What Is Chronic Actinic Dermatitis

Chronic actinic dermatitis is a very rare type of eczema that causes plaques, raised red skin, and other eczema symptoms when the skin is exposed to sunlight or, rarely, artificial light.

People with chronic actinic dermatitis often experience symptoms on their face, neck, chest, and other areas that are exposed to the sun. The condition mostly affects men who are older than 50, although other people can experience it too. 

This article will cover what chronic actinic dermatitis is. It will explain symptoms, who is most at risk, and how to cope if you have chronic actinic dermatitis.

Symptoms of Chronic Actinic Dermatitis

If you have chronic actinic dermatitis (CAD), you’ll experience symptoms of eczema after you’re exposed to the sun. Symptoms include:

• Raised, red, itchy rash
• Skin plaques that are cracked
• Oozing, weeping sores
• Skin that feels hot or burning
• Soreness 

These symptoms are brought on by sunlight, so they’re most likely to appear on areas of the body that are exposed to the sun, including the:

• Face
• Neck
• Ears
• Chest, especially the “v” area left by a buttoned shirt opening
• Hands and forearms

If you have CAD, you won’t see symptoms on your eyelids, under the chin, behind the ears, in skinfolds, or in other areas that are sheltered from the sun.

It may sound simple to make the connection between sun exposure and your symptoms. However, symptoms can appear seven to 24 hours after you are in the sun. That can make it difficult to detect the cause.

Causes

CAD is a type of photosensitivity, a condition that causes severe or unusual reactions when the skin is exposed to sunlight. (CAD used to be known as photosensitive eczema.) The symptoms of CAD occur because the skin has an allergic reaction to sunlight. Though rare, the symptoms also can be triggered by artificial light as well.

Medical experts are working to understand why this allergic reaction happens. As with more common forms of eczema, CAD is thought to have both environmental and immunological triggers. About 75% of people with CAD also have skin allergies or contact dermatitis, which is when the skin touches something the body is allergic to causing an allergic reaction.

Risk Factors

CAD can affect anyone, but it’s most common in men who are 50 or older. Most people who have CAD also have other skin conditions, including contact, atopic or seborrhoeic dermatitis, which are both inflammatory skin conditions.  

Risk factors include:

• CAD is most common in men with a light skin tone.
• Among women, it’s more common in people with darker skin tones. 
• People with darker skin tones are more likely to experience CAD before the age of 50. 
• CAD is most common in areas of the world that have a mild climate.
• CAD is not hereditary, meaning it doesn’t run in families
• Certain medications, including antibiotics and diuretics, can make CAD and other forms of photosensitivity worse.

Diagnosis

If you have symptoms of CAD, you should see a dermatologist, a doctor who specializes in conditions of the skin, hair, and nails. The dermatologist will look for signs of facial eczema. Then, they’ll order tests to confirm that this is CAD. The tests that you can expect are:

• Blood work: Lab tests will help rule out other immunological conditions that can have similar symptoms.
• Light tests (photo tests): A dermatologist will use a special light, called a monochromator, to determine which types of light waves are triggering your reaction. Once they identify the culprit they can help you avoid that type of light. 
• Patch tests: Your dermatologist will also do a series of skin allergy tests to determine what else you might be allergic to. Controlling other allergens (substances that cause allergic reactions) could help reduce your CAD reaction.

Depending on how your symptoms present, your healthcare provider might also suggest a biopsy, or a sample of tissue, to rule out skin cancer.

Treatment

There’s no way to cure CAD. The condition can go away on its own: About half of all people with CAD no longer have symptoms after 15 years. However, most treatments for CAD focus on managing the condition with three main lifestyle adjustments, which are:

• Avoid the sun: Stay out of the sun between 10 a.m. and 4 p.m., when rays are the strongest. Wear sunscreen with a sun protection factor of 30 (SPF 30) and use sun protection including a hat and long sleeves even on days that are cloudy. 
• Avoid allergens: Be sure to avoid other allergens in order to make your CAD outbreaks less severe. 
• Taking care of your skin: Regularly moisturizing your skin and avoiding products with harsh ingredients can help.

Medications

Some people with CAD will need medication to control their symptoms. Your healthcare provider might recommend medication temporarily to treat a flare-up, or as part of ongoing treatment. The medications used to treat CAD include:

• Topical steroid treatments or nonsteroidal anti-inflammatory creams and ointments can help clear up outbreaks. 
• Oral steroids can clear outbreaks. 
• Immunosuppressants can help control severe CAD by helping prevent flare-ups. 
• Phototherapy can help with outbreaks and ongoing management of CAD. 

Coping

Managing CAD can have a big impact on your life. If you work outdoors, you might need to change your job. You may also need to avoid some social situations, like trips to the beach or summer barbecues. 

Talk with your healthcare provider about how best to manage the social impact of your condition. Invest in protective gear like hats, long sleeves, and gloves. Talk to your family and friends about your condition. When they understand more about CAD, they may be willing to adjust their plans to better accommodate your condition.  

Summary

Chronic actinic dermatitis (CAD) is a rare form of eczema in which flare-ups occur after sun exposure. Very rarely do flare-ups occur after exposure to artificial light. CAD symptoms include itchy, inflamed and painful skin on the face, neck, chest, and other areas exposed to the sun. If you have CAD, it’s important to avoid sunlight and wear protective clothing like a hat and long sleeves. 

A Word From Verywell 

A CAD diagnosis can be disappointing since it means having to stay out of the sun. Work with your healthcare provider and loved ones to create a management plan that reduces your symptoms, while allowing you to maintain your social life.