Successful treatment of chronic actinic dermatitis with topical pimecrolimus.

摘要

Chronic actinic dermatitis is a rare photodermatosis with abnormal phototesting to ultraviolet or visible light. Exogenous photosensitizers cannot be identified, and this condition is more commonly found in older men.A 65-year-old White man was examined in our outpatient clinic. Fifteen months ago, at the end of spring, he noticed a pruritic eruption, which was more intense on his sun-exposed skin. He did not use any continuous medication or fragances. Skin examination showed erythema with edema and scaling on the face, neck, forearms and dorsum of the hands. On his neck a clear demarcation between the exposed and the protected skin could be seen. Lymph nodes were of normal size. Light microscopy showed a eczematous dermatitis, without epidermal microabcesses or an interfacedermatitis. Phototesting with UVA was able to reproduce the eruption on his back. Internal investigation ruled out visceral or lymph node enlargement. Serology for autoimmune diseases was negative. He was initially treated with systemic and topical steroids, associated with high-protection sunscreens, which improved his skin only slightly. Dihydroxycloroquine 250 mg a day was also prescribed and was ineffective. Before using systemic immunosuppressors, such as azathioprine, topical 1% pimecrolimus was prescribed twice daily associated with a potent sunscreen. This therapy controlled the disease.After 3 weeks the desquamation and the edema disappeared; topical pimecrolimus was then reduced to once a day. After a further 4 weeks the treatment was reduced again to three applications a week, and maintained at this level until the end of autumn (the southern region of Brazil has a temperate climate with four well-defined seasons).