Dermatitis actínica crónica / Chronic actinic dermatitis

RESUMEN La dermatitis actínica crónica (DAC) - dermatitis por fotosensibilidad, reacción solar persistente o su variante extrema el reticuloide actínico- es una fotodermatosis crónica, propia del adulto más frecuente en el sexo masculino provocada por rayos ultravioletas (UVB), (UVA) y luz visible. El diagnóstico es clínico, caracterizado por placas eccematosas y liquenificadas pruriginosas en aéreas expuestas al sol. Se cree que el DAC se debe a la fotosensibilización secundaria de un antígeno endógeno de la piel.

ABSTRACT Chronic actinic dermatitis (ACD) - photosensitivity dermatitis, persistent solar reaction or its extreme variant actinic reticuloid - is a chronic photodermatosis, typical of the adult male caused by ultraviolet (UVB), (UVA) and visible light. The diagnosis suggested by clinical researchers, characterized by eczematous and lichenified pruritic plaques in areas exposed to the sun. It is believed that DAC is due to the secondary photosensitization of an endogenous skin antigen.

Expression of caspase-14 in skin lesions of patients with chronic actinic dermatitis and effect of ultraviolet B radiation on its mRNA and protein expression in HaCaT cells / 中华皮肤科杂志

Objective To determine the expression of caspase-14 in skin lesions of patients with chronic actinic dermatitis (CAD),and to explore the effect of ultraviolet B (UVB) radiation on its mRNA and protein expression in HaCaT cells.Methods In 2016,skin samples were collected from lesions of 10 patients with CAD (test group),10 patients with eczema (positive control group) and from normal skin of 10 healthy controls after cosmetic surgery (negative control group) in the Department of Dermatology,First Affiliated Hospital of Kunming Medical University.Immunohistochemical staining was performed to determine the expression of caspase-14 in the normal skin,CAD and eczema lesions.Cultured HaCaT cells were divided into several groups:UVB groups irradiated with 0,30,60,90 mJ/cm2 UVB separately,and 5-AzaC groups irradiated with 0,30,60,90 mJ/cm2 UVB separately followed by the treatment with the methylase inhibitor 5-AzaC for 24 hours.Then,the cells were collected,and real-time fluorescence-based quantitative PCR (RT-PCR) and Western blot analysis were conducted to determine the mRNA and protein expression of caspase-14 respectively in HaCaT cells in the UVB groups and 5-AzaC groups.Statistical analysis was carried out with SPSS22.0 software by using chi-square test for the comparison of rates,and t test and two-factor analysis of variance for the comparison of means.Results In the CAD and eczema lesions,caspase-14 was mainly expressed in the spinous and granular layers,but not in the stratum comeum.However,caspase-14 was markedly expressed in the stratum corneum of the normal skin tissues.Of the 10 CAD samples,5 were positive for caspase-14,and 9 of 10 normal skin samples were positive for caspase-14.The positive rate of caspase-14 significantly differed between the two above groups (x2 =7.30,P ＜ 0.05).RT-PCR and Western blot analysis showed significant changes in the mRNA and protein expression of caspase-14 in HaCaT cells after irradiation with different doses of UVB (F =87.54,23.46,both P ＜ 0.05),which showed a decreasing trend along with the increase in the dose of UVB.After exposure to 0,30,60 and 90 mJ/cm2 UVB,the mRNA and protein expression of caspase-14 was significantly higher in the 5-AzaC groups than in the UVB groups (all P ＜ 0.05).Conclusions In CAD lesions,the expression of caspase-14 markedly decreased,and was absent in the stratum corneum.UVB radiation can downregulate the mRNA and protein expression of caspase-14 in HaCaT cells.

