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Henry W. Lim - One of the best experts on this subject based on the ideXlab platform.

  • Chronic Actinic Dermatitis: a Review
    Current Dermatology Reports, 2019
    Co-Authors: Christina E. Artz, Caitlin M. Farmer, Henry W. Lim
    Abstract:

    Purpose of Review To update readers on the current understandings of Chronic Actinic Dermatitis (CAD) in regard to epidemiology, clinical findings, pathophysiology, treatment, and prognosis. Recent Findings CAD is classically thought to be primarily a disease of elderly Caucasian males, though recent evidence suggests that in skin of color, the disease manifests more often in younger females. Recent studies suggest the pathogenesis of CAD involves a type-IV hypersensitivity reaction, similar to allergic contact Dermatitis. There is also evidence of resistance to UV-induced immunosuppression in these patients, similar to polymorphous light eruption (PMLE). Furthermore, a lower CD4/CD8 ratio on flow cytometry in CAD patients has been correlated with increased tissue burden of disease. Photoprotection remains a mainstay of treatment, though recent evidence suggests potential efficacy of tofacitinib or short courses of narrowband UVB phototherapy as treatment options. Summary CAD is an immunologically mediated photodermatosis characterized by pruritic eczematous lesions of sun-exposed areas, most commonly seen in older Caucasian males. While the pathogenesis of the condition is not fully understood, a type-IV hypersensitivity reaction to UV-induced neoantigens is thought to play a role. Photoprotection remains the mainstay of treatment, though adjunctive treatments are rapidly emerging. Though considered a Chronic condition, CAD tends to improve over time.

  • Chronic Actinic Dermatitis
    Dermatologic Clinics, 2014
    Co-Authors: So Y Eon Paek, Henry W. Lim
    Abstract:

    Chronic Actinic Dermatitis (CAD) is an immunologically mediated photodermatosis characterized by pruritic eczematous and lichenified plaques located predominantly on sun-exposed areas with notable sparing of eyelids, skin folds, and postauricular skin. CAD is thought to be due to secondary photosensitization of an endogenous antigen in the skin. Management of CAD should include strict photoprotection and topical agents, including corticosteroids and calcineurin inhibitors. Other treatments with noted efficacy include oral prednisone, cyclosporine, azathioprine, and mycophenolate mofetil. Photoprotection and avoidance of allergens, if identified, may lead to spontaneous resolution of CAD in 50% of patients over 15 years.

  • Polymorphous light eruption, Chronic Actinic Dermatitis, solar urticaria and porphyria cutanea tarda
    Expert Review of Dermatology, 2006
    Co-Authors: Henry W. Lim
    Abstract:

    Photodermatoses can be divided into four general categories: immunologically mediated photodermatoses, drug- and chemical-induced photosensitivity, DNA repaired deficient photodermatoses and photoaggravated dermatoses. In this review, selected photodermomatoses will be discussed: polymorphous light eruption, Chronic Actinic Dermatitis, solar urticaria and porphyria cutanea tarda. The frequency of photodermatoses has been reported from studies assessing patients in photodermatology referral centers in different parts of the world. All studies consistently showed that polymorphous light eruption is the most common primary photodermatosis, ranging in frequency from 23 to 65% of the patients referred to those centers for evaluation. Other commonly seen primary photodermatoses include solar urticaria and Chronic Actinic Dermatitis. In studies reported from Singapore and Melbourne, Australia, photoaggravation of skin diseases was also seen commonly, probably owing to the high level of sun exposure experienced b...

  • Chronic Actinic Dermatitis : Results of patch and photopatch tests with Compositae, fragrances, and pesticides
    Journal of the American Academy of Dermatology, 1998
    Co-Authors: Henry W. Lim, David E. Cohen, Nicholas A. Soter
    Abstract:

    reported from the United Kingdom, 36% to 85% had positive patch or photopatch tests to Compositae oleoresin extracts, and 21% to 66% had positive responses to fragrances.1-3 It has been suggested that repeated exposure to these agents contributes to the pathogenesis of Chronic Actinic Dermatitis. Because Compositae oleoresin extracts are not part of the North American Contact Dermatitis Group photopatch test series, the prevalence of positive reactions to these agents in U.S. patients is not known. The purpose of this study was to determine the prevalence of positive patch and photopatch test responses in patients with Chronic Actinic Dermatitis, by means of a newly expanded series of photoallergens that includes Compositae and pesticide allergens.

