Chronic actinic dermatitis treated with mycophenolate mofetil

Chronic actinic dermatitis (CAD) is a persistent photodermatosis that usually affects elderly men. We report two male patients, aged 55 years (patient A) and 49 years (patient B), who presented with an eczematous eruption on sun-exposed skin. Phototesting revealed a markedly reduced 24-h minimal erythema dose (MED). Both patients had refractory disease and developed significant side-effects to conventional therapies, including topical steroids, prednisolone, psoralen with ultraviolet A, azathioprine and ciclosporin. They had each received at least 6 years of treatment prior to commencing mycophenolate mofetil (MMF). Each noted a significant improvement in symptoms within 6 weeks and subsequent clearing of the eczematous lesions. Patient A still requires continuous treatment with MMF 500 mg twice daily to prevent relapses. Patient B maintains remission by using MMF 1 g twice daily only during the spring and summer months. Both patients have tolerated the treatment well with no abnormalities in blood cell counts or liver biochemistry. Since commencing MMF, their quality of life has significantly improved. These observations suggests that MMF should be considered as an alternative treatment to conventional therapies for refractory CAD.     

Chronic actinic dermatitis in Asian skin: a Singaporean experience

Background/purpose: To study the characteristics of chronic actinic dermatitis (CAD) in a heterogeneous group of Singaporean patients. Methods: The photobiologicial features of all patients phototested and diagnosed with CAD from January 2005 to December 2009 were examined retrospectively. Results: Fifty‐eight patients were diagnosed as having CAD. The mean age at diagnosis was 62 years (range 35–83). Forty‐one were (70.7%) Chinese, six (10.3%) Indians, eight (13.8%) Malays, and three (5.2%) Others. Forty‐seven were (81.0%) male and 11 (19.0%) were female. Forty‐nine (84.5%) had Fitzpatrick skin phototype IV and nine (15.5%) had phototype V. Three of 26 (11.5%) tested for human immunodeficiency virus were positive. The face, neck, and forearms were most commonly affected. Thirty‐two patients (55.2%) had reduced minimal erythema dose (MED) to both ultraviolet B (UVB)and ultraviolet A (UVA), 23 patients (39.7%) had lowered MED to UVB only, while three (5.1%) had reduced MED to UVA only. Patients were followed up for a mean of 16.8 months. All were treated with photoprotection and topical steroids; however, a few required oral immunosuppression with partial improvement. Conclusion: In Singapore, CAD was seen more commonly in elderly Chinese males of Fitzpatrick skin phototype IV. Reduced MED to both UVB and UVA was the most common phototest finding.     

Evaluation of narrow band ultraviolet B phototherapy in the treatment of chronic actinic dermatitis in Chinese patients

Few studies have been conducted in chronic actinic dermatitis (CAD) treated with narrowband ultraviolet B (NB UVB) phototherapy, especially in Asian patients. We aim to evaluate the efficacy and safety of NB UVB phototherapy in Chinese patients with CAD. 19 CAD patients of Fitzpatrick skin phototype IV received NB UVB phototherapy in spring and treatments were given 3 times weekly with incremental dose and maintenance therapy was given twice weekly for 3–4 weeks. The mean initial, endpoint, and cumulative dose of NB UVB was 0.08, 0.33, and 6.0 J/cm², respectively. Patients totally received 27 times of treatments in average. 87.5% of previously ultraviolet B（UVB） sensitive patients and 75% of previously ultraviolet A（UVA） sensitive patients had normal or improved MED after phototherapy. The percentage of patients returned to normal UVB phototesting was higher than that of patients returned to normal UVA phototesting (68.8% vs. 37.5%). The mean 1‐week DLQI and the need for using immunosuppressive agents and antihistamines were significantly reduced after treatment (p < .01 or p < .05). In conclusion, prophylactic NB UVB phototherapy is effective and safe in treatment of CAD in Chinese patients with Fitzpatrick skin phototype IV.     

Erythrodermic chronic actinic dermatitis responding only to topical tacrolimus

Chronic actinic dermatitis (CAD) is a disorder characterized by an often severe persistent eczematous eruption induced by exposure to ultraviolet radiation. Treatment involves photoprotective measures and topical corticosteroid therapy and in more severe cases, systemic immunosuppression. Occasionally, however, the condition can prove very resistant to all therapy and be severely disabling. We report a patient with CAD who resisted standard topical and systemic treatments, but responded to topical tacrolimus ointment 0.1% (Protopic).     

