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October 1994

Chronic Actinic DermatitisAn Analysis of 51 Patients Evaluated in the United States and Japan

Author Affiliations

From the Dermatology Service, New York (NY) Veterans Affairs Medical Center (Drs Lim, Buchness, and Harris); the Photomedicine Section, Charles C. Harris Skin and Cancer Pavilion, the Ronald O. Perelman Department of Dermatology, New York University School of Medicine (Drs Lim, Buchness, Harris, and Soter); the Department of Dermatology, The Johns Hopkins Medical Institutions, Baltimore, Md (Dr Morison); and the Department of Dermatology, Jikei University School of Medicine, Tokyo, Japan (Dr Kamide).

Arch Dermatol. 1994;130(10):1284-1289. doi:10.1001/archderm.1994.01690100068011

Background and Design:  We studied the clinical and photobiologic features of 51 patients with chronic actinic dermatitis who were evaluated at three institutions. The following criteria for patient selection were used: (1) a persistent eczematous eruption in the sun-exposed areas of greater than 3 months' duration; (2) decreased phototest results; and (3) when available, histologic changes of a dermal infiltrate of lymphocytes and macrophages, with or without epidermal spongiosis and atypical mononuclear cells in the dermis and epidermis.

Results:  The 51 patients had a mean age of 62.7 years, a male-to-female ratio of 2.6:1, and a mean duration of eruption of 5.8 years. The most common abnormal results of the phototests were decreased minimal erythema doses to both UV-A and UV-B, followed by decreased minimal erythema doses to UV-A alone. Patients with abnormally low responses to UV-A or visible light and normal minimal erythema doses to UV-B had the same clinical profile as the overall patient population. Aside from protection from sunlight, treatment modalities that have been used include PUVA (8-methoxypsoralen and UV-A) photochemotherapy, azathioprine, hydroxychloroquine sulfate, and, for recalcitrant cases, cyclosporine.

Conclusions:  Chronic actinic dermatitis is a persistent photodermatosis associated with abnormal phototest responses to UV-A, and/or UV-B, and/or increased sensitivity to visible light; histopathologic changes are consistent with photodermatitis. Treatment consists of combinations of topical and oral medications.(Arch Dermatol. 1994;130:1284-1289)