Chronic actinic dermatitis cad is a rare photosensitivity disorder with scant epidemiologic data. Cad is chronic, that is to say it typically persists for a number of years. Chronic actinic dermatitis chronic actinic dermatitis cad is one of the most frequently encountered photodermatoses in patients older than 50 years of age. Chronic actinic dermatitis most frequently occurs in older men in people of lighter skin type. The term chronic actinic dermatitis or cad is used to describe a particularly severe form of eczema in which sensitivity to light is the main feature photosensitivity. Date call number ll as the number of patients was limited and it was not a casecontrol study, therefore, more studies are required to be done in the evaluation of acginica potentially beneficial drug in the treatment of chronic actinic dermatitis. Design historical cohort study involving followup of patients for up to 24 years from diagnosis. It is characterised by severely itchy, red, inflamed, and thickened dry skin due to exposure to ultraviolet radiation and frequently also visible light from the sun or artificial lighting. Proper usage and audio pronunciation of the word actinic dermatitis. Chronic actinic dermatitis is a rare skin condition that mainly affects men over the age of 50 years.
In many cases, 30 seconds is all it takes for a skin reaction to occur. Chronic actinic dermatitis cad, previously photosensitivity dermatitis actinic reticuloid pdar syndrome, is a chronic dermatitis sometimes with pseudoreticuloid features predominantly of photoexposed sites. Chronic actinic dermatitis is a difficult to treat photodermatitis. Older men appear to be most susceptible, and the condition leads to marked photosensitivity, with signs demonstrable after exposure to ultraviolet light even lower than the minimal erythema dose. Chronic actinic dermatitis canadian medical association. What is chronic actinic dermatitis chronic actinic dermatitis is a rare skin condition that mainly affects men over the age of 50 years. Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a dermatitis andor a pseudolymphomatous eruption. The condition is also known as chronic photosensitivity.
Chronic actinic dermatitis cad is a chronic photodermatosis commonly affecting patients with skin of color. The photobiologicial features of all patients phototested and diagnosed with cad. A 52yearold man experienced a pruritic and erythematous eruption on his face, neck, upper chest, and arms. In the management of photosensitivity dermatitis actinic reticuloid syndrome pdar syn. Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a dermatitis andor a. Chronic actinic dermatitis an overview sciencedirect topics. Chronic actinic dermatitis is an immunemediated reaction to sun or artificial light, often accompanied by contact allergies. According to its creators, the conditions persistent light reactivity. Chronic actinic dermatitis cad is one of the most frequently encountered photodermatoses in patients older than 50 years of age. Chronic actinic dermatitis is a condition where a subjects skin becomes inflamed due to a reaction to sunlight or artificial light. Chronic actinic dermatitis cad, one of the immune mediated photodermatoses, comprises a spectrum of conditions including persistent light reactivity, photosensitive eczema and actinic reticuloid. Perelman department of dermatology, new york university abstract. In some patients, chronic actinic dermatitis clears after a long time, but it tends to remain unresolved in 80% patients, even 10 years after diagnosis. A case report of therapeutically challenging chronic.
Chronic actinic dermatitis a study of clinical features. To study the characteristics of chronic actinic dermatitis cad in a heterogeneous group of singaporean patients. From 1993 to 2009, 40 patients who were examined at the nyu charles c. Diagnostic criteria were laid down about 20 years back, but clinical features are the mainstay in diagnosis. Chronic actinic dermatitis an overview sciencedirect. Actinic prurigo must be differentiated from photoaggravated atopic eczema, plme, and chronic actinic dermatitis. Tofacitinib citrate for the treatment of refractory. It is characterised by severely itchy, red, inflamed, and thickened dry skin, mainly in areas that have been exposed to sunlight or artificial light. Chronic actinic dermatitis cad is a severe, socially disabling and intractable photosensitive disorder particularly affecting elderly men. Apr 15, 2018 a rare chronic skin condition that affects mainly males over the age of 50 although it may occur in younger individuals with atopic dermatitis.
The term chronic actinic dermatitis cad was first coined by hawk and magnus and is a unifying label encom passing the conditions of photosensitive eczema, photo sensitivity dermatitis, persistent light reaction, and actinic reticuloid. Skin cancers with diagnosis of chronic actinic dermatitis must also submit a valid prescription. Chronic actinic dermatitis associated with adult tcell leukemia. To evaluate demographic data and results of photopatch and patch tests over a 25year period. Chronic actinic dermatitis cad is a persistent eczematous photodermatitis classically described in older, white men with contact allergy to plants. Many patients also have multiple contact allergens. The natural history of chronic actinic dermatitis allergy and. The terms chronic photodermatoses and chronic actinic dermatitis refer to a group of rare photodermatoses with overlapping clinical features that include persistent photosensitivity, a marked predominance in older males, and the presence of erythematous, edematous, and lichenified plaques in areas exposed to light. Cad is characterized by chronic eczema which is usually severe, accentuated in lightexposed sites, persists all year but is worse in summertime. About 70% of patients with cad are expected to have allergic contact dermatitis or photoallergic contact dermatitis pacd. It primarily affects men older than 50 years and is characterized by pruritic eczematous and. Its appearance resembles severe allergic contact dermatitis acd with pruritic, eczematous.
