Actinic reticuloid L57.1

Chronic dermatitis in light-exposed areas of the skin with extremely low erythema threshold (UVA and UVB), which occurs mainly in older men; this very specific chronic dermatitis is considered a particularly severe subtype of chronic actinic dermatitis.

Mostly extensive, massively itchy, also painful, chronic eczematous skin changes with considerable lichenification and clear infiltration of the skin, which leads to a leather-like increase in the consistency of the lesioned skin, become apparent. The skin lesions are clearly demarcated from the unexposed skin, whereby this transition is not sharply linear, but irregularly loosened with "scattering phenomena". Ectropion (which is clinically very disabling) often occurs in the case of eyelid infestation and requires constant ophthalmological therapy.

The skin changes persist for months after low UV exposure, can subside in winter and then exacerbate and persist again in spring after brief UV exposure. After a number of years, this rhythm is lost and the eczematous skin changes persist throughout the year, with an additional worsening of the chronic eczema condition occurring during the light-rich season.

A Facies leontina as maximum expression of the actinic reticuloid in the facial area is possible.

Furthermore, in rare cases of high light sensitization, the eczematous event can also affect the entire integument with development of erythroderma.

Very rarely a transition into a malignant lymphoma of the T-cell type has been reported. This statement may not be regarded as confirmed.

Remark: See below for further illustrations Dermatitis chronic actinic.

1. local glucocorticoids
2. Light stabilizers
3. Light-hardening
4. Chloroquine (+ internal prednisolone)
5. Azathioprine (+ internal prednisolone)
6. Ciclosporin A. (+ internal prednisolone)

• Light protection: Strict avoidance of UV radiation, if necessary also of visible light (determination of the action spectrum by photo provocation tests). Consistent textile and physical/chemical light protection (e.g. Anthelios, Eucerin Sun, see also light protection agents), if necessary tinted lotions and/or make-up.
• Avoidance of photosensitizing substances (carbamazepine, phenytoin, phenothiazines, hydrochlorothiazide, tetracyclines, quinidine etc.), see Table 1.

Light-hardening: If light protection is not sufficient, a so-called light-hardening with a very cautious UVA dosage such as 0.1 J/cm2 (as a medium UVA dosage) or a PUVA therapy can be initiated.

In the first two weeks of light-hardening with PUVA therapy, a combination with glucocorticoids in a medium dosage(prednisolone: 40-80 mg/day) should be applied; afterwards, a rapid balancing should be carried out. In the course of the treatment, maintenance therapy can be carried out at 4-week intervals. In a long-term study, 20% of patients showed normalized photosensitivity after 10 years (!), 50% after 15 years.

• Chloroquine: If light-hardening is unsuccessful, short-term therapy with chloroquine (e.g. Resochin) once/day 250 mg or hydroxychloroquine (e.g. Quensyl) twice/day 200 mg p.o.
• Azathioprine/glucocorticoids: If necessary, also attempt an immunosuppressive therapy with azathioprin 100 mg/kg bw/day p.o. in combination with glucocorticoids such as methylprednisolone (e.g. Urbason) 40-80 mg/day p.o. (maintenance dose 4-8 mg/day).
• Ciclosporin A/Glucocorticoids: Trial of an immunosuppressive alternative with Ciclosporin A 1.5 mg/kg bw/day p.o. in combination with glucocorticoids such as methylprednisolone (e.g. Urbason: dosage as before)
• Accompanying therapy: beta-carotene (e.g. carotaben cps.) or nicotinamide (e.g. nicotinamide 200 mg Jenapharm).

Photoallergenic substances

1. Angeletti F (2016) Actinic reticuloid. Nude Dermatol 42: 482
2. Dawe RS et al (2003) Diagnosis and treatment of chronic actinic dermatitis. Dermatol Ther 16: 45-51
3. Gramvussakis S et al (2000) Chronic actinic dermatitis (photosensitivity dermatitis/actinic reticuloid syndrome): beneficial effect from hydroxyurea. Br J Dermatol 143: 1340
4. Ive FA, Magnus IA, Warin RP, Jones EW (1969) "Actinic reticuloid"; a chronic dermatosis associated with severe photosensitivity and the histological resemblance to lymphoma. Br J Dermatol 81: 469-485
5. Zak-Prelich M et al (1999) Actinic reticuloid. Int J Dermatol 38: 335-342