Actinic Reticuloid (leonine facies)

Diagnosis: Actinic Reticuloid (leonine facies)

Chronic actinic dermatitis with thickened, furrowed skin (leonine face).

Clinical Presentation

Chronic actinic dermatitis with thickened, furrowed skin (leonine face).

Clinical History

Submitted by Alaa Saad. Originally posted October 12, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Lupus erythematosus • Solar urticaria • Photoallergic drug eruption • Erythema multiforme • Actinic prurigo • Porphyria

Key Learnings

• Most common photodermatosis — pruritic papules/plaques on sun-exposed skin in spring/early summer • "Hardening" phenomenon: lesions improve with repeated sun exposure as summer progresses • Consistent morphology within individual patients but polymorphic between patients • Delayed onset: hours to days after UV exposure (distinguishes from solar urticaria) • More common in fair-skinned, females, and in northern latitudes • Photoprotection and controlled phototherapy ("desensitization") before summer are effective

Tags: actinic, reticuloid, leonine, facies, alaa saad