eMedicine Specialties > Dermatology > Photo-Related Diseases

Actinic Prurigo: Differential Diagnoses & Workup

Author: Juan Pablo Castanedo-Cazares, MD, Photobiology Unit Director, Assistant Professor, Department of Dermatology, Hospital Central. Universidad Autonoma de San Luis Potosi, Mexico
Coauthor(s): Benjamin Moncada, MD, Chairman, Professor, Department of Dermatology, Hospital Central. Universidad Autonoma de San Luis Potosi; Bertha Torres-Alvarez, MD, Assistant Professor of Dermatology, Hospital Central, Universidad Autonoma de San Luis Potosi
Contributor Information and Disclosures

Updated: Jan 15, 2009

Differential Diagnoses

Drug-Induced Photosensitivity
Lupus Erythematosus, Discoid
Erythropoietic Protoporphyria
Polymorphous Light Eruption
Hydroa Vacciniforme
Prurigo Nodularis
Jessner Lymphocytic Infiltration of the Skin
Urticaria, Solar
Lupus Erythematosus, Acute

Other Problems to Be Considered

Chronic actinic dermatitis
Photosensitized atopic dermatitis

Workup

Laboratory Studies

  • Actinic prurigo is not a systemic disease, and no anomalous results occur in routine laboratory workup. Laboratory tests are performed to rule out systemic diseases with photosensitivity, such as lupus erythematosus.
  • Antinuclear antibody levels, anti-Ro and anti-La titers, and porphyrin levels are in the reference range.
  • Direct immunofluorescence study results are negative. These findings should support the diagnosis on the basis of the clinical picture.

Other Tests

  • In a similar way to what happens in PLE, the minimal erythema dose (MED) is decreased in patients with actinic prurigo.
  • Great variation exists in the literature concerning protocols and results of phototesting for photodermatoses, such as PLE and actinic prurigo. Lesions can be reproduced on healthy skin when it is irradiated with 10-20 times the MED with solar simulated light in 75% of cases. A delayed reading at 4-7 days confirms the presence of induced lesions. Patients in all the series reported from the authors' institution are based on these criteria.6,7 Although for routine treatment of patients with actinic prurigo, this phototest protocol may be avoided; however, this protocol may be useful for clinical research studies.
  • Another common phototesting protocol consists of irradiating the volar aspect of the forearm with 0.75 MED for 3-5 consecutive days; the lesions show similar reproduction rates.
  • Photopatch testing is negative.
  • A negative phototesting result does not exclude the diagnosis.

Histologic Findings

Histologic examination shows acanthosis, mild spongiosis, edema of the lamina propria, a moderate-to-dense in a bandlike lymphocytic inflammatory infiltrate, and, occasionally, lymphoid follicles. This latter finding is somewhat more common in the mucosa, the conjunctivae, and the lips (15-20%).2 Abundant eosinophils are usually present. The affected conjunctivae show epithelial hyperplasia alternating with atrophy. Vacuolization of the basal cell layer and dilated capillaries in the dermis are also noted.19 When lesions are experimentally reproduced, histopathologic findings are similar those mentioned.

More on Actinic Prurigo

Overview: Actinic Prurigo
Differential Diagnoses & Workup: Actinic Prurigo
Treatment & Medication: Actinic Prurigo
Follow-up: Actinic Prurigo
Multimedia: Actinic Prurigo
References
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References

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  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].

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  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].

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  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].

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Further Reading

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Keywords

actinic prurigo, AP, polymorphous light eruption of prurigo type, PLE, solar prurigo, solar dermatitis of the high plains

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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: Photomedicine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Benjamin Moncada, MD, Chairman, Professor, Department of Dermatology, Hospital Central. Universidad Autonoma de San Luis Potosi
Disclosure: Nothing to disclose.

Bertha Torres-Alvarez, MD, Assistant Professor of Dermatology, Hospital Central, Universidad Autonoma de San Luis Potosi
Disclosure: Nothing to disclose.

Medical Editor

Craig A Elmets, MD, Director of Dermatology, Departments of Dermatology, Pathology, and Environmental Health Sciences; Professor, The Kirklin Clinic, University of Alabama at Birmingham
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; Merck Consulting fee Independent contractor; Tronox Consulting fee Independent contractor; Amgen Consulting fee Review panel membership; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment

Pharmacy Editor

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
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: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

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.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine 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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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