慢性光化性皮炎的组织病理变化

对５１例慢性光化性皮炎（ＣＡＤ）５７个皮肤活检标本的组织病理变化进行了分析，结果表明其组织病理变化呈多形性，为迟缓性变态反应，自早期或活动期的湿疹样皮炎至晚期皮肤Ｔ细胞淋巴瘤样谱系改变。上述不同组织病理变化与同一标本石蜡包埋块中异倍体或二倍体的发现无明显关系，但ＣＡＤ与皮肤恶性淋巴瘤（ＣＭＬ）皮损石蜡包埋块中异倍体的发生率相似，表明ＣＡＤ与ＣＭＬ有某些类同或相关联。     

慢性光化性皮炎1例

临床资料患者,男,61岁。主因头面、四肢出现红斑、丘疹伴瘙痒2年加重2个月,于2007年7月来我院就诊。患者2年前额顶部出现数粒黄豆大小散在红色斑疹、丘疹,伴瘙痒,后皮疹渐增多,部分融合成片,波及颈项、躯干及四肢,以曝光部位为主,日晒后加重,冬轻夏重,于外院诊断为"泛发性湿疹",予抗炎抗过敏治     

PUVA therapy of chronic actinic dermatitis

Four men with long-standing chronic actinic dermatitis were treated with a modified PUVA regime which initially included generalized applications of topical steroids given immediately after PUVA exposure. All patients are now free of rash, no longer need protection from UV radiation, and are being maintained on twice monthly PUVA therapy (IO J/cm2).     

Tungsten lamp and chronic actinic dermatitis

Chronic actinic dermatitis is often associated with sensitivity to UV light. It is not well recognised that chronic actinic dermatitis may be exacerbated by light in the visible spectrum. We describe an unusual case of chronic actinic dermatitis exacerbated by a tungsten lamp, which emits light in the visible spectrum.     

The photosensitivity dermatitis and actinic reticuloid syndrome (chronic actinic dermatitis) occurring in seven young atopic dermatitis patients

Seven young patients with atopic dermatitis (AD) who presented with a marked photoexposed site dermatitis have been investigated in detail. The results of phototesting, patch testing and other investigations were compatible with the diagnosis of photosensitivity dermatitis/actinic reticuloid syndrome (PD/AR) (chronic actinic dermatitis). It is known that AD patients may have photoaggravation of their dermatitis or exacerbation secondary to a photodermatosis, such as polymorphic light eruption, actinic prurigo or drug-induced phototoxicity. The patients we describe, however, appear to be an uncommon AD subgroup affected by PD/AR. We recommend that all AD patients who have a history of sunlight-induced exacerbation or marked intolerance of PUVA or ultraviolet B phototherapy should have phototesting and patch testing conducted.     

The syndrome of chronic photosensitivity dermatitis and actinic reticuloid

In a Study of thirty-four male subjects suffering from the syndrome of chronic photosensitivity dermatitis and actinic reticuloid the clinical, histological and photobiological features were such as to suggest that they were in fact examples of a single entity in which the degree of response to ultraviolet and visible light varied. Although a wide action spectrum involving UV and visible wavelengths invariably occurred with the classical clinical and histological features of actinic reticuloid (Ive et al., 1969) a broad action spectrum with similar histological appearances was also noted in some of the subjects in whom the morphological changes were those of a chronic dermatitis confined to exposed sites.     

Musk ambrette and chronic actinic dermatitis

A patient with persistent photosensitivity and positive photopatch tests to musk ambrette and an after-shave lotion is reported. Phototests showed extreme sensitivity to UV radiation, especially UVB. Patch tests with the European Standard Series and some plant allergens were negative. Histology showed a granulomatous reaction with epithelioid and giant cells in the dermis.     

Aneuploidy in chronic actinic dermatitis.

DNA content and cell cycle distributions in paraffin-embedded blocks of 19 skin biopsy specimens from 17 patients with chronic actinic dermatitis (CAD) [8 patients showed typical actinic reticuloid (AR)] were estimated by DNA cytometry. Sixty-three percent (12/19) of the skin specimens showed aneuploidy. In the 4 cases with the highest DNA indices (DI), ranging from 1.65 to 1.88 (mean: 1.84), the proportions of cells in S and G2/M phases were increased, ranging from 15-48% (mean: 20%) and from 64-76% (mean: 70.5%), respectively. In 8 cases with DI ranging from 1.15-1.75 (mean: 1.5), the proportion of cells in S-phase was also increased, ranging from 30-90% (mean: 81.1%). Histologically, it seems likely that the relatively high frequency of aneuploidy, DI, and proportions of cells in the S and/or G2/M phases were not proportional to epidermal or vascular endothelial hyperplasia, but they might be related to dermal lymphoid infiltration.     

