Case of chronic actinic dermatitis gets successfully treated with alitretinoin: A Report

Chronic actinic dermatitis (CAD) is a skin condition characterized by an immune reaction against elicited cutaneous antigens. This reaction results in inflammation of skin areas exposed to sunlight leading to eczema or pruritic rash and to scaling and lichenification in the long term. CAD is an underdiagnosed and infrequent photodermatosis reported primarily in adult men. Its treatment is challenging and often requires immunosuppressive medications.

Francisco J. Navarro-Triviño and colleagues from Spain present the case of a patient with refractory chronic actinic dermatitis (CAD) that was successfully treated with alitretinoin 30 mg daily.

"This is the first report to our knowledge to address the suitability of this retinoid specifically for chronic actinic dermatitis," the research team wrote. "Given its acknowledged safety and efficacy, we consider that it might play an important role in treating this condition, although more studies are required."

The case concerns a 62-year-old construction worker who presented with severe hyperkeratotic plaques in sun-exposed areas. He had been suffering from chronic lesions on the dorsal side of his elbows, knees, hands, and upper back for 12 years that progressively became lichenified. Over the holidays, his condition was reported to worsen drastically, including an erythrodermic episode at the onset of the disease, which happened over the summer.chronic actinic dermatitis with alitretinoin

Following the diagnosis of CAD, the patient started a hardening regimen with UVA1 phototherapy, which had to be abruptly stopped due to excessive erythema and incoercible pruritus right after the sessions. The team prescribed azathioprine 2 mg/kg daily apart from topical corticosteroids, sun avoidance measures, strict solar protection, and emollients. This treatment had to be suspended within one month following severe hypertransaminasemia.

Methotrexate 15 mg a week led to severe gastrointestinal side effects. Acitretin improved with dosing of 25 and 35 mg daily but was abandoned after two months due to uncontrollable headaches. Alternatively, alitretinoin 30 mg daily was prescribed, which provided significant symptomatic relief and improved his poikilodermatous appearance.

The patient's condition is entirely resolved eight months after the initiation of the treatment, with no analytical or clinical side effects.

Despite being a challenging condition to diagnose, the research team stresses making all reasonable efforts to accurately differentiate it from other dermatoses in which cytokines profile and the underlying pathophysiology would require more specific treatments for the respective targets.

"Alitretinoin might be especially interesting in the case of CAD refractory patients with poikilodermatous appearance and lichenification rather than eczematous presentations," they concluded.

Reference:

Prados-Carmona, A., Ruiz-Villaverde, R., Aranda, G., Arjona, J. A., & Navarro-Triviño, F. J. Successful treatment of chronic actinic dermatitis with alitretinoin: Should retinoids be included in the therapeutical arsenal? Photodermatology, Photoimmunology & Photomedicine. https://doi.org/10.1111/phpp.12888