  • Chronic Actinic Dermatitis associated with human immunodeficiency virus infection.
    British Journal of Dermatology, 1997
    Co-Authors: Thomas Meola, Henry W. Lim, M. Sanchez, M.r. Buchness, Nicholas A. Soter
    Abstract:

    Chronic Actinic Dermatitis is a photodistributed, eczematous Dermatitis that preferentially affects elderly men and persists for months to years. Its occurrence in individuals infected with human immunodeficiency virus (HIV) has been described in five patients. We report four additional cases of this uncommon, Chronic photodermatosis associated with HIV infection. In two of the patients, photosensitivity was a presenting disorder leading to the diagnosis of HIV infection. All patients were men of skin type VI with a mean age of 50 years, all had decreased minimal erythema doses to ultraviolet B, three of the four patients had decreased minimal erythema doses to ultraviolet A and all had CD4 cell counts of < 200 x 10(6)/L.

Nicholas A. Soter - One of the best experts on this subject based on the ideXlab platform.

  • Chronic Actinic Dermatitis occurring in an adult with atopic Dermatitis.
    Dermatology online journal, 2015
    Co-Authors: Nicola A. Quatrano, Nicholas A. Soter, Marianna Shvartsbeyn, Shane A Meehan, David E. Cohen
    Abstract:

    Chronic Actinic Dermatitis (CAD) is a photosensitivity disorder that is characterized by a persistent eczematous eruption in sun-exposed sites. The hallmark of CAD is a reduced minimal erythema dose (MED) to ultraviolet B (UVB), ultraviolet A (UVA), and/or to visible light, which makes phototesting the essential diagnostic investigation. The uncommon subgroup of patients with atopic Dermatitis (AD) that are affected by CAD has primarily been described in young patients in the United Kingdom. We present an atopic adult women with CAD who was diagnosed years after symptoms began. We believe it is important that dermatologists perform phototests on AD patients with features of a photoaggravated Dermatitis in order to avoid delay in diagnosis of a true photosensitivity condition and provide appropriate management.

  • The natural history of Chronic Actinic Dermatitis: an analysis at a single institution in the United States.
    Dermatitis, 2014
    Co-Authors: Jay E. Wolverton, Nicholas A. Soter, David E. Cohen
    Abstract:

    BACKGROUND Chronic Actinic Dermatitis is a photosensitivity disorder with scant epidemiologic data. Case series in Europe have previously shown that improvement or resolution of Chronic Actinic Dermatitis occurs over time in most patients. However, the natural history of Chronic Actinic Dermatitis in patients in the United States has not been studied. OBJECTIVE To study the natural history of Chronic Actinic Dermatitis in patients in the United States. METHODS We performed a retrospective chart review and telephone questionnaire after a 3- to 19-year follow-up period. RESULTS Of 20 patients with Chronic Actinic Dermatitis, 7 patients (35%) experienced resolution and an additional 11 patients (55%) experienced improvement of their photosensitivity to sunlight during the follow-up period. The proportion of patients experiencing improvement or resolution of their Chronic Actinic Dermatitis increased at 5, 10, and 15 years after diagnosis. CONCLUSIONS Our study demonstrates that abnormal photosensitivity to sunlight in Chronic Actinic Dermatitis improves or resolves over time in most patients in New York. The rates of improvement or resolution in our patients in New York are similar to the rates in case series in Europe despite likely patient demographic differences.

  • Positive patch- and photopatch-test reactions to methylene bis-benzotriazolyl tetramethylbutylphenol in patients with both atopic Dermatitis and Chronic Actinic Dermatitis.
    Dermatitis, 2011
    Co-Authors: Mercedes E. Gonzalez, Nicholas A. Soter, David E. Cohen
    Abstract:

    Ultraviolet filters are the most common topical photoallergens. Although currently not available on the US market, methylene bis-benzotriazolyl tetramethylbutylphenol (referred to as bisoctrizole on product labels) represents a new class of UV filters that have both organic and inorganic properties and are widely available in different preparations in Europe, South America, and Asia. We report two patients with atopic Dermatitis and Chronic Actinic Dermatitis who had positive patch- and photopatch-test reactions, which suggested both an allergic contact and a photoallergic contact Dermatitis from bisoctrizole. Neither patient could identify previous or current contact with the chemical; nonetheless, it is possible that either the allergic contact or photoallergic contact Dermatitis from bisoctrizole led to their Chronic Actinic Dermatitis.