Chronic actinic dermatitis: A clinical study of 15 cases in northern Taiwan

BackgroundChronic actinic dermatitis (CAD) is an idiopathic photosensitive dermatosis induced by ultraviolet B (UVB), sometimes ultraviolet A (UVA), and occasionally visible light. Diagnosis is suggested by the clinical findings, typically a chronic eczematous rash on the sun exposed areas, and confirmed by phototesting, which demonstrates the abnormal photosensitivity. The aim of this study was to determine the characteristics of CAD in Taiwanese patients.MethodsWe retrospectively reviewed the clinical and photobiological features of all patients diagnosed as having CAD at our institute from 2002 to 2012.ResultsA total of 15 patients with CAD were identified. The mean age at diagnosis was 58.6 years (range, 28–82 years). All the patients were males. The face, neck, forearms, and dorsal hands were most commonly involved. Eight patients (53.3%) had decreased minimal erythema dose (MED) to both UVB and UVA; six patients (40.0%) had decreased MED to only UVB; one patient (6.7%) had decreased MED to only UVA. All were managed with photoprotection and topical corticosteroids. Four patients received azathioprine (50 mg twice a day to every other day) and one received prednisolone (10 mg per day to every other day).ConclusionIn Taiwan, CAD affects elderly men more commonly. The most common phototest results were decreased MED to both UVB and UVA, followed by to UVB alone. All patients were managed with photoprotection and topical corticosteroids, and some also required systemic agents, in particular azathioprine.     

Chronic actinic dermatitis in a patient with adult T-cell leukemia

A patient with chronic actinic dermatitis showed a leukocytosis with peripheral atypical lymphocytes. Histology of cutaneous eruptions disclosed a dense infiltrate of lymphocytes mixed with large hyperchromatic cells in the dermis and Pautrier-like microabscesses in the epidermis. However, clonal rearrangements of the T-cell receptors were not detected. On the other hand, monoclonal integration of human T-cell lymphotrophic virus type I provirus was found in the peripheral lymphocytes. In the present case, pseudolymphomatous changes occurred in association with adult T-cell leukemia. Southern blot analyses were useful for the correct diagnosis.     

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.     

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.     

慢性光化性皮炎62例临床分析

目的:了解62例慢性光化性皮炎诱发因素、临床和光生物学特征及治疗情况。方法:回顾性分析62例慢性光化性皮炎患者临床资料。结果:62例患者,男女比例为30:1,平均64岁;皮损分布于曝光部位,主要表现为浸润肥厚的红斑、斑块、苔藓样丘疹。病理上早期为光敏性皮炎(PD)象,后期可呈光化性网织细胞增生症(AR)象。光生物学试验测定最小红斑量(MED)中,96.77%患者对UVB敏感,82.26%对UVA敏感;避光和去除光敏物,服用B族维生素和抗组胺药、羟氯喹,局部外用糖皮质激素有较好疗效,严重病例口服小剂量泼尼松和免疫抑制剂可控制病情。结论:慢性光化性皮炎常见于老年男性,临床诊断主要依靠临床表现和光生物学试验、避光和去除光敏物,外用和内服药物是治疗关键。     

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.     

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105例光试验研究

目的:总结日光模拟器对慢性光化性皮炎(CAD)患者进行光试验的结果与应用价值。方法:采用日光紫外线模拟器,对30名正常人和105例CAD患者进行长波紫外线(UVA)、中波紫外线(UVB)的最小红斑量(MED)测定。结果:在UVA波段,当剂量<40J/cm2时,30名正常人均无红斑反应,而105例CAD患者中63例出现不同程度的红斑反应(60%);在UVB波段,CAD患者的MED显著低于正常人(P=0.001)。结论:采用日光模拟器对CAD患者进行光试验,有助于对CAD的诊断。     

The successful use of topical tacrolimus treatment for a chronic actinic dermatitis patient with complications of idiopathic leukopenia

Chronic actinic dermatitis (CAD) is a photosensitivity disorder marked by severe eczematous lesions on exposed areas. Although associations with contact dermatitis, atopic dermatitis, and human immunodeficiency virus (HIV) have been suggested, its pathogenesis remains unknown. CAD is often refractory, and systemic administration of cyclosporin A has been the treatment of choice. Recently, topical tacrolimus therapy has been reported to be effective. We report the efficacy of topical tacrolimus treatment in a CAD patient who also had the complication of idiopathic leukopenia. A phototest showed marked suppression of erythema formation in the skin pre-treated with tacrolimus before UVB radiation but not in the skin treated after the irradiation. Therefore, it is suggested that tacrolimus may prevent UV-B induced erythema by suppressing a very early phase of the inflammatory process in CAD.     

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 spontaneous resolution of photosensitivity and contact allergy in a patient with chronic actinic dermatitis

Chronic actinic dermatitis (CAD) is an uncommon photodermatosis in which patients typically exhibit photosensitivity together with contact allergy. Improvement of the photosensitivity over time is well recognized in a proportion of patients but the concurrent resolution of contact allergy is rare. We report on a 46-year-old female with longstanding CAD who demonstrated resolution of both of these features.