Dermatology - Chronic Actinic Dermatitis

This guide has been written to help answer some of your questions about chronic actinic dermatitis. You may have been given this guide because you have been diagnosed with chronic actinic dermatitis or because we think this might be the cause of your symptoms.

What is Chronic Actinic Dermatitis?

Chronic Actinic Dermatitis (sometimes shortened to CAD) is a skin complaint caused by sunlight or artificial light. The name is made up of three parts; chronic meaning the condition can last a long time; actinic which means sunlight is involved and dermatitis because the skin is inflamed with a type of eczema.

People with CAD develop a rash on skin that is exposed to sunlight. The skin is red, inflamed, scaly, thickened and hardened. The rash can be very itchy. It can be very easy to bring out the rash with sometimes as little as a few minutes exposure to light setting it off. The rash is often there all year round, even on dull days. Some people can even develop the rash from light coming through windows or from artificial lights. In some cases, the rash is more widespread and can affect areas of the skin that are covered up.

Many patients with CAD also have a history of other types of dermatitis (or eczema). For example, this can include atopic dermatitis and allergic contact dermatitis (especially allergies to plants such as chrysanthemums).

Who suffers from CAD?

CAD can affect people of all ages and ethnic groups. It can affect men and women.

What causes CAD?

The cause of CAD is still unclear. It is thought to be related to an over-reaction of the skin’s immune system to molecules in the skin being altered by sunlight, but the reason for this is not known.

Is CAD infectious?

No. There is no risk of other people catching CAD from you.

Does having CAD increase your risk of cancer?

No. We do not think having CAD increases your risk of cancer.

Can CAD be cured?

No treatment will get rid of CAD forever, but, by careful sun avoidance and use of sunscreens, the rash can often be prevented from flaring up, and there are treatments that can help (see below). Sometimes CAD can get better on its own, but for most people it is a long term condition.

How will having CAD affect me?

If you have been diagnosed as having CAD you may have to make changes to your lifestyle.

You should try to

• Avoid the sun during conditions that provoke your photosensitivity and particularly when sunlight is intense. In the UK this is mainly between 11 and 3pm, although other times of day can be troublesome
• Wear protective clothing, with close/tightly woven fabrics, long sleeves and trousers, hats with broad brims. Glasses and sunglasses with wrap around lenses can also be helpful
• Use a sunscreen that is SPF 30 or above (high UVB protection) and generally also has high UVA protection. Remember to re- apply the sunscreen evenly and often
• If your skin is sensitive to UVA you might benefit from using special UV-blocking window film on car or home windows

What about other artificial light sources?

Some patients with CAD need to be careful around bright artificial light sources.

Avoid using single envelope compact fluorescent bulbs in the home, though these have now mostly been phased out. The ultraviolet lights that some beauticians use when applying artificial fingernails may trigger your rash. You should not use a sun bed if you have a sun allergy.

What about vitamin D?

Importantly, for people to make enough Vitamin D themselves, they need a certain amount of sun exposure. The sun protection measures needed for people with CAD mean Vitamin D deficiency is a real risk and this does require treatment with supplements if it occurs. This can be monitored through blood tests.

How can CAD be treated?

Sunscreens

A high factor broad spectrum sunscreen should be used to protect any exposed areas of skin. Your doctor should be able to provide you with sunscreens on prescription and these will help protect your skin. Sunscreen should be applied as thickly as possible and re-applied as often as possible.

Skin creams

Your doctor may prescribe steroid creams or ointments to put on your skin. Steroid creams can be strong and should only be applied as directed, but when used carefully they can control the inflammation and help to ease the itch and tightness of your skin. If you have a severe flare up of your rash you could use a strong steroid at first, then as the rash eases you could switch to a lower strength one. Lower strength steroid creams are used on the face when necessary.

More information about steroid creams and how they should be used can be accessed through the British Association of Dermatologists website at https://www.bad.org.uk/pils/topical- corticosteroids/ and through the National Eczema Society website.
 
Some other creams, including calcineurin inhibitors such as tacrolimus, may sometimes be used as alternatives to steroids.

It is also important to apply moisturising creams or emollients. Emollients can help to combat the dryness of your skin.

Oral medication

There are strong tablets that can help if your CAD is difficult to control. These are generally immunosuppressive drugs, and they can be very helpful in improving quality of life in CAD. However, these tablets can have side effects and need careful monitoring by a dermatologist. You and your dermatologist should weigh up the benefits against the side effects to decide whether and what type should be prescribed in your case.

Injection treatments

There are some newer medications that have been developed for treating eczema, and they may be helpful for some people with CAD. As with tablet treatments, there may be side effects, so the risks and benefits need to be carefully considered.

Contact us

You can contact the Photobiology Unit on 0161 206 4081 or by email Photobiology.Salford@nca.nhs.uk