Radiation dermatitis an overview sciencedirect topics. These growths are more common in fairskinned people and those who are frequently in the sun. Radiation dermatitis is most directly related to increased dose inhomogeneity, which itself is a function of increasing breast size or chest wall diameter. A variety of skin responses to ultraviolet irradiation in patients with atopic dermatitis. Chronic actinic dermatitis is a chronic photodermatosis that occurs most commonly in men in their 60s and 70s. 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.
Histopathology consistent with chronic eczema with or without lymphoma like changes, and. Histopathology four patients had skin biopsies taken from areas of existing dermatitis. The reactions cause inflammation, sunburns and occur on sensitized skin, where the sensitizers could be both external and internal agents. The term actinic keratosis can be literally understood as a disorder of epidermal keratinocytes that is induced by ultraviolet uv light exposure. Photosensitive atopic dermatitis exacerbated by uvb. Chronic actinic dermatitis a study of clinical features.
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. Over those years, pinsized papules had developed into dark nodules. Results from two biopsies will be available next week. Multiple biopsies of both fresh and mature papulonodules had been performed for routine histopathology and electron microscopy. Chronic actinic dermatitis primary care dermatology. Patients one hundred seventyeight patients with chronic actinic dermatitis. 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. Chronic actinic dermatitis lesley clarkloeser md dermatology online journal 94. Provide a patient information leaflet on chronic actinic dermatitis. Radiation dermatitis presents at the site of previous radiotherapy for cancer or following accidental exposure to radiation. Chronic acquired dyskeratotic papulosis of the face mdedge. For phototesting, and possibly patch testing some of these patients will have an airbourne. Chronic actinic dermatitis definition of chronic actinic.
Chronic actinic dermatitis cad, one of the immune mediated photodermatoses, comprises a spectrum of conditions including persistent light reactivity, photosensitive eczema and actinic reticuloid. Photosensitive atopic dermatitis exacerbated by uvb exposure. Based on clinical examination histology chronic eczema with or without lymphoma like changes. Chronic actinic dermatitisa study of clinical features. 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 is a rare skin disease that mainly affects middleaged and elderly men. In this study, we characterize the histopathologic and immunohistochemical. Buildup of excessive keratin due to chronic exposure to sunlight on sunexposed sites face, arms, dorsum of hands called actinic cheilitis in lips may become invasive with only a single layer of atypical keratinocytes risk factors. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology. The condition is also known as chronic photosensitivity. Actinic dermatitis is dermatitis due to exposure to the sun. 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 cad is a chronic photodermatosis commonly affecting patients with skin of color.
Clinical findings, histopathologic features, and phototests were consistent with a diagnosis of chronic actinic dermatitis. Chronic actinic dermatitis cad, previously photosensitivity dermatitis actinic reticuloid pdar syndrome, is a chronic dermatitis sometimes with pseudoreticuloid features predominantly of photoexposed sites. 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. Results had been positive for spongiosis with exocytosis, acanthosis, dyskeratotic keratinocytes, and marked incontinence of pigment, which together are suggestive of a previously unreported clinical entity that we. Chronic actinic dermatitisactinic reticuloid request pdf. Chronic actinic dermatitis cad is a severe, socially disabling and intractable photosensitive disorder particularly affecting elderly men. That is why it is also known as chronic actinic dermatitis, photosensitive dermatitis, photo sensitive eczema or persistent light reactivity.
Chronic actinic dermatitis cad is a severe photosensitivity disease. A vietnam veteran who had been exposed to agent orange presented with a 28year history of a papulonodular disease mainly affecting the face. The characteristic atopic reaction to patch tests with human dander and the naturally occurring lesions of the disease atopic dermatitis resemble each other grossly in the occurrence of papules, papulovesicles, redness and slight desquamation and in. Diagnostic criteria were laid down about 20 years back, but clinical features are the mainstay in diagnosis.
Chronic acquired dyskeratotic papulosis of the face. Chronic actinic dermatitis also known as actinic reticuloid, chronic photosensitivity dermatitis, persistent light reactivity, and photosensitive eczema. Diagnosis is based on clinical, histopathologic, and photobiologic features. My doctors have declared a working diagnosis meaning guess of chronic actinic dermatitis, although i do not fit the typical profile of middleaged to elderly male. Acute, subacute or chronic spongiotic dermatitis in acute lesions, there is focal, usually mild, spongiosis with overlying scale crust containing a few neutrophils. Cad is considered a chronic complaint as it usually lasts for several years. Lim, in goldmans cecil medicine twenty fourth edition, 2012. Chronic actinic dermatitis an overview sciencedirect topics. 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. Clinical features and histological findings of 17 patients with chronic actinic dermatitis. Chronic radiation dermatitis shows dermal sclerosis, elastosis and vascular ectasia overlying an epidermis which is often hyperkeratotic figure 1. Patients often suffer from other related conditions of the skin that. 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 a study of clinical features core.