Pseudolymphoma due to Hair Dye on Background of Chronic Actinic Dermatitis Responding to Intra-lesional Triamcinolone

Cutaneous pseudolymphoma refers to a heterogenous group of benign T-cell or B-cell lymphoproliferative processes that mimic cutaneous lymphoma clinically and sometimes histologically. The causes of cutaneous pseudolymphoma are diverse, including lymphomatoid drug eruptions, lymphomatoid contact dermatitis, arthropod-bite reactions, chronic actinic dermatitis (CAD). Here we describe a case of pseudolymphoma due to hair dye on background of CAD.

Clinical Retrospective Dermatology Study on 169 Cases of Chronic Actinic Dermatitis / 昆明医科大学学报

Objective To investigate clinical features of chronic actinic dermatitis (CAD) in Kunming of Yunnan Province.Methods From October 2008 to October 2013,CAD in-patients in our hospital were selected and their general conditions,outcomes of photo-sensitive test and photo-patch test were analyzed in details.Results (1) Among 169 CAD patients,gender ratio (male:female) was 8.9:1.The lesions were mainly distributed on the exposed areas.(2) Photo-sensitive tests of 93 patients showed that the average value of UVA-MPPDwas 7.39 JPcm2 and that of UVB-MED was 20.91 mJPcm2.(3) The results of photo-patch test in 83 patients showed that 48 patients (67.8％) had positive reactions in patch test,and the most common contactant was balsam peru.Fifty-eight patients (69.9％) had positive reactions in photo-patch test indicating that the most common contactant in photo-patch test was balsam peru.Conclusions CAD appears mostly in the middle aged and the aged males and the lesions are mainly distributed on exposed areas.The most common contactants in photo-patch test are balsam peru and perfumed compounds.

Photobiological responses in patients with chronic actinic dermatitis and their relationship with the melanocortin-1 receptor gene Arg163Gln variant:a preliminary study / 中华皮肤科杂志

Objective To explore differences in phototest and photopatch test results, and in skin color?related parameters between healthy subjects and patients with chronic actinic dermatitis (CAD), and to examine their relationship with the melanocortin?1 receptor gene(MC1R)Arg163Gln variant. Methods Phototests were performed by using a sun simulator SUN1000, and skin color was analyzed by using Hexameter MX18 in 25 patients with CAD and 25 healthy subjects. The MC1R genotype at position?163 was determined by PCR. Photopatch tests were performed on 25 patients with CAD and 5 healthy subjects using a standard series of photoallergens(RuiMin)and an ultraviolet (UV)phototherapy equipment, SS?03A. Results Regarding phototest results, both UVA?minimal persistent pigment darkening dose(MPPD)and UVB?minimal erythema dose(MED)were significantly lower in CAD patients compared with healthy controls (both P 0.05), but that of the CAA genotype differed significantly between the two groups(P<0.01). UVA?MPPD and UVB?MED were both significantly lower in CAD patients with the CAA genotype at position?163 in the MC1R gene than in those without the genotype(P=0.055, 0.325, respectively). Conclusions Skin photobiological testing plays a critical role in the diagnosis of CAD. Further studies are needed to clarify the role of the CAA genotype at position?163 in the MC1R gene in the diagnosis, prevention and treatment of CAD.

Observation of Therapeutic Effect of Tacrolimus Ointment and Mometasone Furoate Cream in the Treatment of Chronic Actinic Dermatitis / 昆明医科大学学报

Objective To evaluate the efficacy of 0.1% tacrolimus ointment and 0.1% mometasone furoate cream in the treatment of chronic actinic dermatitis (CAD). Methods Forty male patients with CAD were recruited and divided into two groups randomly.Twenty cases were treated with 0.1%tacrolimus ointment (Group A), and the other 20 cases were treated with 0.1% mometasone furoate cream (Group B) . The medications mentioned were applied topically to the lesions on the face twice a day and mizolastine tablet 10 mg per day given orally for 4 weeks. The therapeutic efficacy and side effects of medications were observed. The enzyme linked immunosorbent assay (ELISA) method was used to measure the serum levels of IFN-γ, IL-2 and IL12 in CAD patients before and after treatment with topical tacrolimus ointment and mometasone furoate cream. Results (1) Both groups had overall response rates of 100%, with no statistically significant difference ( > 0.05) . (2) Serum levels of IFN-γ,IL-2 and IL-12 were down-regulated after treatment in both treatment groups respectively ( 0.05) . Conclusion 0.1%tacrolimus ointment is effective in the treatment of CAD. Its therapeutic efficacy is equivalent to that of 0.1%mometasone furoate cream. It can be used as a possible steroid sparing equivalent.

