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Actinic reticuloid: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Actinic reticuloid was first described and isolated as a separate nosological entity in 1969 by FA Ive et al. This disease is described in the literature under the name chronic actinic dermatitis. Actinic reticuloid is a chronic dermatosis, combined with severe photosensitivity and histologically resembling lymphoma.
The causes and pathogenesis of the disease are unknown. It is based on increased sensitivity to solar radiation. It is assumed that photocontact dermatitis can transform into actinic reticuloid.
Symptoms of actinic reticuloid. It occurs mainly in middle-aged and elderly men after frequent, long-term, eczema-like manifestations in areas exposed to insolation. Hyperplastic and infiltrative processes lead to a picture resembling facies leonina. The spread of the process to other, closed parts of the body can lead to erythroderma. There is an increase in subcutaneous lymph nodes and gelatomegaly. Transformation into malignant lymphoma has not been described.
On exposed skin areas (neck, face, anterior upper surface of the chest, dorsal surface of the hands) on an erythematous-edematous background there are pink-red papular elements merging into solid infiltrative plaques of a rich pink-cyanotic color with fine-plate peeling, dense consistency. The lesions have clear boundaries. Patients complain of severe itching in the lesions. The lymph nodes are not enlarged.
To establish a diagnosis, according to some authors, the disease must meet the following criteria:
- persistent chronic course, presence of eczematous rashes even in the absence of photosensitizers;
- hypersensitivity to UVA, UVB or visible light;
- Histological studies reveal a picture typical of chronic dermatitis and cutaneous lymphoma (Patrier's microabscesses).
Pathomorphology. Morphological changes correspond to clinical polymorphism. In foci with eczematous changes there is a picture of usual chronic eczema, with the presence of a dense strip-like infiltrate of lymphoid elements with fibrosis of the dermis. Epidermotropism of large mononuclear cells with the formation of cavities of the Pautrier microabscess type, filled with lymphoid cells with hyperchromic, irregularly shaped nuclei, reminiscent of those at the early stage of mycosis fungoides, is noted. Sometimes the infiltrate is dense, diffuse, occupies the entire dermis down to the subcutaneous adipose tissue, consists of small lymphocytes, large atypical lymphoid cells with hyperchromic bean-shaped nuclei, plasma cells, eosinophilic granulocytes, fibroblasts and giant cells of the foreign body type. This picture resembles lymphogranulomatosis or a persistent reaction to parasites. Based on clinical and histological features, H. Kerl and H. Kresbach (1979) classify this disease as solar eczema.
Differential diagnosis. The disease should be distinguished from atopic dermatitis, eosinophilic granuloma, sarcoidosis.
Treatment of actinic reticuloid is a complex task. Systemic corticosteroids, cytostatics, and antimalarial drugs are used. Cyclosporine A (Sandymun-Neoral) has a good effect, but when the drug is discontinued, the disease relapses. Encouraging results have been obtained using low doses of PUVA therapy. Corticosteroid ointments are used externally.
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