Actinic reticuloidL57.1

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Actinic erythroderma; actinic reticuloid; Actinoreticulosis; Chronic actinic dermatitis; Reticuloid actinic

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HistoryThis section has been translated automatically.

Ive, 1969

DefinitionThis section has been translated automatically.

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.

Clinical featuresThis section has been translated automatically.

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.

TherapyThis section has been translated automatically.

Step-by-step plan:
  1. local glucocorticoids
  2. Light stabilizers
  3. Light-hardening
  4. Chloroquine (+ internal prednisolone)
  5. Azathioprine (+ internal prednisolone)
  6. Ciclosporin A. (+ internal prednisolone)
Accompanying: beta-carotene or nicotinamide.

General therapyThis section has been translated automatically.

  • 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.

External therapyThis section has been translated automatically.

Acute treatment of the inflammatory areas with weakly effective glucocorticoids, e.g. 0.5% hydrocortisone cream R121, 0.1% hydrocortisone butyrate (e.g. Alfason cream), 0.1% betamethasone ointment.

Radiation therapyThis section has been translated automatically.

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.

Internal therapyThis section has been translated automatically.

  • 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).

TablesThis section has been translated automatically.

Photoallergenic substances

Substance

Occurrence

External application

Hexachlorophen

Disinfectants

Bithionol

Disinfectants

Musk

Fragrance

paraaminobenzoic acid

Sunscreen (UVB range)

4-isopropyldibenzoylmethane

Sunscreen products

2-hydroxy-4-methoxybenzophenone

Sunscreen products

p-Methoxycinnamic acid isoamyl ester

Sunscreen products

Halogenated salicylanilides

Soaps, disinfectants

Tetracyclines

Acne preparations

Systemic application

Tetracyclines

antibiotic

Tiaprofenic acid

Antirheumatic agent

Quinidine

Antiarrhythmics

Promethazine

Psychotropic drug

Hydrochlorothiazide

Diuretic

Carbamazepine

anti-epileptic drug

Phenytoin

anti-epileptic/antiarrhythmic agent

Sulfonamides

antibiotic

LiteratureThis section has been translated automatically.

  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

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Last updated on: 29.10.2020