Clinical Features and Histological Findings of 17 Patients with Chronic Actinic Dermatitis / 고신대학교의과대학학술지

OBJECTIVES: This study was designed to evaluate the clinical, histological and immunohistochemical findings and treatment of chronic actinic dermatitis in Korean patients. METHODS: Seventeen Korean patients with chronic actinic dermatitis were enrolled for this study. The clinical and histological findings and the results of phototest were reviewed with medical records, clinical photographs and pathologic slides. We also reviewed the effectiveness of the treatments in all patients with chronic actinic dermatitis. RESULTS: In all patients with chronic actinic dermatitis, pruritus was severe, and the patients present in the early stages with erythemas on the face, neck and the back of the hands. As the eruption progresses, it became lichenified and scaly plaques and papules developed. The face, upper extremity and neck were most commonly affected. The most common abnormal results of the phototests were decreased MED-UVB alone. In 8 patients with actinic reticuloid, histopathologic findings showed irregular acanthosis, parakeratosis, spongiosis, atypical hyperchromatic cells with cerebriform nuclei, epidermotropism, Pautrier-like microabscess, deep perivascular lymphocytic infiltrates, vertically-streaked collagen in the papillary dermis, stellate and multinucleated fibroblasts. Treatment includes topical tacrolimus and corticosteroid, oral corticosteroid, azathioprine and cyclosporine. CONCLUSIONS: Our study showed classic clinical and histological findings. The most common abnormal results of the phototests were decreased MED-UVB alone. Topical steroid, tacrolimus and systemic cyclosporine, azathioprine are effective in treating chronic actinic dermatitis.

Topical treatment of actinic keratosis with imiquimod 5% cream / Tratamento tópico de ceratose actínica com imiquimod creme 5%

The viability and the efficiency of imiquimod 5% cream in a cat which suffered from nasal actinic keratosis were evaluated. The procedures were carried out at home by the owners themselves. Six packets of the cream were used, one per week, in three consecutive daily applications, with a four-day interval (without treatment). The cytological results were negative for neoplastic cells 30 days after the end of the treatment. A clinical revision was conducted 18 months later and the animal showed no signs of recurrence. The cream proved to be safe and efficient. There are no reports regarding efficiency in animals concerning the treatment with imiquimod 5% cream and also regarding other effects related to this treatment. A case report presenting a positive response can reveal with terapeutical possibilities that it would be easily available and applicable for all professionals. In the future it would be a new alternative to avoid progressions of this kind of neoplasia which is often observed in the small animal clinic.

Avaliaram-se a viabilidade e a eficácia da utilização do imiquimod creme 5% em um gato portador de ceratose actínica nasal. As aplicações foram realizadas no domicílio, pelos proprietários, sendo utilizados seis sachês do creme, um por semana, em protocolo de três aplicações diárias consecutivas e quatro dias de descanso (sem tratamento). Após 30 dias do término do tratamento, obteve-se citologia negativa para células neoplásicas. Em revisão clínica 18 meses após o tratamento, o paciente apresentava-se sem sinais de recidiva. O protocolo mostrou-se seguro e eficaz. Em animais não há relatos sobre a eficácia da terapia com imiquimod, bem como sobre efeitos adversos decorrentes deste tratamento. A apresentação de um caso em que se observou resposta positiva pode descortinar uma nova possibilidade terapêutica, acessível a todo clínico, que poderá evitar a progressão destas neoplasias que são frequentemente observadas na clínica de pequenos animais.

