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Actinic reticuloid: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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The actinic reticuloid was first described and isolated in a separate nosological unit in 1969. FA Ive et al. This disease in the literature is described under the name of chronic actinic dermatitis. Actinic reticuloid is a chronic dermatosis, combined with strong photosensitivity and histologically resembling lymphoma.
The causes and pathogenesis of the disease are unknown. The basis is increased sensitivity to solar radiation. Assume the possibility of the transition of photocontact dermatitis to the actinic reticuloid.
Symptoms of the actinic reticuloid. It occurs mainly in middle-aged and elderly men after frequent perennial eczematic-like manifestations on the ground exposed to insolation. Hyperplastic and infiltrative processes lead to a picture reminiscent of facies leonina. Spreading the process to other, closed body parts can lead to erythroderma. There is an increase in subcutaneous lymph nodes and gelatomegaly. Transformation into malignant lymphoma is not described.
In open areas of the skin (neck, face, anterior upper surface of the chest, the back surface of the hands), on the erythematous-edematic background there are papular elements of pink-red color, merging into continuous infiltrative plaques of intense pink-cyanotic color with fine-lamellar ecdysis, dense consistency. Foci of defeat have clear boundaries. Patients complain of severe itching in the lesions. Lymph nodes are not enlarged.
To establish the diagnosis, according to some authors, the disease should meet the following criteria:
- persistent chronic course, the presence of eczematous rashes even in the absence of photosensitizers;
- increased sensitivity to UVA, UVB, or visible light;
- Histological examination reveals a picture typical of chronic dermatitis and skin lymphoma (micro patches of Patria).
Pathomorphology. Morphological changes correspond to clinical polymorphism. In foci with eczematous changes, there is a picture of the usual chronic eczema, with the presence of a thick banded infiltrate from the lymphoid elements with dermis fibrosis. Epidermotropism of large mononuclear cells is noted with the formation of cavities of the type of microabscesses of Sodium that are filled with lymphoid cells with hyperchromic, irregularly shaped nuclei reminiscent of those in the early stage of fungal mycosis. Sometimes the infiltration is thick, diffuse, occupies the entire dermis up to the subcutaneous adipose tissue, consists of small lymphocytes, large atypical lymphoid cells with hyperchromic bean-shaped nuclei, plasmocytes, eosinophilic granulocytes, fibroblasts and giant cells such as foreign bodies. This picture resembles a lymphogranulomatosis or a persistent reaction to parasites. According to clinical and histological features, N. Kerl and N. Kresbach (1979) refer this disease to solar eczema.
Differential diagnosis. The disease should be distinguished from atopic dermatitis, eosinophilic granuloma, sarcoidosis.
Treatment of the actinic reticuloid is a difficult task. Apply systemic corticosteroids, cytostatics, antimalarial drugs. There is a good effect of cyclosporine A (sandimun-neoral), but when the drug is canceled, the disease recurs. Encouraging results were obtained using low doses of PUVA therapy. External apply corticosteroid ointments.
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