Actinic Prurigo Clinical Presentation

  • Author: Juan Pablo Castanedo-Cazares, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 30, 2011
 

History

Actinic prurigo is clinically different from PLE and is characterized by an intensely itchy, excoriated papular and nodular eruption that lasts longer than PLE. It can affect any area that is exposed to the sun.

  • Patients typically report onset or exacerbation in spring and summer, but many patients have clinical symptoms that persist during autumn and winter, particularly in tropical areas.[18, 19]
  • In 65% of patients, the lips are involved, and, in 10% of patients, the lips are the only sites of involvement. In 45% of patients, the conjunctivae are affected.[2, 3]
Next

Physical

Lesions are erythematous papules, appear singly or in itchy groups, and can form large plaques, as shown below. Lesions have serosanguineous crusting, and, because the ailment is chronic, lichenification is eventually seen. Chronic scratching of the face can produce pseudoalopecia of the eyebrows.

Multiple itchy papules coalescing into plaques on Multiple itchy papules coalescing into plaques on the neck. These lesions are similar to lesions of polymorphous light eruption. Note the excoriations induced by scratching.
  • The dermatitis is generally disseminated, bilateral, and symmetric. It affects sun-exposed areas, such as the cheeks, the dorsum of the nose, the forehead, the chin, the ear lobes, the V of the neck and the chest, the extensor surfaces of the arms and the forearms, and the dorsum of the hands. In severe and long-standing disease, lesions in covered areas can also be seen, although this finding is infrequent. See the images below. One third of patients are children. The nose is frOne third of patients are children. The nose is frequently affected. This clinical feature is useful in distinguishing it from other entities, such as atopic dermatitis. Photodistribution of lesions over the body. Photodistribution of lesions over the body.
  • Conjunctival involvement, as shown below, is manifested by hyperemia, brown pigmentation, photophobia, epiphora, and formation of pseudopterygium. This finding is present in 45% of patients. One half of patients have bilateral conjunctivitisOne half of patients have bilateral conjunctivitis. Eye protection is needed to avoid disease progression.
  • Lesions on the lips are manifested by cheilitis (as shown below), and pruritus, edema, scales, fissures, crusts, and ulceration may be present. This finding occurs in 60-70% of patients.[2, 3] Actinic cheilitis resulting from actinic prurigo. Actinic cheilitis resulting from actinic prurigo.
  • When the skin on the nose is not affected, photosensitized atopic dermatitis, as shown below, is more likely than actinic prurigo. Young girl with a history of atopic dermatitis andYoung girl with a history of atopic dermatitis and itchy, lichenified plaques on her face for the last 3 months. Atopic dermatitis with photosensitivity is the main differential diagnosis with actinic prurigo in children.
Previous
Next

Causes

  • UV-A and UV-B light seem to be the main provoking agents. This observation is supported by the fact that most patients live at high altitudes (>1000 m above sea level), and the condition improves in many patients when they move to lower altitudes. However, some patients who are affected already live at sea level.[18, 19, 27]
  • Some authors are considering a food photosensitizer or a nutritional selective deficiency as a cause; however, no evidence proves this theory.[27]
Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Juan Pablo Castanedo-Cazares, MD  Photobiology Unit Director, Assistant Professor, Department of Dermatology, Hospital Central. Universidad Autonoma de San Luis Potosi, Mexico

Juan Pablo Castanedo-Cazares, MD is a member of the following medical societies: Mexican National Research Association and Photomedicine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Bertha Torres-Alvarez, MD  Assistant Professor of Dermatology, Hospital Central, Universidad Autonoma de San Luis Potosi

Disclosure: Nothing to disclose.

Benjamin Moncada, MD  Chairman, Professor, Department of Dermatology, Hospital Central. Universidad Autonoma de San Luis Potosi

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig A Elmets, MD  Professor and Chair, Department of Dermatology, Director, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Palomar Medical Technologies Stock None; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor; UpToDate Salary Employment; Biogen Grant/research funds Independent contractor; Clinuvel Independent contractor; Covan Basilea Pharmaceutical Grant/research funds Independent contractor; ISDIN None Consulting; TenX BIopharma Grant/research funds Independent contractor

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Veronica Lepe Murillo, MD, to the development and writing of this article.

References

  1. Cazarin-Barrientos J, Roman D, Messina M. Talidomida en ninos con prurigo solar refractario. Actas Dermatol Dermatopatol. 2002;1:11-5.

  2. Herrera-Geopfert R, Magana M. Follicular cheilitis. A distinctive histopathologic finding in actinic prurigo. Am J Dermatopathol. Aug 1995;17(4):357-61. [Medline].

