Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Actinic Prurigo Clinical Presentation

  • Author: Juan Pablo Castanedo-Cazares, MD, MSc; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Oct 07, 2015
 

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. Note tPhotodistribution of lesions over the body. Note the hypopigmented areas of the skin, which are very common after intense scratching in children.
Lichenified plaques, excoriated nodules, and atropLichenified plaques, excoriated nodules, and atrophic scars on the dorsal aspect of hands are frequently seen in children.

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.
Erythematous and very itchy plaques on solar exposErythematous and very itchy plaques on solar exposure areas of the face and pseudopterygium are commonly observed in actinic prurigo.

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
 
 
Contributor Information and Disclosures
Author

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

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

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.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, 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, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories<br/>Received research grant from: NIH, Veterans Administration, California Grape Assn<br/>Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Veronica Lepe Murillo, MD, and Benjamin Moncada, 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. 1995 Aug. 17(4):357-61. [Medline].

  3. Magana M, Mendez Y, Rodriguez A, Mascott M. The conjunctivitis of solar (actinic) prurigo. Pediatr Dermatol. 2000 Nov-Dec. 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. 2001 Jan-Feb. 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. 2001 Jun. 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. 2000 May 29. 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. 1990 Jun. 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. 1990 Jun. 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. 1999 Feb. 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. 2001 Jan. 144(1):194-6. [Medline].

  21. Worret WI, Vocks E, Frias G, Burgdorf WH, Lane P. [Actinic prurigo. An assessment of current status]. Hautarzt. 2000 Jul. 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. 2000 Jan. 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. 2002 May. 43(2):128-32. [Medline].

  26. Rizwan M, Haylett AK, Richards HL, Ling TC, Rhodes LE. Impact of photosensitivity disorders on the life quality of children. Photodermatol Photoimmunol Photomed. 2012 Dec. 28(6):290-2. [Medline].

  27. Magana M. Actinic or solar prurigo. J Am Acad Dermatol. 1997 Mar. 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. 1973 Sep-Oct. 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. 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].

Previous
Next
 
Itchy plaques mainly on photoexposed areas of the face; these plaques are characteristic of actinic prurigo.
Photodistribution of lesions over the body. Note the hypopigmented areas of the skin, which are very common after intense scratching in children.
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.
Erythematous and very itchy plaques on solar exposure areas of the face and pseudopterygium are commonly observed in actinic prurigo.
Lichenified plaques, excoriated nodules, and atrophic scars on the dorsal aspect of hands are frequently seen in children.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.