Dupilumab for the treatment of severe photodermatitis. The lesions of cad are characterized as a widespread eczematous eruption with scale, lichenification, and infiltrated plaques occurring on sunexposed skin. We report two male patients, aged 55 years patient a and 49 years patient b, who presented with an eczematous eruption on sun. Diagnosis and treatment of chronic actinic dermatitis dawe 2003. Chronic actinic dermatitis also known as actinic reticuloid, chronic photosensitivity dermatitis, persistent light reactivity, and photosensitive eczema. Objective abnormal photosensitivity to ultraviolet b uvb and often uva and visible light is an essential component of the syndrome. Chronic actinic dermatitis actinic reticuloid cadar is an eczematous hypersensitivity reaction to ultraviolet rays that can vary from mild eczematous cases to ar, the most severe cases which. Research has shown that people with actinic keratoses have an increased risk of developing other types of skin cancer, including basal cell carcinoma and melanoma. We are a participant in the amazon services llc associates program, an affiliate. It is characterized by persistent redness of the face and other exposed areas. However, evidence from recent studies suggests that some demographics of cad patients may be changing. Actinic means caused by sun and dermatitis which is.
Chronic actinic dermatitis website was set up to provide quality information about all the aspects of cad, with highly informative articles. Chronic actinic dermatitis cad, 1 formerly called the photosensitivity dermatitis actinic reticuloid syndrome, 2 occurs across the world. Chronic actinic dermatitis cad is an uncommon inflammatory dermatosis characterized by dermatitis involving ultraviolet uv lightexposed skin with notable sparing of sunprotected areas. Actinic keratoses canadian dermatology association. The intellectual artifact termed chronic actinic dermatitis cad based on the unifying concept of a hypothetical endogenous photoallergen 1 denies the essentially clinical nature of history taking, physical examination, and patch testing in the diagnosis and prevention of contact dermatitis. Patients often suffer from other related conditions of the skin that cause dermatitis in response to a variety of stimuli.
Actinic dermatitis is dermatitis due to exposure to the sun. Increasing experience indicates that these syndromes ta. Chronic actinic dermatitis with leonine facies and iatrogenic adrenal insufficiency successfully treated with topical tacrolimus article pdf available in case reports in dermatology 31. Objectiveto determine the prognosis for resolution of abnormal cutaneous photosensitivity in patients with chronic actinic dermatitis also known as the photose. It occurs in patients of all ethnic groups, but in the united states, it is more commonly seen in darkskinned individuals. Chronic actinic dermatitis cad is persistent light reactivity encompassing actinic reticu loid and photosensitive eczema.
Chronic actinic dermatitis primary care dermatology society. This article is within the scope of wikiproject medicine, which recommends that medicinerelated articles follow the manual of style for medicinerelated articles and that biomedical information in any article use highquality medical sources. Patients with chronic actinic dermatitis cad frequently have positive patch or photopatch tests. It primarily affects men older than 50 years and is characterized by pruritic eczematous and lichenified plaques on sunexposed areas, with notable sparing of skin folds, including submental chin, retroauricular areas and nasolabial folds. Chronic actinic dermatitis is a rare skin disease that mainly affects middleaged and elderly men. The aim of this report is to show the spectrum of presentations of patients with cad and to outline the proper diagnostic workup of these individuals. Cad is being diagnosed in an increasing number of patients at our center. Chronic actinic dermatitis cad is a condition in which the skin becomes inflamed, particularly in areas that have been exposed to sunlight or artificial light. It affects both genders and most often affects elderly men. Chronic actinic dermatitis cad is the term first proposed in 1979 by hawk and magnus to unify the conditions known as persistent light reactivity described by wilkinson in 1961, actinic reticuloid described by ive et al. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease.
Chronic actinic dermatitis is a chronic photodermatosis that occurs most commonly in men in their 60s and 70s. Guidelines published in 2015 for canadian doctors recommend that all actinic keratoses be treated, since it is impossible to predict which ones will develop into skin cancer. Treatment is not standardized and involves topical corticosteroids and immunomodulators, and systemic immunosuppressive agents. Examples include photosensitive atopic dermatitis, chronic actinic dermatitis, polymorphous light eruption, and solar urticaria. It is apparently a chronic, cutaneous reaction mediated by sunlightinduced antigens within the skin. Get the basics on actinic keratosis, a skin condition caused by too much sun exposure, from the experts at webmd. Cad is considered a chronic complaint as it usually lasts for several years. Chronic actinic dermatitis actinic reticuloid cadar is an eczematous hypersensitivity reaction to ultraviolet rays that can vary from mild eczematous cases. 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. Chronic actinic dermatitis cad is a severe form of eczema in which either natural sunlight or artificial light uv is the main causal factor, thus individuals with cad are very sensitive to light. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Persistent light reactivity, photosensitive eczema, photosensitivity dermatitis, or actinic reticuloid.