  • Chronic Actinic Dermatitis: an analysis at a single institution over 25 years.
    Dermatitis, 2011
    Co-Authors: Syril Keena T. Que, Nicholas A. Soter, Jeremy A. Brauer, David E. Cohen
    Abstract:

    BACKGROUND Chronic Actinic Dermatitis (CAD) is a rare photosensitivity disorder with scant epidemiologic data. OBJECTIVE To evaluate demographic data and results of photopatch and patch tests over a 25-year period. METHODS Retrospective chart review of patients with CAD from 1993 to 2009. RESULTS Forty patients had a mean age of 57.8 years, and 27 (67.5%) were men. Twelve patients (30%) were skin types I and II, and 17 (42.5%) were skin types V and VI. Nine patients (22.5%) were younger than 50 years, and 4 of these (44.4%) were men. One of the nine patients (11.1%) was skin type I, and 4 (44.4%) were skin types V and VI. Carba mix and para-phenylenediamine were the two most commonly positive agents in patch tests. Sunscreens and plants and plant derivatives were the most commonly positive agents in photopatch tests. CONCLUSIONS Our findings suggest a trend of two new classes of North American patients at our institution being diagnosed with CAD-younger women with skin types IV to VI and older men with skin types I to III. We observed a greater-than-expected number of positive patch-test reactions to para-phenylenediamine. We suggest that patch testing and photopatch testing of individuals may be useful adjuncts in the assessment of CAD.

  • Chronic Actinic Dermatitis.
    Dermatology online journal, 2008
    Co-Authors: Alexandria V Booth, Stephanie Mengden, Nicholas A. Soter, David E. Cohen
    Abstract:

    A 71-year-old man presented with a six-year history of a pruritic, erythematous, blistering eruption of the face, chest, and arms. Clinical findings, histopathologic features, and phototests were consistent with a diagnosis of Chronic Actinic Dermatitis. The patient also had contact allergy and photocontact allergy to multiple allergens. A discussion of Chronic Actinic Dermatitis is presented.

John L M Hawk - One of the best experts on this subject based on the ideXlab platform.

  • Contact and photocontact sensitization in Chronic Actinic Dermatitis: a changing picture
    Contact Dermatitis, 2010
    Co-Authors: Ai-lean Chew, John L M Hawk, R. A. Palmer, Ian R. White, Saqib Bashir, John Mcfadden
    Abstract:

    Background: Patients with Chronic Actinic Dermatitis (CAD) frequently have positive patch or photopatch tests. In our previous study (period 1987–1992), the most prominent contact allergen was the sesquiterpene lactone mix (36% of patients with CAD). Objective: To assess whether contact allergy profiles in CAD patients between 2000 and 2005 have changed in respect to our previous data (1987–1992). Patients and Methods: Fifty CAD patient records from 2000 to 2005 for patch and photopatch testing were retrospectively analysed and data were compared with that from 86 patients seen between 1987 and 1992. Results: Thirty-two (64%) and 64 (74%) patients had positive patch or photopatch tests in 2000–2005 and 1987–1992, respectively. The allergen profile has altered. A decline in sesquiterpene lactone mix positive reactions was noted: 29 (36%) patients were positive in 1987–1992 and 10 (20%) patients in 2000–2005, but this was not significant (P = 0.08). Reactions to non-fragrance consumer allergens (i.e. p-phenylenediamine and preservatives) had risen from 7 reactions (1987–1992) to 21 reactions in 13 individuals (2000–2005) (P < 0.001). Of these allergens, p-phenylenediamine was the most common (12%; P = 0.004). Conclusions: A significant rise in positive patch tests to non-fragrance consumer allergens, particularly p-phenylenediamine, was seen in CAD patients in 2000–2005. We speculate this alteration of allergen profile may be partly due to changes in exposure patterns.

