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Jang, Lee, Han, Park, Kang, Kim, and Suh: Clinical Features and Histological Findings of 17 Patients with Chronic Actinic Dermatitis
Original Article

Kosin Medical Journal 2013;28(2):145-153.

Published online: 19 January 2013

DOI: https://doi.org/10.7180/kmj.2013.28.2.145

Clinical Features and Histological Findings of 17 Patients with Chronic Actinic Dermatitis

Min Soo Jang, Kang Hoon Lee, Sang Hwa Han, Jong Bin Park, Dong Young Kang, Sang Tae Kim, Kee Suck Suh

Department of Dermatology, College of Medicine, Kosin University, Busan, Korea

Corresponding author: Kee Suck Suh, Department of Dermatology, College of Medicine, Kosin University, 34 Amnamdong, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6145 FAX: +82-51-990-3041 E-mail: ksderm98@unitel.co.kr

Received 18 July 201324 September 2013       Accepted 24 September 2013

Copyright © 2013 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

This study was designed to evaluate the clinical, histological and immunohistochemical findings and treatment of chronic actinic dermatitis in Korean patients.

Methods

Seventeen Korean patients with chronic actinic dermatitis were enrolled for this study. The clinical and histological findings and the results of phototest were reviewed with medical records, clinical photographs and pathologic slides. We also reviewed the effectiveness of the treatments in all patients with chronic actinic dermatitis.

Results

In all patients with chronic actinic dermatitis, pruritus was severe, and the patients present in the early stages with erythemas on the face, neck and the back of the hands. As the eruption progresses, it became lichenified and scaly plaques and papules developed. The face, upper extremity and neck were most commonly affected. The most common abnormal results of the phototests were decreased MED-UVB alone. In 8 patients with actinic reticuloid, histopathologic findings showed irregular acanthosis, parakeratosis, spongiosis, atypical hyperchromatic cells with cerebriform nuclei, epidermotropism, Pautrier-like microabscess, deep perivascular lymphocytic infiltrates, vertically-streaked collagen in the papillary dermis, stellate and multinucleated fibroblasts. Treatment includes topical tacrolimus and corticosteroid, oral corticosteroid, azathioprine and cyclosporine.

Conclusions

Our study showed classic clinical and histological findings. The most common abnormal results of the phototests were decreased MED-UVB alone. Topical steroid, tacrolimus and systemic cyclosporine, azathioprine are effective in treating chronic actinic dermatitis.

Keywords: Chronic actinic dermatitis, Clinical features, Histological findings

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Fig. 1.
(A) Irregular acanthosis, and lymphocytic infiltration in the papillary dermis and reticular dermis (H&E, x 40), (B) Epidermotropism, irregular acanthosis and a perivascular infiltrate of the papillary dermis (H&E, x 100) (Case 16).
kmj-28-145f1.tif
Fig. 2.
Immunohistochemical studies showed that CD4 positive T cells (A) and CD8 positive T cells (B) were in the epidermis and dermis (x 100). CD8 positive T cells predominated in the epidermis (B) compared to CD4 positive T cells (A). (Case 6).
kmj-28-145f2.tif
Fig. 3.
Immunohistochemical studies showed that CD4 positive T cells (A) and CD8 positive T cells (B) were in the epidermis and dermis (x 100). CD8 positive T cells predominated in the epidermis (B) compared to CD4 positive T cells (A). (Case 6).
kmj-28-145f3.tif
Fig. 4.
Immunohistochemical studies showed that CD4 positive T cells (A) and CD8 positive T cells (B) were in the epidermis and dermis (x 100). CD8 positive T cells predominated in the epidermis (B) compared to CD4 positive T cells (A). (Case 6).
kmj-28-145f4.tif
Table 1.
Summary of clinical characteristics in patients with chronic actinic dermatitis
Case Sex Age (yr) Fitzpatrick skin type Duration Site
 Occupation
Face Neck Upper extremities
1 M 27 III 10 years ○ ○ ○ (forearm) Student
2 M 74 III 2 years ○ ○ ○ (hand) Unknown
3 M 64 IV 2 years ○ ○ Farmer
4 M 54 III 1 year ○ ○ ○ Office worker
5 M 57 IV 6 months ○ ○ (hand) Office worker
6 F 46 III 1 year ○ House wife
7 M 67 IV 10 years ○ ○ ○ (hand) Farmer
8 M 50 IV 2 years ○ ○ Office worker
9 F 54 III 7 months ○ House wife
10 M 56 IV 8 months ○ Office worker
11 M 61 III 4 years ○ ○ ○ Office worker
12 M 72 III 1 year ○ Farmer
13 M 61 III 1 year ○ Unknown
14 M 69 IV 10 years ○ ○ ○ Laborer
15 M 60 IV 4 years ○ Unknown
16 M 67 IV 4 years ○ ○ (forearm) Farmer
17 M 60 IV 1 year ○ ○ ○ Unknown
Table 2.
Results of phototests in patients with chronic actinic dermatitis
Case Minimal Erythema Dose
 Visible light
UVA (J/cm2) UVB (mJ/cm2)
1 >40 35 NR
2 35 >40 NR
3 >40 30 NR
4 >40 35 NR
5 >40 30 NR
6 35 25 NR
7 30 35 NR
8 30 25 NR
9 >40 35 NR
10 >40 30 NR
11 >40 35 NR
12 35 >40 NR
13 30 >40 NR
14 35 >40 NR
15 35 >40 NR
16 >40 30 NR
17 35 30 NR

NR, non reactive

Table 3.
Results of photopatch tests in patients with chronic actinic dermatitis
Case 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Photo
patch test		 - DN DN - - - DN - DN - DN - DN DN DN DN DN

DN, data not shown.

Table 4.
Summary of treatment in patients with chronic actinic dermatitis
Number Treatment Clinical response of skin lesions and pruritus
1 Oral azathioprine, oral steroid Partial improvement
2 Oral azathioprine, oral steroid, topical steroid Partial improvement
3 Oral azathioprine, oral steroid, topical tacrolimus Complete improvement
4 Topical steroid Partial improvement
5 Topical steroid Partial improvement
6 Oral azathioprine, oral steroid, topical tacrolimus Partial improvement
7 Oral cyclosprine, topical steroid Complete improvement
8 Oral cyclosprine, topical steroid Partial improvement
9 Oral cyclosprine, topical tacrolimus Partial improvement
10 Oral cyclosprine, topical steroid Complete improvement
11 Oral cyclosprine, topical steroid Complete improvement
12 Oral cyclosprine, topical steroid Complete improvement
13 Topical steroid Partial improvement
14 Oral cyclosprine, topical tacrolimus Complete improvement
15 Oral cyclosprine, topical steroid Partial improvement
16 Oral cyclosprine, topical steroid Partial improvement
17 Oral cyclosprine Partial improvement
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