Actinic reticuloid in a black man: successful therapy with azathioprine

A 61-year-old black man suffering from actinic reticuloid with contact allergy to four substances, extreme sensitivity to both ultraviolet A and ultraviolet B, normal visible light sensitivity, and negative results on photopatch tests was placed on a regimen of azathioprine, 50 mg twice a day. At 3 months, clinical appearance was unchanged, as was his strong contact allergy; however, tolerance to natural sunlight was markedly improved. At 6 months the clinical appearance and ultraviolet responses were normal; however, strong contact allergy persisted. To our knowledge, this is the first report of actinic reticuloid in a black person. Azathioprine, after giving an excellent clinical response without leukopenia, was discontinued. A further 9-month follow-up showed continued remission. The persistence of contact allergy, despite profound improvement in photosensitivity and the skin's appearance, suggests that the role of contact allergy in the cause of actinic reticuloid is unclear, and the existence and identity of the hypothesized photosensitizer(s) in actinic reticuloid remain unproved.