Cyclosporin A in chronic actinic dermatitis

Two patients with chronic actinic dermatitis received considerable benefit from the administration of cyclosporin A. The drug was initially given at 5 mg/kg/day and then reduced to about 4 mg/kg/day. No side effects have been registered so far. The scanty literature is reviewed. Cyclosporin A may be a useful adjunct to the armamentarium in this difficult-to-manage disorder.     

The coexistence of photosensitive psoriasis with chronic actinic dermatitis

A 57-year-old-male who had been a known case of psoriasis vulgaris for 30 years had a history of summer exacerbation of the disease. Subsequently in the course of the disease process, he developed lesions of chronic actinic dermatitis (CAD) on the face and dorsum of both hands. The association of CAD with photosensitive psoriasis is very rare. Only one case report is known till now. It may suggest that there is a relationship between the two diseases.     

Treatment of chronic actinic dermatitis with azathioprine

Fourteen patients with severe unremitting chronic actinic dermatitis were treated with oral azathioprine in a dosage of 100-200 mg daily for a mean 11.5 months. Clinical improvement, apparently permanent, occurred after a few weeks to several months and continued for up to 2 years. Nine patients cleared or improved markedly, one patient cleared and then relapsed again on treatment, two patients showed no response and two patients needed to discontinue therapy because of gastrointestinal side-effects. We feel that in many patients azathioprine can be a very effective therapy for this extremely incapacitating disease.     

Diagnosis and treatment of chronic actinic dermatitis

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.     

Incipient osteomalacia occurring in chronic actinic dermatitis

Incipient osteomalacia developed in a Pakistani patient living in the UK after strict sunlight avoidance forming part of the management of the photosensitivity disorder, chronic actinic dermatitis. The patient's skin type and diet, which included calcium-binding phytates in chappattis, had increased his risk of the condition. Proximal muscle weakness and bony tenderness resulting from the disorder resolved on vitamin D replacement therapy.     

慢性光化性皮炎的DNA流式细胞分析

应用ＤＮＡ流式细胞分析法检测１７例慢性光化性皮炎的皮肤活检标本。１２例（７０．５９％）示异倍体。ＤＮＡ指数（Ｘ±Ｓ）为１．４０±０．８１。增殖指数（Ｘ±Ｓ）为６５．７１±３１．２８。Ｓ和（或）Ｇ２Ｍ期细胞比例亦增加，可能与真皮内浸润的淋巴样细胞有关，但不可认作是恶性的标志。     

The natural history of actinic keratosis: a systematic review

Knowledge about the development of untreated actinic keratosis (AK) and risk of progression into squamous cell carcinoma (SCC) is important. Therefore, we set out to synthesize primary data on the natural history of AK. We carried out a systematic literature search (Medline, Medline in Process, Embase, Cochrane) of studies on the natural course of AK, regarding (i) progression and regression rates per lesion‐year, (ii) changes in total lesion counts over time, and (iii) spontaneous field regression and recurrence rates, taking into account studies on participants without immunosuppression and history of skin cancer, immunosuppressed patients and participants with a history of skin cancer and sunscreen use. Twenty‐four eligible studies were identified providing data on at least one of the outcomes. Progression rates of AK to SCC ranged from 0% to 0·075% per lesion‐year, with a risk of up to 0·53% per lesion in patients with prior history of nonmelanoma skin cancer. Rates of regression of single lesions ranged between 15% and 63% after 1 year. The data available on recurrence rates of single lesions 1 year after regression indicate a recurrence rate of 15–53%. Data on the relative change of total AK count over time are heterogeneous, and range from ?53% to +99·1%. Spontaneous complete field regression rates range from 0% to 21%, with recurrences in 57%. In general, the available data are limited. Important methodological limitations apply. Currently, no reliable estimates concerning the frequency of AK developing into invasive carcinoma can be given, and further studies are needed.