Actinic Prurigo Follow-up
- Author: Juan Pablo Castanedo-Cazares, MD, MSc; Chief Editor: Dirk M Elston, MD more...
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.
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.
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