Actinic Prurigo Clinical Presentation
- Author: Juan Pablo Castanedo-Cazares, MD, MSc; Chief Editor: Dirk M Elston, MD more...
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]
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.
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.
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.
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]
When the skin on the nose is not affected, photosensitized atopic dermatitis, as shown below, is more likely than actinic prurigo.
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.
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