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.

Chronic actinic dermatitis.

Chronic actinic dermatitis (CAD) is an immunologically mediated photodermatosis characterized by pruritic eczematous and lichenified plaques located predominantly on sun-exposed areas with notable sparing of eyelids, skin folds, and postauricular skin. CAD is thought to be due to secondary photosensitization of an endogenous antigen in the skin. Management of CAD should include strict photoprotection and topical agents, including corticosteroids and calcineurin inhibitors. Other treatments with noted efficacy include oral prednisone, cyclosporine, azathioprine, and mycophenolate mofetil. Photoprotection and avoidance of allergens, if identified, may lead to spontaneous resolution of CAD in 50% of patients over 15 years.

A Comparative Histopathologic Study of Actinic Reticuloid and Mycosis Fungoides / 대한피부과학회지

BACKGROUND: Actinic reticuloid is a severe persistent photodermatitis that usually affects older men. It is characterized by extreme photosensitivity to a broad spectrum of ultraviolet radiation. Actinic reticuloid has many of the clinical and histological features of mycosis fungoides and Sezary syndrome. No Korean studies are available regarding a histopathological and immunohistochemical comparison of actinic reticuloid and mycosis fungoides. OBJECTIVE: This study was designed to evaluate the histopathological characteristics and conduct a immunophenotypic analysis to distinguish actinic reticuloid from mycosis fungoides. METHODS: We reviewed the histomorphological findings of 10 patients diagnosed with actinic reticuloid and those of 15 patients diagnosed with mycosis fungoides from 1996 to 2012 at our clinic. In addition, an immunophenotypic analysis was performed on the skin to assess the proportions of CD4+ and CD8+ T cells in all patients. RESULTS: We found a broad overlap in non-specific inflammatory histological features and more prominent histological features between the two diseases. Irregular acanthosis, vertically-streaked collagen in the papillary dermis, thickened and increased blood vessels, and an eosinophil and plasma cell infiltrate were significantly higher in patients with actinic reticuloid than in those with mycosis fungoides. Stuffed lymphocytes in dermal papillae and a psoriasiform lichenoid pattern were observed significantly more often in patients with mycosis fungoides. Solar elastosis (80%) was seen only in the actinic reticuloid cases. CD8-positive T cells were predominant in the epidermis in eight of 10 patients with actinic reticuloid. In contrast, CD4-positive T cells in the epidermis and dermis predominated in the majority of patients with mycosis fungoides (73.3%) compared with CD8-positive T cells. CONCLUSION: Histopathological findings and immunophenotypic analyses may be an important adjunct to distinguish actinic reticuloid from mycosis fungoides, but a correlation with clinicopathological findings, phototest, patch test, and photopatchtest is necessary to reliably distinguish actinic reticuloid from mycosis fungoides. Further prospective studies should be conducted on a larger number of cases regarding the differences between actinic reticuloid and mycosis fungoides.

A Case of Actinic Reticuloid

Actinic reticuloid as a manifestation of chronic actinic dermatitis (CAD) is a rare dermatosis whose clinical and histologic features resemble other types of pseudolymphomas including mycosis fungoides and Jessner's lymphocytic infiltration, and it is regarded as an eventual stage of various photodermatoses like photosensitive eczema or persistent light reaction or chronic photoallergic contact dermatitis and so on. Phototests in the patients with actinic reticuloid usually reveal hypersensitivity to UVB, UVA, and sometimes to visible light. We present a case of actinic reticuloid in a 65-year-old male, whose skin lesions developed as erythematous lichenified infiltrating plaques on the face at first, and then spread themselves onto the upper trunk later. Histologically those skin lesions showed the aggregation of atypical lymphocytes and photobiologically the results of phototests revealed photosensitivity to UVB and UVA.

A Case of Actinic Reticuloid / 대한피부과학회지

Actinic reticuloid is a rare, chronic photosensitivity dermatosis with clinical and histologic femtures resembling a cutaneous T cell lymphoma. Phototesting in these patients typically reveals extreme sensitivity to UVB, to UVA, and sometimes to visible light. has site of lymphomatoid histologic appearance, actinic reticuloid is now regarded as a histologic arant of chronic actinic dermatitis, which is the spectriam of several photosensitivity dermatosis, delet to its benign course and transition to or from other photosensitivity dermatosis. We present a case of actinic veticuloid in 58-year-old male, who has severely edematous infiltrated lichenified erytherratous patches on sun-exposed skin, lynptmatoid histologic features with selective T cell infiltrat,ion, and selective photosensitivity to UV.