  • THE ACTION SPECTRUM FOR INDUCTION OF Chronic Actinic Dermatitis IS SIMILAR TO THAT FOR SUNBURN INFLAMMATION
    Photochemistry and Photobiology, 2008
    Co-Authors: H D Menagé, Graham I. Harrison, Christopher S Potten, Antony R. Young, John L M Hawk
    Abstract:

    The action spectrum for induction of the abnormal cutaneous response at 24 h in the photosensitivity disorder Chronic Actinic Dermatitis (CAD) was determined in 15 patients and found to be the same in shape as that for normal sunburn in fair-skinned individuals at 24 h, as determined for 47 control volunteers, although displaced in magnitude. This suggests that an endogenous chromophore(s), the same as or similar to that/those responsible for human sunburn, may be responsible for initiation of the abnormal reaction to irradiation in CAD, and that the putative antigen associated with the CAD reaction may be derived from that/those or associated molecules.

  • Exacerbation of presumed Chronic Actinic Dermatitis by cockpit visible light in an airline pilot with atopic eczema.
    Photodermatology Photoimmunology and Photomedicine, 2005
    Co-Authors: S. S. Yones, R. A. Palmer, J. M. Hextall, John L M Hawk
    Abstract:

    Chronic Actinic Dermatitis (CAD) is a persistent ultraviolet radiation- or visible light-induced eczema of predominantly the exposed areas of usually elderly people. We now present the case of a young pilot with atopic eczema who developed CAD, regularly exacerbated by exposure to visible light through his aircraft cockpit window.

  • Erythrodermic Chronic Actinic Dermatitis responding only to topical tacrolimus
    Photodermatology Photoimmunology and Photomedicine, 2004
    Co-Authors: A. V. Evans, R. A. Palmer, John L M Hawk
    Abstract:

    Chronic Actinic Dermatitis (CAD) is a disorder characterized by an often severe persistent eczematous eruption induced by exposure to ultraviolet radiation. Treatment involves photoprotective measures and topical corticosteroid therapy and in more severe cases, systemic immunosuppression. Occasionally, however, the condition can prove very resistant to all therapy and be severely disabling. We report a patient with CAD who resisted standard topical and systemic treatments, but responded to topical tacrolimus ointment 0.1% (Protopic®).

  • Incipient osteomalacia occurring in Chronic Actinic Dermatitis.
    Clinical and Experimental Dermatology, 2000
    Co-Authors: N. Kapur, D. Creamer, John L M Hawk
    Abstract:

    Incipient osteomalacia developed in a Pakistani patient living in the UK after strict sunlight avoidance forming part of the management of the photosensitivity disorder, Chronic Actinic Dermatitis. The patient's skin type and diet, which included calcium-binding phytates in chappattis, had increased his risk of the condition. Proximal muscle weakness and bony tenderness resulting from the disorder resolved on vitamin D replacement therapy.

Jean-pierre Lepoittevin - One of the best experts on this subject based on the ideXlab platform.

David E. Cohen - One of the best experts on this subject based on the ideXlab platform.

  • Chronic Actinic Dermatitis occurring in an adult with atopic Dermatitis.
    Dermatology online journal, 2015
    Co-Authors: Nicola A. Quatrano, Nicholas A. Soter, Marianna Shvartsbeyn, Shane A Meehan, David E. Cohen
    Abstract:

    Chronic Actinic Dermatitis (CAD) is a photosensitivity disorder that is characterized by a persistent eczematous eruption in sun-exposed sites. The hallmark of CAD is a reduced minimal erythema dose (MED) to ultraviolet B (UVB), ultraviolet A (UVA), and/or to visible light, which makes phototesting the essential diagnostic investigation. The uncommon subgroup of patients with atopic Dermatitis (AD) that are affected by CAD has primarily been described in young patients in the United Kingdom. We present an atopic adult women with CAD who was diagnosed years after symptoms began. We believe it is important that dermatologists perform phototests on AD patients with features of a photoaggravated Dermatitis in order to avoid delay in diagnosis of a true photosensitivity condition and provide appropriate management.

