eMedicine Specialties > Dermatology > Photo-Related Diseases

Actinic Prurigo: Follow-up

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

Follow-up

Further Inpatient Care

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

Deterrence/Prevention

  • 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.

Complications

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

Prognosis

  • 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.
  • 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.

Miscellaneous

Medicolegal Pitfalls

  • Failure to regularly supervise patients and to inform them of the possibility of exacerbation during spring and summer months is a pitfall.
  • Failure to monitor the use of thalidomide in women, especially those of childbearing age, is a pitfall. Birth control measures must always be implemented.

Special Concerns

  • Certifying to proper authorities that patients do not have a contagious or infectious disease is important.
  • Women of childbearing age must be supervised monthly if oral drugs are being administrated.
 
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.



More on Actinic Prurigo

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Follow-up: Actinic Prurigo
Multimedia: Actinic Prurigo
References
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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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