Actinic Prurigo Medication

  • Author: Juan Pablo Castanedo-Cazares, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 30, 2011
 

Medication Summary

Treatment is mainly aimed at avoiding sun exposure. However, oral and topical corticosteroids are frequently used for short periods. Thalidomide is used, either alone or with topical corticosteroids, for resistant or multiple relapse cases.

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Immunosuppressant agents

Class Summary

These agents inhibit key steps responsible for initiating immune activity.

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Thalidomide (Thalomid)

 

Immunomodulatory agent that may suppress activated lymphocytes or prevent their activation. Also down-regulates excessive production of tumor necrosis factor-alpha and selected cell-surface adhesion molecules involved in leukocyte migration.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

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Prednisone (Orasone, Meticorten, Sterapred, Deltasone)

 

Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Stabilizes lysosomal membranes and also suppresses lymphocytes.

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Betamethasone topical (Diprolene, Maxivate, Alphatrex)

 

For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Affects production of lymphokines and has inhibitory effect on Langerhans cells.

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Antimalarial agents

Class Summary

These agents are used for their anti-inflammatory and photoprotective effects.

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Hydroxychloroquine (Plaquenil)

 

Exerts anti-inflammatory activity by suppressing lymphocyte transformation and may have photoprotective effect. Use in actinic prurigo requires small doses once a day for long periods.

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Chloroquine phosphate (Aralen Phosphate)

 

Inhibits chemotaxis of eosinophils and locomotion of neutrophils, and impairs complement-dependent antigen-antibody reactions. May also have photoprotective effect.

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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: Mexican National Research Association and Photomedicine Society

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.

Benjamin Moncada, MD  Chairman, Professor, Department of Dermatology, Hospital Central. Universidad Autonoma de San Luis Potosi

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig A Elmets, MD  Professor and Chair, Department of Dermatology, Director, 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, and Society for Investigative Dermatology

Disclosure: Palomar Medical Technologies Stock None; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor; UpToDate Salary Employment; Biogen Grant/research funds Independent contractor; Clinuvel Independent contractor; Covan Basilea Pharmaceutical Grant/research funds Independent contractor; ISDIN None Consulting; TenX BIopharma Grant/research funds Independent contractor

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, Northside 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: 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, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

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.

References

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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.
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.
 
 
 
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