  • The natural history of Chronic Actinic Dermatitis: an analysis at a single institution in the United States.
    Dermatitis, 2014
    Co-Authors: Jay E. Wolverton, Nicholas A. Soter, David E. Cohen
    Abstract:

    BACKGROUND Chronic Actinic Dermatitis is a photosensitivity disorder with scant epidemiologic data. Case series in Europe have previously shown that improvement or resolution of Chronic Actinic Dermatitis occurs over time in most patients. However, the natural history of Chronic Actinic Dermatitis in patients in the United States has not been studied. OBJECTIVE To study the natural history of Chronic Actinic Dermatitis in patients in the United States. METHODS We performed a retrospective chart review and telephone questionnaire after a 3- to 19-year follow-up period. RESULTS Of 20 patients with Chronic Actinic Dermatitis, 7 patients (35%) experienced resolution and an additional 11 patients (55%) experienced improvement of their photosensitivity to sunlight during the follow-up period. The proportion of patients experiencing improvement or resolution of their Chronic Actinic Dermatitis increased at 5, 10, and 15 years after diagnosis. CONCLUSIONS Our study demonstrates that abnormal photosensitivity to sunlight in Chronic Actinic Dermatitis improves or resolves over time in most patients in New York. The rates of improvement or resolution in our patients in New York are similar to the rates in case series in Europe despite likely patient demographic differences.

  • Positive patch- and photopatch-test reactions to methylene bis-benzotriazolyl tetramethylbutylphenol in patients with both atopic Dermatitis and Chronic Actinic Dermatitis.
    Dermatitis, 2011
    Co-Authors: Mercedes E. Gonzalez, Nicholas A. Soter, David E. Cohen
    Abstract:

    Ultraviolet filters are the most common topical photoallergens. Although currently not available on the US market, methylene bis-benzotriazolyl tetramethylbutylphenol (referred to as bisoctrizole on product labels) represents a new class of UV filters that have both organic and inorganic properties and are widely available in different preparations in Europe, South America, and Asia. We report two patients with atopic Dermatitis and Chronic Actinic Dermatitis who had positive patch- and photopatch-test reactions, which suggested both an allergic contact and a photoallergic contact Dermatitis from bisoctrizole. Neither patient could identify previous or current contact with the chemical; nonetheless, it is possible that either the allergic contact or photoallergic contact Dermatitis from bisoctrizole led to their Chronic Actinic Dermatitis.

  • Chronic Actinic Dermatitis: an analysis at a single institution over 25 years.
    Dermatitis, 2011
    Co-Authors: Syril Keena T. Que, Nicholas A. Soter, Jeremy A. Brauer, David E. Cohen
    Abstract:

    BACKGROUND Chronic Actinic Dermatitis (CAD) is a rare photosensitivity disorder with scant epidemiologic data. OBJECTIVE To evaluate demographic data and results of photopatch and patch tests over a 25-year period. METHODS Retrospective chart review of patients with CAD from 1993 to 2009. RESULTS Forty patients had a mean age of 57.8 years, and 27 (67.5%) were men. Twelve patients (30%) were skin types I and II, and 17 (42.5%) were skin types V and VI. Nine patients (22.5%) were younger than 50 years, and 4 of these (44.4%) were men. One of the nine patients (11.1%) was skin type I, and 4 (44.4%) were skin types V and VI. Carba mix and para-phenylenediamine were the two most commonly positive agents in patch tests. Sunscreens and plants and plant derivatives were the most commonly positive agents in photopatch tests. CONCLUSIONS Our findings suggest a trend of two new classes of North American patients at our institution being diagnosed with CAD-younger women with skin types IV to VI and older men with skin types I to III. We observed a greater-than-expected number of positive patch-test reactions to para-phenylenediamine. We suggest that patch testing and photopatch testing of individuals may be useful adjuncts in the assessment of CAD.

  • Chronic Actinic Dermatitis.
    Dermatology online journal, 2008
    Co-Authors: Alexandria V Booth, Stephanie Mengden, Nicholas A. Soter, David E. Cohen
    Abstract:

    A 71-year-old man presented with a six-year history of a pruritic, erythematous, blistering eruption of the face, chest, and arms. Clinical findings, histopathologic features, and phototests were consistent with a diagnosis of Chronic Actinic Dermatitis. The patient also had contact allergy and photocontact allergy to multiple allergens. A discussion of Chronic Actinic Dermatitis is presented.