Actinic reticuloid (AR) is the severest clinical variant of chronic actinic dermatitis (CAD) and describes a persistent photoinduced skin disorder often associated with delayed-type hypersensitivity reactions. Histopathologically, AR resembles pseudolymphoma and may also show features of cutaneous lymphoma. In contrast to other UV-induced skin diseases, AR patients show persistent photosensitivity to UV radiation and visible light parallel to permanent changes of skin texture with infiltrated papules and thickened plaques. Therapeutically, CAD is a problematic condition. Daily application of sun protection has to be combined with local or systemic immunosuppression. However, various therapeutic approaches including systemic corticosteroids and other systemic immunosuppressive agents are limited by severe side effects. Tacrolimus, a Streptomyces-derived immunosuppressive macrolide antibiotic and inhibitor of calcineurin, has been proven successful in vari ous inflammatory skin diseases including atopic eczema, allergic contact dermatitis and photodermatoses without undesired side effects. We present a case of severe recalcitrant and nodular chronic actinic dermatitis responding to topically applied tacrolimus (Protopic®). To avoid further relapses we continued this therapy twice a day over a period of 2 years.

Keywords:
Actinic reticuloid, Chronic actinic dermatitis, Tacrolimus
1.
Ive FA, Magnus IA, Warin RP, Jones EW: Actinic reticuloid: a chronic dermatosis associated with severe photosensitivity and the histological resemblance to lymphoma. Br J Dermatol 1969;81:469–485.
2.
Hawk JLM, Magnus IA: Chronic actinic dermatitis: an idiopathic photosensitivity syndrome including actinic reticuloid and photosensitive eczema. Br J Dermatol 1979;101 (suppl 17):24.
3.
Dawe RS, Crombie IK, Ferguson J: The natural history of chronic actinic dermatitis. Arch Dermatol 2000;136:1215–1220.
4.
Lim HW, Morison WL, Kamide R, et al: Chronic actinic dermatitis: an analysis of 51 patients evaluated in the United States and Japan. Arch Dermatol 1994;130:1284–1289.
5.
Mark KA, Brancaccio RR, Soter NA, et al: Allergic contact and photoallergic dermatitis to plant and pesticide allergens. Arch Dermatol 1999;135:67–70.
6.
Heller P: Chronic actinic dermatitis: an immunohistochemical study of its T-cell antigenic profile, with comparison to cutaneous T-cell lymphoma. Am J Dermatopathol 1994;16:510–512.
7.
Yap LM, Foley P, Crouch R, Baker C: Chronic actinic dermatitis: a retrospective analysis of 44 cases referred to an Australian photobiology clinic. Australas J Dermatol 2003;44:256–262.
8.
Evans AV, Palmer RA, Hawk JLM: Erythrodermic chronic actinic dermatitis responding only to topical tacrolimus. Photodermatol Photoimmunol Photomed 2004;20:59–61.
9.
Uetsu N, Okamoto H, Fujii K, Doi R, Horio T: Treatment of chronic actinic dermatitis with tacrolimus ointment. J Am Acad Dermatol 2002;47:881–884.
10.
Abe R, Shimizu T, Tsuji A, Matsumura T, Shimizu H: Severe refractory chronic actinic dermatitis successfully treated with tacrolimus ointment. Br J Dermatol 2002;147:1273–1275.
11.
Schuster C, Zepter K, Kempf W, Dummer R: Successful treatment of recalcitrant chronic actinic dermatitis with tacrolimus. Dermatology 2004;209:325–328.
12.
Kang S, Lucky A, Pariser D: Long-term safety and efficacy of tacrolimus ointment for the treatment of atopic dermatitis in children. J Am Acad Dermatol 2001;44:58–64.
13.
Patel R, van der Straten MR, Korman NJ: The safety and efficacy of tacrolimus therapy in patients younger than 2 years with atopic dermatitis. Arch Dermatol 2003;139:1184–1186.
14.
Bieber T, Cork M, Ellis C, Girolomoni G, Groves R, Langley R, Luger T, Meurer M, Murrelli D, Orlow S, Paller A, de Prost Y, Puig L, Ring J, Saurat JH, Schwarz T, Shear N, Stingl G, Taïeb A, Thestrup-Pedersen K: Consensus statement on the safety profile of topical calcineurin inhibitors. Dermatology 2005;211:77–78.
15.
Cheer SM, Plosker GL: Tacrolimus ointment: a review of its therapeutic potential as a topical therapy in atopic dermatitis. Am J Clin Dermatol 2001;2:389–406.
16.
Zabawski EJ Jr, Costner M, Cohen J, Cockerell CJ: Tacrolimus: pharmacology and therapeutic uses in dermatology. Int J Dermatol 2000;39:721–727.
17.
Zonneveld M, Rubens A, Jablonska S: Topical tacrolimus is not effective in chronic plaque psoriasis. Arch Dermatol 1998;134:1101–1102.
18.
Tran C, Lübbe J, Sorg O, Doelker L, Carraux P, Antille C, Grand D, Leemans E, Kaya G, Saurat J-H: Topical calcineurin inhibitors decrease the production of UVB-induced thymine dimers from hairless mouse epidermis. Dermatology 2005;211:341–347.
© 2006 S. Karger AG, Basel
2006
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