A Cross-Sectional with Retrospective Review of Chronic
Actinic Dermatitis: A Rare Photodermatosis in Thailand
Alita Sombatmaithai MD1, Narumol Silpa-archa MD1, Chanisada Wongpraparut MD1
Affiliation :
1 Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Chronic actinic dermatitis [CAD] is an idiopathic photodermatosis that has been reported worldwide and occurs
mainly in elderly men with a history of chronic exposure to sunlight.
Objective : To investigate the clinical characteristics, photobiological characteristics, and treatment outcomes of CAD patients in
Thailand.
Materials and Methods : The present study was cross-sectional retrospective chart review conducted in patients that underwent
phototesting at the Photodermatology clinic of Siriraj Hospital between 1997 and 2013. Data were collected from patient medical
records and follow-up telephone interviews. Complete response was de(cid:976)ined as 100% clinical improvement, and partial response
was de(cid:976)ined as 25% to 99% clinical improvement.
Results : Forty-(cid:976)ive patients were included, of which 39 (86%) were male and six (14%) were female. The mean age was 57.5 (range
28 to 84) years. More than half of patients (51%) had decreased minimal erythema dose [MED] to both ultraviolet [UV] A and UVB,
while 18 patients (40%) had decreased MED to UVB alone and four patients (9%) had decreased MED to UVA alone. Eleven patients
(24%) had extensive skin involvement beyond the sun-exposed area. All patients showed some degree of clinical improvement
after initiation of photoprotection and medical treatment. Analysis of clinical course was available in 35 patients, with a mean ±
standard deviation follow-up duration of 24.5 (range 1 to 72) months. Six patients (17%) achieved complete response and
29 patients (83%) showed partial response to treatment. In the complete response group, the mean duration of disease was
19.67±15.15 (range 3 to 40) months and no systemic medication was required. Systemic corticosteroids and/or immunosuppressants
were required in severe patients, particularly in patients who had exfoliative dermatitis or leonine facies. In patients with recalcitrant
facial lesions, 0.1% tacrolimus ointment showed a promising response.
Conclusion : CAD had a chronic course in the present study and only a minority of patients achieved complete response. In severe
cases, lesions demonstrated a tendency to spread beyond the sun-exposed areas. UVA and UVB were the most common action
spectra. In patients with recalcitrant disease, 0.1% tacrolimus ointment should be considered, especially in patients with facial
lesions.
Keywords : Chronic actinic dermatitis, Photodermatosis, Photosensitivity, Thailand
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