  3. Magana M, Mendez Y, Rodriguez A, Mascott M. The conjunctivitis of solar (actinic) prurigo. Pediatr Dermatol. Nov-Dec 2000;17(6):432-5. [Medline].

  4. Moncada B, Gonzalez-Amaro R, Baranda ML, Loredo C, Urbina R. Immunopathology of polymorphous light eruption. T lymphocytes in blood and skin. J Am Acad Dermatol. Jun 1984;10(6):970-3. [Medline].

  5. Gonzalez-Amaro R, Baranda L, Salazar-Gonzalez JF, Abud-Mendoza C, Moncada B. Immune sensitization against epidermal antigens in polymorphous light eruption. J Am Acad Dermatol. Jan 1991;24(1):70-3. [Medline].

  6. Santos-Martinez L, Llorente L, Baranda L, Richaud-Patin Y, Torres-Alvarez B, Moncada B, et al. Profile of cytokine mRNA expression in spontaneous and UV-induced skin lesions from actinic prurigo patients. Exp Dermatol. Apr 1997;6(2):91-7. [Medline].

  7. Torres-Alvarez B, Baranda L, Fuentes C, Delgado C, Santos-Martinez L, Portales-Perez D, et al. An immunohistochemical study of UV-induced skin lesions in actinic prurigo. Resistance of langerhans cells to UV light. Eur J Dermatol. Feb 1998;8(1):24-8. [Medline].

  8. Gonzalez-Rodriguez G, Ocadiz-Delgado R. [T and B clonal populations in actinic prurigo, a photodermatosis]. Gac Med Mex. Jan-Feb 2001;137(1):15-20. [Medline].

  9. Wiseman MC, Orr PH, Macdonald SM, Schroeder ML, Toole JW. Actinic prurigo: clinical features and HLA associations in a Canadian Inuit population. J Am Acad Dermatol. Jun 2001;44(6):952-6. [Medline].

  10. Schnell AH, Elston RC, Hull PR, Lane PR. Major gene segregation of actinic prurigo among North American Indians in Saskatchewan. Am J Med Genet. May 29 2000;92(3):212-9. [Medline].

  11. Bernal JE, Duran de Rueda MM, Ordonez CP, Duran C, de Brigard D. Actinic prurigo among the Chimila Indians in Colombia: HLA studies. J Am Acad Dermatol. Jun 1990;22(6 Pt 1):1049-51. [Medline].

  12. Sheridan DP, Lane PR, Irvine J, Martel MJ, Hogan DJ. HLA typing in actinic prurigo. J Am Acad Dermatol. Jun 1990;22(6 Pt 1):1019-23. [Medline].

  13. Hojyo-Tomoka T, Granados J, Vargas-Alarcon G, Yamamoto-Furusho JK, Vega-Memije E, Cortes-Franco R, et al. Further evidence of the role of HLA-DR4 in the genetic susceptibility to actinic prurigo. J Am Acad Dermatol. Jun 1997;36(6 Pt 1):935-7. [Medline].

  14. Surez A, Valbuena MC, Rey M, de Porras Quintana L. Association of HLA subtype DRB10407 in Colombian patients with actinic prurigo. Photodermatol Photoimmunol Photomed. Apr 2006;22(2):55-8. [Medline].

  15. Menage H duP , Vaughan RW, Baker CS, Page G, Proby CM, Breathnach SM, et al. HLA-DR4 may determine expression of actinic prurigo in British patients. J Invest Dermatol. Feb 1996;106(2):362-7. [Medline].

  16. Zuloaga-Salcedo S, Castillo-Vazquez M, Vega-Memije E, Arellano-Campos O, Rodriguez-Perez JM, Perez-Hernandez N, et al. Class I and class II major histocompatibility complex genes in Mexican patients with actinic prurigo. Br J Dermatol. 2007;156(5):1074-75. [Medline].

  17. Grabczynska SA, McGregor JM, Kondeatis E, Vaughan RW, Hawk JL. Actinic prurigo and polymorphic light eruption: common pathogenesis and the importance of HLA-DR4/DRB1*0407. Br J Dermatol. Feb 1999;140(2):232-6. [Medline].

  18. Hojyo-Tomoka T, Vega-Memije E, Granados J, Flores O, Cortes-Franco R, Teixeira F, et al. Actinic prurigo: an update. Int J Dermatol. Jun 1995;34(6):380-4. [Medline].

