Chronic actinic dermatitis

Last Updated: 2019-08-27

Author(s): -

Hawk & Magnus 1979

CAD, persistent light reaction, persistent light reaction, photosensitive eczema, actinic reticuloid, chronic photosensitive dermatitis, chronic persistent photosensitivity, photosensitive eczema.

Dermatitis caused by chronic UV exposure.

Very rare.

Men > Women.

Usually occurring in middle to older age.

Subtypes:

  • Persistent light reaction
  • Actinic reticuloid
  • chronic photosensitive dermatitis,
  • Photosensitive eczema
  • Photoagraved atopic dermatitis

In persistent stimulus, photoallergic dermatitis, contact dermatitis, atopic eczema or mycosis fungoides develop chronic persistent photosensitivity, which leads to chronic actinic dermatitis. From this point on, electromagnetic radiation alone (for photoallergic dermatitis UV-A is particularly important, in the further course for chronic actinic dermatitis then UV-B) can be sufficient for the progression of the disease.

Erythematic, lichenified, discreetly scaly areas in the area of UV-exposed areas. Secondary scattering phenomena may occur.

Medical history

Clinic

Biopsy

TCR PCR for clonality determination

Photoprovocation testing

Areas exposed to light, especially face.

Hyper(para)keratosis, acanthosis, spongiosis.

UV protection

  • Calcineurin inhibitors
    • Tacrolimus
      • Protopic® Ointment 0.1% 2x daily 2 weeks
    • Pimecrolimus 
      • Elidel® cream 1% 2x daily for 2 weeks
  • Systemic glucocorticoids
    • Prednisolone (Spiricort®) p.o. 0.5-1.0 mg/kg/d, in creeping application Frequency
  • Azathioprine (Imurek®) p.o. 1x daily
    • Initial: 1-3 mg/kg bw
    • Course: Reduction by approx. 0.5 mg/kg bw to the lowest still effective Dosage.
    • CAVE: If allopurinol is administered simultaneously, a reduction of the azathioprine dose to ¼ is indicated.
    • Prior to this, a thiopurine methyltransferase deficiency is excluded.
  • Ciclosporin (Sandimmun®) p.o. 3-5 mg/ kg bw daily
    • To be taken independently of meals
  • PUVA