Chronic actinic dermatitis

TY - CHAP

T1 - Chronic actinic dermatitis

AU - Ibbotson, Sally H.

AU - Dawe, Robert S.

N1 - Publisher Copyright: © 2022, Elsevier Inc. All rights reserved.

PY - 2021/10/5

Y1 - 2021/10/5

N2 - Chronic actinic dermatitis (CAD) is an immunological photosensitivity disease, with typically broadband photosensitivity, predominantly involving ultraviolet B (UVB), extending into ultraviolet A (UVA) and sometimes visible parts of the spectrum. The condition typically affects elderly males, although increasingly patients who are younger, female, and often of higher skin phototypes are reported. Accurate diagnosis through clinical assessment and photodiagnostic investigations is essential for management. Photoprotection is a mainstay, with emphasis on environmental and behavioral measures, high sun protection factor, hypoallergenic sunscreens, and advice on window film and artificial lighting choices where indicated. Avoidance of coexistent allergens or photoallergens, which are present in >75% of patients, is also essential, in addition to advice regarding vitamin D supplementation. Suppression of active disease and prevention of flares by minimizing UV exposure underpin longer-term management, with photosensitivity resolving spontaneously in approximately 50%. Management includes topical corticosteroids and immunomodulators for disease suppression and systemic immunosuppressants, such as azathioprine, ciclosporin, or methotrexate, although the evidence base is limited. Cautious UV-based light therapies, in particular psoralen-UVA photochemotherapy, can be effective for disease suppression and desensitization. Combined treatment with systemic corticosteroids may be necessary as phototherapy, particularly UVB, may be difficult to tolerate. With increased understanding of disease mechanisms, more targeted immunomodulation may be beneficial, but minimal evidence with biologics such as dupilumab exists so far, showing only limited impact on CAD photosensitivity.

AB - Chronic actinic dermatitis (CAD) is an immunological photosensitivity disease, with typically broadband photosensitivity, predominantly involving ultraviolet B (UVB), extending into ultraviolet A (UVA) and sometimes visible parts of the spectrum. The condition typically affects elderly males, although increasingly patients who are younger, female, and often of higher skin phototypes are reported. Accurate diagnosis through clinical assessment and photodiagnostic investigations is essential for management. Photoprotection is a mainstay, with emphasis on environmental and behavioral measures, high sun protection factor, hypoallergenic sunscreens, and advice on window film and artificial lighting choices where indicated. Avoidance of coexistent allergens or photoallergens, which are present in >75% of patients, is also essential, in addition to advice regarding vitamin D supplementation. Suppression of active disease and prevention of flares by minimizing UV exposure underpin longer-term management, with photosensitivity resolving spontaneously in approximately 50%. Management includes topical corticosteroids and immunomodulators for disease suppression and systemic immunosuppressants, such as azathioprine, ciclosporin, or methotrexate, although the evidence base is limited. Cautious UV-based light therapies, in particular psoralen-UVA photochemotherapy, can be effective for disease suppression and desensitization. Combined treatment with systemic corticosteroids may be necessary as phototherapy, particularly UVB, may be difficult to tolerate. With increased understanding of disease mechanisms, more targeted immunomodulation may be beneficial, but minimal evidence with biologics such as dupilumab exists so far, showing only limited impact on CAD photosensitivity.

KW - chronic actinic dermatitis

KW - contact allergy

KW - immunological photoprotection photosensitivity

KW - immunosuppression

KW - phototherapy treatment

KW - ultraviolet radiation

KW - UVB

UR - https://www.scopus.com/pages/publications/105042003565

U2 - 10.1016/B978-0-7020-8210-8.00044-0

DO - 10.1016/B978-0-7020-8210-8.00044-0

M3 - Chapter

AN - SCOPUS:105042003565

SN - 9780702069123

SP - 154

EP - 157

BT - Treatment of Skin Disease

A2 - Lebwohl, Mark G

A2 - Heymann, Warren R

A2 - Coulson, Ian H

A2 - Murrell, Dedee F

PB - Elsevier

ER -