Careers  |  Sign In  |  Register  |   Twitter

45-Year-Old Male with Photodistributed Rash

Can you diagnose this case?

David L. Kaplan, MD—Series EditorSeries Editor

Signs and Symptoms

This 45-year-old man presented with a 1- to 2-month history of an extremely pruritic photodistributed rash that had started in the late spring. He denied any exposure history, taking any new medications, and using any new colognes or new personal products. Physical examination revealed coalescing lichenoid papules with some hyperpigmentation and areas of excoriation./p>

What explains this itchy rash?

Choose one to reveal diagnosis and discussion

Airborne contact dermatitis
Atopic dermatitis
Mycosis fungoides
Lupus erythematosus
Actinic reticuloid

Actinic reticuloid

See the full case at Consultant360

Results of a skin biopsy revealed the diagnosis of actinic reticuloid, also called chronic actinic dermatitis and persistent light reaction. This condition generally begins with persistent erythema of sun-exposed areas. Severe pruritus of the affected area is a hallmark of the disease process, and the lesions and associated symptoms worsen with sun exposure. As the condition progresses, lichenification occurs; however, papules and plaques may be seen. The evolution of this condition may be linked to a patient’s work outdoors and thus to the degree of UV radiation exposure. Nevertheless, severe disease can persist during winter months despite decreased sun exposure.

Complete avoidance of sun exposure is essential, since sunscreens are rarely effective in cases of actinic reticuloid. Hydroxychloroquine is not effective, and patients generally rely on corticosteroids for relief or utilize steroid-sparing agents to avoid chronic corticosteroid use. A biopsy is often necessary to make the diagnosis, while the results of laboratory studies can exclude some diagnoses.

David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.

More Cases
40-Year-Old Male with Erythematous Rash

Can you identify this skin ailment? Take this week's Derm Case Challenge to validate your diagnosis.

40-Year-Old Male with Erythematous Rash
45-Year-Old Female with Asymptomatic Solitary Papule

Can you identify this skin ailment? Take this week's Derm Case Challenge to validate your diagnosis.

45-Year-Old Female with Asymptomatic Solitary Papule
43-Year-Old Male With Asymptomatic Papules On Both Eyelids

Test your dermatology knowledge with this week's Derm Case Challenge.

43-Year-Old Male With Asymptomatic Papules On Both Eyelids
83-Year-Old Female With Asymptomatic Rash On Trunk

Can you identify this skin ailment? Take this week's Derm Case Challenge to validate your diagnosis.

83-Year-Old Female With Asymptomatic Rash On Trunk
28-Year-Old Female With Itchy Rash On Both Hands

Test your dermatology knowledge with this week's Derm Case Challenge.

28-Year-Old Female With Itchy Rash On Both Hands
81-Year-Old Male with Pigmented Lesion on Head

Can you identify this skin ailment? Take this week's Derm Case Challenge to validate your diagnosis.

81-Year-Old Male with Pigmented Lesion on Head
73-Year-Old Female with Diffuse Rash

Test your dermatology knowledge with this week's Derm Case Challenge.

73-Year-Old Female with Diffuse Rash
10-Year-Old Male with Severe Hyperkeratosis on Hands

Test your dermatology knowledge with this week's Derm Case Challenge.

10-Year-Old Male with Severe Hyperkeratosis on Hands
54-Year-Old Female with Brownish Spots and Nodules on Back

Can you identify this skin ailment? Take this week's Derm Case Challenge to validate your diagnosis.

54-Year-Old Female with Brownish Spots and Nodules on Back
69-Year-Old Male with Lesions on Lower Extremities

Test your dermatology knowledge with this week's Derm Case Challenge.

69-Year-Old Male with Lesions on Lower Extremities