A new approach to Actinic Folliculitis: prophylactic narrowband UVB phototherapy.

BACKGROUND We have observed an increasing number of patients referred to the Scottish Photobiology Service (SPS), who are diagnosed with Actinic Folliculitis (AF) and have positive phototesting. Treatment options for AF are limited, with only few reports in the literature. The use of prophylactic narrowband Ultraviolet-B (nb-UVB) phototherapy for AF has not previously been described and we report on this for the first time. AIM We analysed the clinical characteristics, phototesting results and responses to treatment for patients with AF diagnosed in the SPS. METHODS We undertook a retrospective review over a ten-year period of all case notes of patients who were assessed and diagnosed with AF through the SPS, based in the Photobiology Unit, Dundee, Scotland. RESULTS All 10 patients were female. Mean age of onset was 25 years; mean time to referral for investigation was seven years. The commonest site involved was the face, with the main clinical feature being monomorphic pustules appearing following sunlight exposure. The eruption was provoked with iterative doses of broadband UVA irradiation in five patients. All patients were offered photoprotective advice and prophylactic nb-UVB phototherapy. Five patients proceeded with phototherapy; four completed the desensitisation course and all four reported either a delay in symptom onset or total prevention of rash induction, with complete efficacy of desensitisation maintained for three years in one patient. CONCLUSION We demonstrate the successful use of UVA provocation testing as a diagnostic tool in AF. Additionally, we recommend the use of prophylactic nb-UVB phototherapy in AF as an effective and well-tolerated approach.