Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
Practice

Chronic actinic dermatitis

Christina M. Huang and Yuka Asai
CMAJ March 12, 2018 190 (10) E297; DOI: https://doi.org/10.1503/cmaj.171111
Christina M. Huang
School of Medicine (Huang); Division of Dermatology (Asai), Department of Medicine, Queen’s University, Kingston, Ont.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yuka Asai
School of Medicine (Huang); Division of Dermatology (Asai), Department of Medicine, Queen’s University, Kingston, Ont.
MD MSc
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

A 60-year-old man presented to our dermatology clinic with a photodistributed, eczematous eruption of the face, neck and arms (Figure 1). He had red hair and blue eyes, and worked as a mechanic. He had a history of eczema, asthma and hayfever with allergies to grass, tree, ragweed and flower pollen. He had been prescribed topical desoximetasone, and oral diphenhydramine, cetirizine and prednisone, with little effect. His presentation, age, gender and history were suggestive of chronic actinic dermatitis.

Figure 1:
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1:

Chronic actinic dermatitis in a 60-year-old man with typical photo-distribution, affecting areas of his face and neck that were exposed to light while sparing the skin underneath the chin and the nasolabial folds.

The patient underwent patch testing, and he was positive to tixocortol pivalate (2+), relevant to his cortisone cream; decyl glucoside (3+), a preservative in his sunscreen; and bisphenol A epoxy resin (3+), which was present in his workplace. Phototesting showed a minimal erythema dose of less than 5 J/cm2 to ultraviolet A and less than 0.05 J/cm2 to broadband ultraviolet B. In the clinic where testing was completed, these scores were considered low for his skin type (Fitzpatrick skin type 3) and suggested photosensitivity to both ultraviolet A (which can penetrate window glass) and B. The result of a subsequent photopatch test using ultraviolet A (at 3 J/cm2) was negative. He also had a skin biopsy to rule out cutaneous T-cell lymphoma. He was diagnosed with chronic actinic dermatitis.

In addition to strict sun avoidance and photoprotective garments (Appendix 1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.171111/-/DC1), the patient failed or was unable to tolerate topical therapies and several steroid-sparing agents (acitretin, cyclosporine, methotrexate, azathioprine). He required additional prednisone for flares of his condition. The severity of his disease led him to quit his job. To prevent exacerbations, he stopped pastimes such as biking, and limited his daytime activities, leading to social isolation. After multiple failures of therapy — well described in patients with chronic actinic dermatitis — the use of mycophenolic acid (180 mg taken orally three times daily) and prednisone, along with strict sun avoidance and protective garments, eventually allowed him to control his condition enough to resume daily activities of living. His head covering, however, resulted in a publicized misunderstanding with the police.1

Chronic actinic dermatitis is an immune-mediated reaction to sun or artificial light, often accompanied by contact allergies.2 It is uncommon but may be underrecognized; it has been reported in the United States, Europe, Asia and Africa. It primarily affects men older than 50 years and is characterized by pruritic eczematous and lichenified plaques on sun-exposed areas, with notable sparing of skin folds, including submental chin, retroauricular areas and nasolabial folds.2 Careful history, examination and workup is essential, because many conditions may mimic chronic actinic dermatitis, including drug eruption, allergic or photoallergic contact dermatitis, cutaneous T-cell lymphoma and connective tissue diseases.2 In addition to itchy and painful eruptions and the adverse effects of treatment, light-sensitive disorders can result in social isolation, loss of work, decreased self-esteem and social stigma.

Acknowledgements

The authors thank Drs. M. Pratt and S. Glassman for their help with patch- and phototesting of this case.

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • The authors have obtained patient consent.

References

  1. ↵
    1. McEwen T
    . Port Hope Police takedown of man in mask deemed misunderstanding in Northumberland. Northumberland News [Cobourg (ON)] 2016 Aug. 11. Available: www.northumberlandnews.com/news-story/6805571-port-hope-police-takedown-of-man-in-mask-deemed-misunderstanding-in-northumberland/ (accessed 2017 Sept. 10).
  2. ↵
    1. Paek SY,
    2. Lim HW
    . Chronic actinic dermatitis. Dermatol Clin 2014;32:355–61.
    OpenUrl
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 190 (10)
CMAJ
Vol. 190, Issue 10
12 Mar 2018
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Chronic actinic dermatitis
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Chronic actinic dermatitis
Christina M. Huang, Yuka Asai
CMAJ Mar 2018, 190 (10) E297; DOI: 10.1503/cmaj.171111

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Chronic actinic dermatitis
Christina M. Huang, Yuka Asai
CMAJ Mar 2018, 190 (10) E297; DOI: 10.1503/cmaj.171111
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • SARS-CoV-2 vaccination in pregnancy
  • Infantile perianal pyramidal protrusion
  • Topical nonsteroidal anti-inflammatory drugs
Show more Practice

Similar Articles

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire