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Chronic actinic dermatitis
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Chronic actinic dermatitis

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Contributors: Viet Nguyen MD, Christopher T. Burnett MD, Jeffrey D. Bernhard MD
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Synopsis

Chronic actinic dermatitis (CAD), which includes persistent light reaction, actinic reticuloid, and photosensitive dermatitis, is a photodistributed eczematous dermatitis without a known photosensitizing agent that persists for a period of greater than 3 months.

Although the etiology is unclear, one proposed pathophysiologic mechanism is that CAD results from an endogenous cutaneous antigen. This antigen is normally suppressed, but chronic immunosuppression from chronic ultraviolent light exposure may cause activation of this antigen, resulting in a cutaneous reaction similar to that of allergic contact dermatitis.

CAD is most commonly seen in male patients over the age of 50, although the condition can be seen in women and also rarely in younger patients. In younger patients, it is usually associated with a history of atopic dermatitis. In general, affected patients of all ages often have a history of atopic dermatitis and/or multiple contact allergies. CAD can occur in any skin type and anywhere in the world, although it is more commonly seen in patients with Fitzpatrick skin types V and VI and in temperate climates.

CAD may be a presenting sign of human immunodeficiency virus (HIV), especially in younger CAD patients. If the diagnosis of CAD is considered, testing for HIV is recommended for patients with positive risk factors for HIV.

Codes

ICD10CM:
L57.8 – Other skin changes due to chronic exposure to nonionizing radiation

SNOMEDCT:
52636001 – Actinic reticuloid

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Polymorphous light eruption – Occurs in younger patients and in discrete attacks with clearance of lesions between flares.
  • Photoexacerbated drug eruption – Usually appears more edematous and erythematous, but chronic cases may have lichenification. Check the medication list of the patient for potential causes.
  • Acute / subacute cutaneous lupus erythematosus – Malar distribution or polycyclic erythematous scaly plaques, usually not lichenified.
  • Porphyrias (see porphyria cutanea tarda, variegate porphyria) – Can mimic this disease; rule out with stool / urine / serum porphyrins as appropriate.
  • Cutaneous T-cell lymphoma – Not confined to photoexposed skin (although there is a rare photosensitive form of mycosis fungoides, and spillover to non-exposed sites can occur in CAD).
  • Pellagra – May present similarly to CAD. The classic symptoms of diarrhea and dementia may or may not coincide. Check serum niacin levels if there are pellagra risk factors such as a history of alcohol abuse.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 09/19/2017
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Chronic actinic dermatitis
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Chronic actinic dermatitis : Lichenified plaque, Scaly plaque, Sun-exposed distribution
Clinical image of Chronic actinic dermatitis
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