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Actinic Prurigo Follow-up

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

Further Inpatient Care

The need of inpatient care for patients with Actinic prurigo is extremely infrequent.



Long-term precautions are important to avoid worsening of the condition. Therefore, patients should be aware of the sunniest months of the year to reduce outbreaks.

Photoprotection is important. Explaining the nature of the disease to patients is mandatory because they must protect themselves from the sun with sunglasses, hats, umbrellas, long sleeves, high neck shirts, and appropriate clothing on a daily basis. Patients must also avoid sun exposure between 9:00 am and 6:00 pm, even during the winter.

Sunscreens are only an adjunctive treatment. They do not represent a reliable control treatment. Physical sunscreens could be better than chemical sunscreens, especially in cases where excoriation is present and a burning sensation can be elicited.

Outdoor shade is not enough to provide photoprotection. Regularly, trees reduce ultraviolet light only by half.

Staying indoors could also be unsafe because window glasses do not filter long wavelengths (UV-A 315-400 nm). This is especially problematic when people who are affected work close to windows.



Common complications are secondary infection and irritant contact dermatitis, mainly due to the use of sunscreens. Impetigo is another typical complication.



The prognosis is poor, with frequent relapses, especially during spring and summer. Actinic prurigo does not improve with time, contrary to what happens in PLE.


Patient Education

Teaching patients how to apply sunscreen is important. In the early phases of treatment, patients may not apply it properly; they may spread the cream all over their skin without allowing it to fully absorb. Therefore, teach patients to try to reach at least a 2-mg/cm2 dose on the exposed areas. A full UV coverage (290-400 nm) sunscreen is necessary to avoid exacerbations.

The patient should be aware of the UV index. The UV index forecast is usually available on the Internet or through the media in many parts of the world.

Patients should know that actinic prurigo is not a dose-dependent disease, and, similar to all immune-mediated hypersensitivity disorders, a minor amount of the offensive agent may provoke outbreaks.

Contributor Information and Disclosures

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.


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.


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.

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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.
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