Chronic actinic dermatitis (CAD) is an immunologically mediated photodermatosis characterized by pruritic eczematous and lichenified plaques located predominantly on sun-exposed areas with notable sparing of eyelids, skin folds, and postauricular skin. CAD is thought to be due to secondary photosensitization of an endogenous antigen in the skin. Management of CAD should include strict photoprotection and topical agents, including corticosteroids and calcineurin inhibitors. Other treatments with noted efficacy include oral prednisone, cyclosporine, azathioprine, and mycophenolate mofetil. Photoprotection and avoidance of allergens, if identified, may lead to spontaneous resolution of CAD in 50% of patients over 15 years.