Parthenium dermatitis in India: Past, present and future.

Parthenium dermatitis is an immuno-inflammatory disease caused by Parthenium hysterophorus and is the commonest cause of plant dermatitis in India. It is caused by airborne dry and friable plant particles including trichomes, and the most important allergens responsible for allergic contact dermatitis are sesquiterpene lactones. The combined type IV and type I hypersensitivity to parthenium has been recently postulated. In sensitized individuals, it can cause a spectrum of clinical patterns, such as classical airborne pattern, chronic actinic dermatitis-like presentation, mixed pattern dermatitis, exfoliative dermatitis, widespread dermatitis, and other rare patterns. There is definite trend towards change from airborne pattern to chronic actinic pattern in natural history of parthenium dermatitis. Contact sensitivity to parthenium is everlasting, and hence the disease runs a chronic course with exacerbation during summers. Patch testing with acetone or aqueous plant extract is the simplest way of confirming parthenium contact allergy. Management includes avoiding contact with allergen, managing dermatitis with topical corticosteroids/tacrolimus, and other immunosupressives like azathioprine. In future, we expect parthenium dermatitis to become less prevalent due to rapid urbanization and possible development of new biological methods to eradicate the parthenium. Genetic factors associated with susceptibility to parthenium dermatitis need to be studied.

Clinical Study of 12 Cases with Chronic Actinic Dermatitis / 대한피부과학회지

BACKGROUND: Chronic actinic dermatitis (CAD) has been defined using three criteria: clinical photobiological and histological aspects. CAD is a rare disease with only a few clinical analyses reported in Korea. OBJECTIVE: The purpose of this study was to investigate the clinical characteristics of CAD including epidemiology, clinical presentations and results of phototests in Korean patients. METHODS: A retrospective analysis was conducted according to patients' medical records at Seoul National University Hospital. RESULTS: Twelve patients were enrolled in this study. Most were elderly men with skin lesions on the sun-exposed areas. The mean age was 55. 4 years. Ten patients were male and the other 2 were female. The mean duration of the disease was 12.7 years. Phototests showed that 6 patients showed decreased minimal erythema dose (MED) to UVA and 2 patients decreased MED to UVB. The remaining 4 patients decreased to both UVA and UVB. CONCLUSION: The most common abnormal phototest results were decreased MED to UVA. More patients showed normal MED to UVB in this study compared with other studies. Our study analyzed the clinical and photobiological characteristics of CAD in Korean patients.

Clinical Observation of Polymorphous Light Eruption and Chronic Actinic Dermatitis Treated with Artemtherin / 昆明医科大学学报

Objective To observe the clinical effect and safety of polymorphous light eruption(PLE) and those of chronic actinic dermatitis(CAD) treated with Artemtherin.To further study better treatment methods for photodermatitis.Methods 105 patients with CAD and 63 patients with PLE were divided into the treatment group and the control group randomly.In the treatment group,63 cases of CAD and 32 cases of PLE were treated with Artemtherin.In the control group,42 cases of CAD and 31 cases of PLE treated with Hydroxychlorquine.The dosages of both groups were 40 mg and 200 mg at each time,twice a day respectively.Both groups were topically treated with 10% ointment zinc oxide,twice a day,for one month.Results The effective rate of treatment group and control group with PLE patients were 84.4%(27/32) and 80.6%(25/31),respectively.There was no significant difference between both groups in terms of the effective rate of PLE.The effective rate of treatment group and control group with CAD patients were 85.7%(54/63) and 81%(34/4),respectively.There was not any side-effect reported among these patients treated with Artemtherin.Conclusions It is effective,safe,economic,and convenient to treat PLE and CAD with Artemtherin.

