Chronic actinic dermopathy - A clinical study in Ladakh

Introduction

The native highlanders are exposed to prolonged high doses of ultraviolet radiation especially those who work outdoors. They have been reported to develop pigmentation, thickening and furrowing of the skin.[1] Histopathological entity with specific changes in epidermis and dermis called high altitude dermopathy has been described earlier by Eguren.[2] This prompted us to undertake a study of skin changes in highlander Ladakhis staying at an altitude of 3445 meters at Leh (Ladakh).

Materials and Methods

Atotal of 176 highlander Ladakhis were examined for skin changes on the exposed parts of the body.

Results

The mean age of the subjects was 22.28 years (range 3 - 58 years). 125 (71.02%) were males and 51 (28.98%) were females.

A total of 111(63. 07%) of patients had hyperpigmentation over forehead, nose, cheek or chin. Telangiectasia over cheeks, ear lobules or nose was seen in 53 (30.11%). 21(11.93%) had thickening and furrowing over forehead and lateral aspects of eyes. Solar keratosis was seen in only 5(2.82%) of the subjects. Relationship between sex and chronic actinic dermopathy is as shown in [Table - 1].

Relationship between age and these changes is an shown in [Table - 2].

The subjects belonged to various occupations and the relationship between the occupations and these changes is as shown in [Table - 3]. In the miscellaneous group two of them were preschool children, 3 were housewives not involved in farming,one each were clerk, teacher and shopkeeper.

Discussion

Native highlanders especially peasants engaged for long hours in the field exposed to ultraviolet radiation of shorter wave lengths have been described to develop pigmentation, thickening and furrowing of the skin.[1] Apart from this we also found a high incidence of telangiectasia over the cheeks, nose or ear lobules in highlander Ladakhis. The values of UVB radiation at Leh have been found to be 250% of those found at the sea level at mid noon.[3]

The clinical changes of chronic actinic dermopathy should thus include hyperpigmentation, telangiectasia, thickening and furrowing of the skin exposed to prolonged ultraviolet radiation as is present in high altitude areas. Histopathologically it produces changes as has been described by Eguren as high altitude dermopathy.[2] The presence of dilated blood vessels and lymphatics as described by him correlates well with our finding of telangiectasia. The prevalence of solar keratosis in Ladakhis has been found to be low as compared to some of the Western reports in individuals with fairer complexion.[1],[4] We did not come across any case of skin malignancy.

The skin changes of chronic actinic dermopathy start right in the childhood. Due to chronic sunburn reactions high incidence of hyperpigmentation (48%) and telangiectasia (24%) has been seen even in the first decade in this study. These changes continue to incise during second, third and fourth decades of life. The incidence of telangiectasia reaches its peek in the third decade. Then due to thickening and furrowing of the skin most commonly seen in the fifth and sixth decades incidence of telangiectasia and hyperpigmentation decreases. These changes thus represent the process of acclimatisation of the skin to high doses of short wavelength ultraviolet radiation.

Telangiectasia, thickening and furrowing of the skin have been found to be slightly more common in females. High incidence of hyperpigmentation over face found in students and recruits is because this group is in the first and second decades of life and being exposed to long hours of outdoor playing or training activities. Thickening and furrowing of the skin is more common in peasants.