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.
Key points
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Chronic actinic dermatitis (CAD) is an immunologically mediated photodermatosis characterized by pruritic eczematous lesions of sun-exposed areas.
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Evaluation should include histologic examination, phototesting, and laboratory workup, including human immunodeficiency virus (HIV) test and Sezary count.
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The most common action spectrum is ultraviolet B (UVB) plus ultraviolet A (UVA), although CAD may also be seen with UVB or UVA alone, or with a combination of UVB, UVA, and visible light.
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Management begins with strict photoprotection, topical corticosteroids, and topical calcineurin inhibitors. Other treatments with noted efficacy include oral prednisone, cyclosporine, azathioprine, and mycophenolate mofetil.
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Proper diagnosis and management are essential, as CAD can have a moderate to large impact on quality of life.
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