A Case of Chronic Actinic Dermatitis Treated with 0.03% Topical Tacrolimus

Chronic actinic dermatitis is an idiopathic photodermatoses presenting as severe persistent eczematous skin eruptions on sun-exposed skin, with an enormous itching sensation. The treatment includes photoprotective measurements, topical or systemic corticosteroids and other immunosuppressive agents. However, occasionally, the condition is resistant to these therapies and results in a significant disabling of the involved individuals. We tried 0.03% topical tacrolimus ointment on a chronic actinic dermatitis patient who had previously been treated with conventional steroid therapy with no improvement. Two weeks after application of the topical tacrolimus ointment, the itching sensation was significantly improved and in 4 weeks, the skin lesions began to improved with no other side effects.

Results of Photopatch and Patch Tests in 35 Korean Patients with Chronic Actinic Dermatitis and Clinical Importance of These Findings / 대한피부과학회지

BACKGROUND: Chronic actinic dermatitis (CAD) is a rare disease worldwide. It has been defined on the basis of three criteria: 1) clinical - a persistent eczematous eruption on sun- exposed area with possible extension into non-exposed areas, 2) photobiological - a reduction in the minimal erythema dose to UVB irradiation, and possibly longer wavelengths, and 3) histologic - an appearance consistent with chronic eczema, with or without the presence of lymphoma-like changes. However, only a few clinicohistopathologic and photobiological analyses of CAD have been undertaken in Korea. OBJECTIVE: To explore photoallergens and/or allergens causing or thought to be associated with CAD in Korean patients, and to compare the photopatch or patch test results in Korea with those from other countries. METHODS: Thirty-five Korean patients with CAD were enrolled for this study. Photopatch tests were carried out by applying two sets of the Scandinavian photopatch series to each patient. Two days after application, the photopatch tests were analysed, and one set of the photoallergens was irradiated with 50% of the MED-UVA. Both sets of photoallergens were examined 2 days later. A European standard series was used to assess the patch tests. At two and four days after application, patch tests were analysed. RESULT: Twenty-seven of the 35 patients (77.1%) who had photopatch tests showed positive responses; balsam of Peru, promethazine HCl, perfume mix, fentichlor, chlorhexidine digluconate, and chlorpromazine HCl were the common photoallergens that elicited a positive response. Twenty-one of the 35 patients (70%) showed allergy to nickel, chrome, and/or ammoniated mercury. Noticeably, photoallergens such as balsam of Peru, perfume mix, cobalt, and captan revealed positive reactions in the patch tests, too. CONCLUSION: In 77.1% and 74.3% of CAD patients, photoallergens and allergens were identified, respectively. Among them, 57.1% showed positive reactions including both photopatch and patch tests. After the most frequent photoallergens, perfume and spices, and phenothiazines or related antihistamines ranked next and were found to be a unique characteristic to Korea. Photopatch and patchtests are the method for detecting photoallergens and allergens as important initiating agents and are the diagnostic tool for the epidemiologic study of CAD.

A Case of Chronic Actinic Dermatitis / 대한피부과학회지

Chronic actinic dermatitis was recently proposed as a syndrome including photosensitive eczema, photosensitivity dermatitis, actinic reticuloid, and persistent light reactivity. It is defined on the basis of 3 criteria, including clinically persistent eczematous eruption on sun-exposed skin, histologically consistent with chronic eczema, and photobiologically decreased MED to UVB. We report herein a 61-year-old man presented with 2-year history of erythematous to brownish lichenified papules and plaques on sun-exposed areas and shown decreased minimal erythema doses to both UVB and UVA. Biopsy specimen showed consistent with chronic eczema. He was treated with topical therapies of topical steroids and intralesional injection of triamcinolone, and oral anti-histamine, with avoidance of exposure to sun.

A clinical analysis of 11 patients with chronic actinic dermatitis in Korea

Chronic actinic dermatitis is a rare disease worldwide and also in Korea. However there has been no clinicohistologic and photobiological analysis of chronic actinic dermatitis in Korea. We examined 11 patients who were diagnosed as chronic actinic dermatitis and the results of this study were compared with previous reports. Most patients were elderly men who had erythematous papules or lichenified plaques on sun-exposed areas such as the face, neck, and dorsum of the hands with severe itching sensation. All patients had severe sensitivity to UVB and biopsied specimens showed findings of chronic eczema. Five patients had positive photopatch test materials. The patients were treated with systemic and topical steroid, cyclosporine and antihistamine.

