Chronic Actinic Dermatitis: Clinical Cases, Diagnostic Workup, and Therapeutic Management

Abstract

Background: We report four cases of chronic actinic dermatitis (CAD) occurring in middle-aged men with significant outdoor exposure. Objective: The aim of this report is to show the spectrum of presentations of patients with CAD and to outline the proper diagnostic workup of these individuals. Methods: Phototesting was performed to determine the minimal erythema doses to ultraviolet (UV)A (315–400 nm) and UVB (280–315 nm) and photopatch testing and patch testing for each individual with the North American Contact Dermatitis Group Standard series and the Chemotechnique Plant series, supplemented by the Hausen Plant series and the patients' own products. Results: All patients were men, over 45 years, who worked outdoors or had outdoor hobbies. Two had a past known history of allergic contact dermatitis. Two had atopic dermatitis. Three had positive reactions to Compositae plants and sesquiterpene lactone; one had a reaction to lichen acid mix. All had photocontact dermatitis or contact dermatitis to sunscreen chemicals, including benzophenone 3 (oxybenzone), butyl methoxydibenzoylmethane (avobenzone), and ethylhexyl methoxycinnamate (octinoxate). All reacted to fragrance mix; two reacted to balsam of Peru and two to colophony. All had biopsies showing an eczematous pattern. Conclusion: CAD is persistent, with a classic presentation, and requires a specific diagnostic workup. Effective therapeutic options exist for patients with CAD.