Chronic actinic dermatitis (CAD), which includes persistent light reaction, actinic reticuloid, photosensitive dermatitis, and photosensitive eczema, is a photodistributed eczematous dermatitis without a known photosensitizing agent that persists for more than 3 months.
Although the etiology is unclear, one proposed pathophysiologic mechanism is that CAD results from photoinduced modification of endogenous cutaneous antigen(s).
CAD is most commonly seen in men aged older than 50 years, with a long history of either occupational or recreational outdoor activities. The condition can be seen in women and also rarely in younger patients. Affected patients of all ages often have a history of atopic dermatitis and/or a history of allergic contact dermatitis and thus have a baseline tendency for delayed-type hypersensitivity reactions. 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 HIV infection, 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.
Chronic actinic dermatitis
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Synopsis
Codes
ICD10CM:
L57.1 – Actinic reticuloid
SNOMEDCT:
52636001 – Actinic reticuloid
L57.1 – Actinic reticuloid
SNOMEDCT:
52636001 – Actinic reticuloid
Look For
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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 patient's medication list 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.
- Mycosis fungoides – Not confined to photoexposed skin (although there is a rare photosensitive form of mycosis fungoides, and spillover to nonexposed 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 use disorder.
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 Reviewed:02/23/2021
Last Updated:03/07/2021
Last Updated:03/07/2021
Chronic actinic dermatitis