Effects and Significance of Cyclosporine Therapy in Chronic Actinic Dermatitis / 대한피부과학회지

BACKGROUND: Chronic actinic dermatitis comprises a spectrum of chronic photosensitivity disorders. Treatment includes avoidance of UV light, application of broad-spectrum topical sunscreens, PUVA therapy, corticosteroid, azathioprine and cyclosporine. OBJECTIVE: Our purpose was to determine the efficacy of cyclosporine in the treatment of chronic actinic dermatitis. METHODS: Six patients with chronic actinic dermatitis refractory to conventional treatment were treated with cyclosporine 100-200mg a day for four to eighteen weeks. RESULTS: In all six patients improvement of the skin lesions and itching were dramatic, but in three of them hyperterision developed during the cyclosporine treatment. After stopping the cyclosporine therapy, their blood pressures normalized within two to five weeks. Other side effects of cyclosporine were not found. Although the skin lesions of all of the six patients were aggravated more or less after stopping the cyclosporine therapy, we could maintain their improved states with topical corticosteroids and oral antihistamines. CONCLUSION: 1. Cyclosporine is a good alternative in treating chronic actinic dermatitis patients who are suffering from severe symptoms refractory to conventional therapy. 2. Hypertension is the frequent side effect of cyclosporine.

Three Cases of Chronic Actinic Dermatitis Treated with Systemic PUVA Therapy

Chronic actinic dermatitis is an uncommon disabling ecxematous photosensitive eruption. The skin lesion is characterized by persistent eczematous eruptions on sun exposed skin with possible extension into nonexposed areas. The phototest shows decreased minimal erythema doses (MED) to UVB and possibly UVA. Histological features demonstrate chronic eczema with or without the presence of lymphoma like changes. The present cases showed pruritic erythematous patches and plaques on sun exposed areas and showed decreased minimal erythema doses to both UVB and UVA. We herein report three cases of chronic actinic dermatitis treated with systemic PUVA therapy.

A Case of Chronic Actinic Dermatitis Showing Contact Allergy / 대한피부과학회지

Chronic actinic dermatitis is an uncommon, persistent, light induced eruption occurring mostly on exposed skin. It is eczematous or pseudolymphomatous in nature, probably representing delayed type hypersensitivity to endogerious photoallergens. It usually worsens in summer and affects elderly men. A 72-old-male was presented with a 14 month history of pruritic skin lesions. They were composed of waxy thickened scaly plaques of the face and dorsa of the hands, and depigmented patches of the neck, which worsened when exposed to sun light. We performed photo test and photopatch test. MED of UVA was lowered and the patch and photopatch test revealed only contact sensitivity to Balsam of Peru, perfume mix and fragrance mix. A biopsy specimen showed hyperkeratosis and spongiosis of the epidermis and perivascular lymphocytic and many eosinophilic infiltrations of the dermis. The patient was treated with systemic and topical corticosteroids with marked improvement.

A case of chronic actinic dermatitis / 대한피부과학회지

Chronic actinic dermatitis was recently proposed to be a syndrome of chronic photosen-sitivity that incudes photosensitive eczema, persitent light reection, photosensitivity dermatitis and actinic reticuloid. We report herein a case of chronic actinic dermatitis which occured in a 60-year-old man. He suffered from a chronic eczematous dermatitis affecting e posed skin and some covered area with a feature of erythroderma. Phototesting showed abnormal photosensitivity to both UVB and UVA as will as to visible light. Skin biopsy specimes revealed histologic findings of spongiotic dermatitis in which dermal infiltrates were mainy consisted of T lymphocytes with suppressor T cells dominance on immunohistochemistry.