, ionizing radiation, hydrocarbon or arsenic exposure, renal transplant variants. Chronic actinic dermatitisactinic reticuloid request pdf. Actinic prurigo ap is an idiopathic familial photodermatosis seen in american indians.
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. In addition to extreme sensitivity to uvb, uva andor visible light, about. Lim, in goldmans cecil medicine twenty fourth edition, 2012. Clinical features and histological findings of 17 patients with. Studies from europe reported that most patients also have allergic contact dermatitis, 36 although this has been detected in a lower proportion in a north american series. The characteristic atopic reaction to patch tests with human dander and the naturally occurring lesions of the disease atopic dermatitis resemble each other grossly in the occurrence of papules, papulovesicles, redness and slight desquamation and in. Chronic actinic dermatitis cad, previously photosensitivity dermatitis actinic reticuloid pdar syndrome, is a chronic dermatitis sometimes with pseudoreticuloid features predominantly of photoexposed sites. Radiation dermatitis an overview sciencedirect topics. Cad is chronic, that is to say it typically persists for a number of years. That is why it is also known as chronic actinic dermatitis, photosensitive dermatitis, photo sensitive eczema or persistent light reactivity.
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