Chronic actinic dermatitis cad is an idiopathic photosensitive dermatosis. In addition to extreme sensitivity to uvb, uva andor visible light, about. Cad is chronic, that is to say it typically persists for a number of years. 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. Spongiotic dermatitis may be a feature of eczema, atopic dermatitis, seborrheic dermatitis, and other allergic skin reactions. It occurs mostly in people who are allergic to sensitizers, such. Chronic actinic dermatitis an overview sciencedirect. Actinic dermatitis what is actinic dermatitis it is a skin disorder due to the exposure of uv rays, visible light or sun rays. What is chronic actinic dermatitis chronic actinic dermatitis is a rare skin condition that mainly affects men over the age of 50 years. Photobiologic reduction in med of uvb, uva on normal skin. The lesions of cad are characterized as a widespread eczematous eruption with scale, lichenification, and infiltrated plaques occurring on sunexposed skin. Reduction in the minimal erythema dose med to both uvb and. Patients with chronic actinic dermatitis cad, 1 also known as the photosensitivity dermatitis and actinic reticuloid syndrome, 2 are abnormally photosensitive to uv uvb and uva and often visible wavelengths.
The term chronic actinic dermatitis is being used increasingly for this group of chronic photodermatoses. The natural history of chronic actinic dermatitis allergy. The skin becomes photosensitive and reacts after the exposure of light. Chronic actinic dermatitis cad is a photosensitivity disorder defined by a persistent eczematous reaction of 3 months or greater duration on sun. The histopathologic features in the early stages are comparable to contact dermatitis.
Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology reference and guide. The lesions of cad are characterized as a widespread eczematous eruption with scale, lichenification, and. A 52yearold man experienced a pruritic and erythematous eruption on his face, neck, upper chest, and arms. Studies from europe reported that most patients also have allergic contact dermatitis, 36 although this has been detected in a lower proportion in a north american series.
Chronic actinic dermatitis cad comprises a broad range of abnormal reactions of the skin to ultra violet or other visible light radiation. Chronic actinic dermatitis cad, previously photosensitivity dermatitisactinic reticuloid pdar syndrome, is a chronic dermatitis sometimes with pseudoreticuloid features predominantly of photoexposed sites. The histologies of acute ap and polymorphous light eruption ple. Clinical features and histological findings of 17 patients with. Jul 31, 20 dermatopathology reference describes actinic reticuloid histopathology including histologic features and provides links to additional medical references. Chronic actinic dermatitis is a persistent photodermatitis, likely resulting from a delayed hypersensitivity reaction. Chronic actinic dermatitisactinic 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 article about chronic actinic. Chronic actinic dermatitis has been described in european, american, and asian populations.
Many patients also have multiple contact allergens. Chronic actinic dermatitis a study of clinical features somani vk. Actinic means caused by sun and dermatitis which is. The characteristic atopic reaction to patch tests with human dander and the naturally occurring lesions of the disease atopic dermatitis resemble each other grossly in the occurrence of papules, papulovesicles, redness and slight desquamation and in their chronologic development and retrogression.
Comparison of demographic and photobiological features of chronic actinic dermatitis in patients with lighter vs darker skin types. Patients often suffer from other related conditions of the skin that cause dermatitis in response to a variety of stimuli e. Chronic actinic dermatitis with leonine facies and iatrogenic. 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. Chronic actinic dermatitis is a rare skin condition that mainly affects men over the age of 50 years. Chronic actinic dermatitis primary care dermatology society. In the meantime, i have been reading about this condition and i do not have the rash. Perelman department of dermatology, new york university abstract. It affects both genders and most often affects elderly men. Ten patients had acute dermatitis and six had chronic dermatitis. Actinic keratosis ak, sometimes called solar keratosis or senile keratosis, is a precancerous area of thick, scaly, or crusty skin. The natural history of chronic actinic dermatitis allergy and. 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. Histopathology, patch testing and photoaggravation testing were also performed.
Chronic actinic dermatitis, synonymous with the photosensitivity dermatitis and actinic reticuloid syndrome, presents as a dermatitis andor a pseudolymphomatous eruption. Chronic actinic dermatitisactinic reticuloid cadar is an eczematous hypersensitivity reaction to ultraviolet rays that can vary from mild eczematous cases to ar, the most severe cases which. It occurs in patients of all ethnic groups, but in the united states, it is more commonly seen in darkskinned individuals. Actinic prurigo ap is an idiopathic familial photodermatosis seen in american indians.
Actinic dermatitis article about actinic dermatitis by. Actinic reticuloid persistent light reactors photosensitivity dermatitis and eczema diagnosis. Diagnosis and treatment of chronic actinic dermatitis. Actinic dermatitis definition of actinic dermatitis by. Results had been positive for spongiosis with exocytosis. Chronic actinic dermatitis cad, an idiopathic photosensitive dermatosis, is an eczema of the exposed areas induced by uvb. 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. Provide a patient information leaflet on uv protection for more information on sunscreen, including the dundee formulation, refer to the related chapter on photodermatoses. The photosensitivity dermatitis and actinic reticuloid syndrome chronic actinic dermatitis occurring in seven young atopic dermatitis patients. Key differences identified between actinic keratosis and cutaneous squamous cell carcinoma by transcriptome profiling.
Fair skin, ionizing radiation, hydrocarbon or arsenic exposure, renal transplant variants. Abnormal photosensitivity to ultraviolet uv and often visible radiation is a feature. Aldehyde dehydrogenase 1 expression in basal cell carcinoma, actinic keratosis and bowens disease. Lumican as a novel marker for differential diagnosis of bowen disease and actinic keratosis. Objective abnormal photosensitivity to ultraviolet b uvb and often uva and visible light is an essential component of the syndrome.
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