Chronic actinic dermatitis definition of chronic actinic. Chronic actinic dermatitis cad is an uncommon photosensitive disorder which occurs predominantly in elderly men. Treatment the treatment of choice is thalidomide, the use of which must be examined in depth considering the serious adverse reactions teratogenicity, irreversible neuropathies. Chronic actinic dermatitis primary care dermatology.
Apr 10, 2020 chronic actinic dermatitis cad is a photosensitivity disorder defined by a persistent eczematous reaction of 3 months or greater duration on sunexposed body parts, abnormally low phototest. Chronic actinic dermatitis journal of cutaneous medicine and. Chronic actinic dermatitis cad is one of the previously socalled idiopathic photodermatoses, now preferably called autoimmune photodermatoses. The prognosis for the associated contact allergic dermatitis is even worse, with some predicting chronic actinic dermatitis.
Chronic actinic dermatitis cad is a persistent photodermatosis that usually affects elderly men. Increasing experience indicates that these syndromes table, which were defined 15 or more years ago and generally occur in elderly men, represent arbitrary, confusing, and largely unnecessary subclassifications, and in this issue of the archives lim et al 1 rightly. Contact and photocontact sensitization in chronic actinic. Chronic actinic dermatitis lesley clarkloeser md dermatology online journal 94. To update readers on the current understandings of chronic actinic dermatitis cad in regard to epidemiology, clinical findings, pathophysiology, treatmen cad is classically thought to be primarily a disease of elderly caucasian males, though recent evidence suggests that in skin of color, the disease manifests more often in younger females. The term chronic actinic dermatitis or cad is used to describe an unusual type of eczema or dermatitis that is caused by abnormal skin sensitivity to sunlight photosensitivity. Chronic actinic dermatitis actinic reticuloid cadar is an eczematous hypersensitivity reaction to ultraviolet rays that can vary from mild eczematous cases to ar, the most severe cases which may resemble cutaneous tcell lymphoma. Chronic actinic dermatitis cad, an idiopathic photosensitive dermatosis, is an eczema of the exposed areas induced by uvb, sometimes uva, and occasionally visible light.
We report four cases of chronic actinic dermatitis cad occurring in middleaged men with significant outdoor exposure. That is why it is also known as chronic actinic dermatitis, photosensitive dermatitis, photo sensitive eczema or persistent light reactivity. Actinic dermatitis definition of actinic dermatitis by. If you continue browsing the site, you agree to the use of cookies on this website. Diagnosis is based on clinical, histopathologic, and photobiologic features. Diagnosis and treatment of chronic actinic dermatitis request pdf. Chronic actinic dermatitis treated with mycophenolate. Objective to determine the prognosis for resolution of abnormal cutaneous photosensitivity in patients with chronic actinic dermatitis also known as the photosensitivity dermatitis and actinic reticuloid syndrome.
Comparison of demographic and photobiological features of chronic actinic dermatitis in patients with lighter vs darker skin types. Diagnosis and treatment of chronic actinic dermatitis. Chronic actinic dermatitis differs in lighter versus darker. Abnormal photosensitivity to ultraviolet uv and often visible radiation is a feature. The skin becomes photosensitive and reacts after the exposure of light. Definition of actinic dermatitis in the dictionary. Chronic actinic dermatitis with leonine facies and iatrogenic adrenal insufficiency successfully treated with topical tacrolimus. Chronic actinic dermatitis a study of clinical features request pdf. Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a. Mar 30, 2016 people who have chronic actinic dermatitis cad are extremely sensitive to sunlight or even artificial light and develop redness, inflammation, itching, burning, blistering, and dryness on their skin, especially in areas that are most often exposed to the sun. Actinic dermatitis what is actinic dermatitis it is a skin disorder due to the exposure of uv rays, visible light or sun rays. A clinical study of 15 cases in northern taiwan tzulin hsiao, chiayu chu department of dermatology, national taiwan university hospital and national taiwan university college of medicine, taipei, taiwan. Photodermatoses constitute a heterogenous group of cutaneous conditions caused or exacerbated by ultraviolet radiation andor visible light.
Pdf chronic actinic dermatitis with leonine facies and. The natural history of chronic actinic dermatitis allergy. Chronic actinic dermatitis cad is an immunologically mediated photodermatosis characterized by pruritic eczematous and lichenified plaques located. Lim, in goldmans cecil medicine twenty fourth edition, 2012. Request pdf chronic actinic dermatitis a study of clinical features chronic actinic dermatitis cad, one of the immune mediated photodermatoses.
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