Severe chronic actinic dermatitis treated with cyclosporine: 2 cases

INTRODUCTION: The treatment of the severe forms of photodermatoses often requires potent systemic immunosuppressive drugs. We report two patients suffering from severe photodermatitis successfully treated with oral cyclosporine. CASES REPORT: A 58-year-old man developed severe pruritic eczematous reactions for several years on light-exposed and light-protected skin following each sun exposure. A 66-year-old man showed similar lesions restricted to the head and neck. The clinical presentation and evolution as well as histologic, immunohistologic, allergologic and photobiologic assessments suggested the diagnosis of actinic reticuloid and persistent light reactivity, respectively. The lesions of both patients did not respond to a high dose regimen of systemic corticosteroids (methylprednisolone 1 mg/kg/day) for several weeks. The severity of cutaneous lesions and pruritus required another potent immunosuppressive treatment. Oral cyclosporine at the maximum daily dose of 4 mg/kg was given for three months. A rapid improvement of the pruritus and skin lesions occurred in the two patients, without significant side-effect. The first patient experienced recurrent lesions after termination of cyclosporine treatment during summer time. The other patient did not develop new skin eruption for 3 years after stopping the initial treatment with cyclosporine. DISCUSSION: Low-dose oral cyclosporine is a quick-acting and well tolerated symptomatic treatment of severe photodermatoses resistant to other systemic immunosuppressive drugs. However, therapeutic results do not consistently exhibit long-standing remanent effect.