17 - 95 - ACTINIC DERMATITIS

Question 1

rare, acquired, persistent eczematous eruption of exposed skin, sometimes having pseudolymphomatous (reticuloid) features

Answer 1

CHRONIC ACTINIC DERMATITIS

Question 2

Answer 2

Question 3

Answer 3

The lesions of CAD are eczematous, patchy or confluent, and acute, subacute, or chronic (Figs. 95-1 and 95-2).

Question 4

what areas are usually spared in chronic actinic dermatitis?

Answer 4

There is sparing of deep skin creases, upper eyelids, finger webs, and skin behind the earlobes

Question 5

Question 6

Several dermatoses that are not caused by UVR may be worsened by it. Mechanisms of this phenomenon is called ______

Answer 6

photoexacerbation

Question 7

Diseases Sometimes Exacerbated by Ultraviolet Irradiation

Answer 7

Question 8

Question 9

Patients with abnormal photosensitivity present in 3 ways:

Answer 9

(a) sporadic or (b) persistent eruptions in sunlight-exposed areas (Fig. 95-4), or, infrequently, (c) erythroderma.

Question 10

An eruption appearing in minutes and remitting within 2 hours suggests ______

Answer 10

solar urticaria or, occasionally, photosensitivity to drugs, such as amiodarone

Question 11

Onset within 20 minutes to several hours, with resolution over days suggests ________

Answer 11

PLE/PMLE, HV, erythropoietic protoporphyria, cutaneous lupus erythematosus, or other photoexacerbated dermatoses, or other drug photosensitivities, such as to thiazides

Question 12

Question 13

Phototesting falls into 2 categories:

Answer 13

(a) monochromator phototesting (testing to wavebands, it is not strictly monochromatic, produced by an irradiation monochromator), usually of the upper back with selected wavebands and selected doses to identify the action spectrum for the disorder and to provoke the eruption (frequently responses at 24 hours and later after irradiating small circles of back skin with a monochromator look eczematous in CAD), and
(b) photoprovocation with a broad-spectrum source to induce the eruption for its clinical appearance and subsequent biopsy if indicated

Question 14

Edilberto is a 75 year old male retired gardener who came in to your clinic with a chief complaint of pruritic plaques on the neck and forearms with sparing of deep skin creases. With the diagnosis in mind, which one is a close differential?

a. Cutaneous T-Cell Lymphoma

b. Polymorphic light eruption

c. Hydroa Vacciniforme

d. Solar urticaria

Answer 14

A

Question 15

Edilberto is a 75 year old male retired gardener who came in to your clinic with a chief complaint of pruritic plaques on the neck and forearms with sparing of deep skin creases.

Which is TRUE about Edilberto’s case?

a. It usually involves severe sensitivity to UVA

b. It affects older men, women and children

c. It is likely the result of a Type 1 hypersensitivity reaction against an endogenous photoinduced antigen

d. All of the above are true

Answer 15

B

Question 16

Edilberto is a 75 year old male retired gardener who came in to your clinic with a chief complaint of pruritic plaques on the neck and forearms with sparing of deep skin creases.

Which is FALSE regarding Edilberto’s case?

a. Once established, this usually persists for years before resolving gradually.

b. Phototesting is essential to make the diagnosis in his case

c. Phototesting should be done on the involved skin on the arms with no topical or oral steroid medications prior to testing

d. Assessment of lupus antibodies is usually done to exclude cutaneous lupus erythematosus

Answer 16

C

Question 17

Edilberto is a 75 year old male retired gardener who came in to your clinic with a chief complaint of pruritic plaques on the neck and forearms with sparing of deep skin creases.

What blood tests can you ask Edilberto to do to rule out other possible causes?

a. Serum Immunoglobulin E

b. HIV testing

c. Lupus autoantibodies

d. All of the above

Answer 17

D