  19. Hojyo-Tomoka MT, Vega-Memije ME, Cortes-Franco R, Dominguez-Soto L. Diagnosis and treatment of actinic prurigo. Dermatol Ther. 2003;16(1):40-4. [Medline].

  20. Batard ML, Bonnevalle A, Segard M, Danze PM, Thomas P. Caucasian actinic prurigo: 8 cases observed in France. Br J Dermatol. Jan 2001;144(1):194-6. [Medline].

  21. Worret WI, Vocks E, Frias G, Burgdorf WH, Lane P. [Actinic prurigo. An assessment of current status]. Hautarzt. Jul 2000;51(7):474-8. [Medline].

  22. Kuno Y, Sato K, Hasegawa K, Tsuji T. A case of actinic prurigo showing hypersensitivity of skin fibroblasts to ultraviolet A (UVA). Photodermatol Photoimmunol Photomed. 2000;16:38-41. [Medline].

  23. Wong SN, Khoo LS. Analysis of photodermatoses seen in a predominantly Asian population at a photodermatology clinic in Singapore. Photodermatol Photoimmunol Photomed. 2005;21:40-44. [Medline].

  24. Akaraphanth R, Gritiyarangsan P. A case of actinic prurigo in Thailand. J Dermatol. Jan 2000;27(1):20-3. [Medline].

  25. Crouch R, Foley P, Baker C. Actinic prurigo: a retrospective analysis of 21 cases referred to an Australian photobiology clinic. Australas J Dermatol. May 2002;43(2):128-32. [Medline].

  26. Jong CT, Finlay AY, Pearse AD, Kerr AC, Ferguson J, Benton EC, et al. The quality of life of 790 patients with photodermatoses. Br J Dermatol. 2008;159(1):192-97. [Medline].

  27. Magana M. Actinic or solar prurigo. J Am Acad Dermatol. Mar 1997;36(3 Pt 1):504-5. [Medline].

  28. Estrada-G I, Garibay-Escobar A, Nunez-Vazquez A, Hojyo-Tomoka T, Vega-Memije E, Cortes-Franco R, et al. Evidence that thalidomide modifies the immune response of patients suffering from actinic prurigo. Int J Dermatol. 2004;43:893-897. [Medline].

  29. Londono F. Thalidomide in the treatment of actinic prurigo. Int J Dermatol. Sep-Oct 1973;12(5):326-8. [Medline].

  30. Moncada B, Baranda ML, Gonzalez-Amaro R, Urbina R, Loredo CE. Thalidomide--effect on T cell subsets as a possible mechanism of action. Int J Lepr Other Mycobact Dis. Jun 1985;53(2):201-5. [Medline].

  31. Torres-Alvarez B, Castanedo-Cazares JP, Moncada B. Pentoxifylline in the treatment of actinic prurigo. A preliminary report of 10 patients. Dermatology. 2004;208(3):198-201. [Medline].

  32. McCoombes JA, Hirst LW, Green WR. Use of topical cyclosporin for conjunctival manifestations of actinic prurigo. Am J Ophthalmol. 2000;130(6):830-831. [Medline].

  33. Millard TP, Kondeatis E, Cox A, Wilson AG, Grabczynska SA, Carey BS, et al. A candidate gene analysis of three related photosensitivity disorders: cutaneous lupus erythematosus, polymorphic light eruption and actinic prurigo. Br J Dermatol. Aug 2001;145(2):229-36. [Medline].

 
Previous
Next
 
Itchy plaques mainly on photoexposed areas of the face; these plaques are characteristic of actinic prurigo.
Photodistribution of lesions over the body.
Multiple itchy papules coalescing into plaques on the neck. These lesions are similar to lesions of polymorphous light eruption. Note the excoriations induced by scratching.
One third of patients are children. The nose is frequently affected. This clinical feature is useful in distinguishing it from other entities, such as atopic dermatitis.
One half of patients have bilateral conjunctivitis. Eye protection is needed to avoid disease progression.
About 75% of patients have cheilitis, which can take the form of solid lesions or erosions.
A phototest with UV-B light shows reproduction of lesions on the inner aspect of the arm. The result from the phototest with UV-A light was negative.
Histologic examination shows acanthosis, mild spongiosis, edema of the lamina propria, and a moderate-to-dense perivascular lymphocytic inflammatory infiltrate.
A close-up view shows edema of the lamina propria as well as a lymphocytic inflammatory infiltrate in the dermis.
Young girl with a history of atopic dermatitis and itchy, lichenified plaques on her face for the last 3 months. Atopic dermatitis with photosensitivity is the main differential diagnosis with actinic prurigo in children.
Actinic cheilitis resulting from actinic prurigo.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.