eMedicine Specialties > Dermatology > Photo-Related Diseases
Actinic Prurigo: Treatment & Medication
Updated: Jan 15, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- The cornerstone of pharmacologic treatment is 100 mg/d of thalidomide. Studies have shown that this drug modulates its effect on PA through suppression of tumor necrosis factor-alpha synthesis and modulation of interferon-gamma–producing CD3+ cells.28 Thalidomide can be gradually reduced and then reinstituted in cases of relapse. Women in their childbearing years must use contraceptives because of the teratogenic potential of thalidomide. On some occasions, topical steroids or immunosuppressors are indicated, especially in acute exacerbated cases. Once the skin lesions remit, sunscreens should be used.1,29,30
- Other medications frequently used with moderate results, because of their anti-inflammatory action, are antimalarials and pentoxyphilline,31 although these drugs are more useful as topical corticosteroid-sparing agents.
- Localized symptoms such as ocular signs of severe limbitis and conjunctivitis have been successfully controlled with sustained topical therapy using 2% cyclosporine A.32
- Less favorable results are obtained with antihistaminics, beta-carotenes, and psoralen plus UV-A light.
- If complications (eg, secondary infection, eczema) occur, patients can be treated with oral antibiotics or topical Burow solution.
Activity
Patients affected by actinic prurigo should not have restrictions in any areas, such as employment and education. However, changing from outdoor to indoor occupations is important if the patient is not improving with treatment.
Medication
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.
Immunosuppressant agents
These agents inhibit key steps responsible for initiating immune activity.
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.
Adult
100-300 mg/d PO qd with water, preferably hs and at least 1 h pc
<50 kg (110 lb): Start at low end of dose regimen
Pediatric
0.5-2.5 mg/kg/d PO qd with water
May increase sedation of alcohol, barbiturates, chlorpromazine, and reserpine; because of teratogenic effects, women must use 2 additional methods of contraceptives or abstain from intercourse
Documented hypersensitivity
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Perform pregnancy test within 24 h prior to initiating therapy (weekly during the first month, followed by monthly tests in women with regular menstrual cycles or q2wk in women with irregular menstrual cycles); bradycardia may occur; use protective measures (eg, sunscreens, protective clothing) against exposure to sunlight or UV light (eg, tanning beds); prescribing physician must enter STEPS program established by manufacturer
Corticosteroids
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
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.
Adult
0.5-2 mg/kg/d PO; taper as condition improves; single morning dose is safer for long-term use, but divided doses have more anti-inflammatory effect
Pediatric
4-5 mg/m2/d PO; alternatively, 0.05-2 mg/kg PO divided bid/qid; taper over 2 wk as symptoms resolve
Coadministration with estrogens may decrease clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; viral, fungal, connective tissue, or tubercular skin infections; peptic ulcer disease; hepatic dysfunction; GI bleeding or ulceration
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use
Betamethasone (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.
Adult
Apply thin film bid/qid until response
Pediatric
Apply as in adults with caution
None reported
Documented hypersensitivity; paronychia; cellulitis; impetigo; angular cheilitis; erythrasma; erysipelas; rosacea; perioral dermatitis; acne
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not use in skin with decreased circulation; can cause atrophy of groin, face, and axillae; may cause striae distensae or rosacealike eruption; may increase skin fragility; rarely may suppress HPA axis; if infection develops and is not responsive to antibiotic treatment, discontinue until infection is under control; do not use monotherapy to treat widespread plaque psoriasis
Antimalarial agents
These agents are used for their anti-inflammatory and photoprotective effects.
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.
Adult
200 mg/d PO qd to bid
Pediatric
4 mg/kg/d PO once
Cimetidine may increase serum levels of chloroquine (possibly other 4-aminoquinolones); magnesium trisilicate may decrease absorption of 4-aminoquinolones
Documented hypersensitivity to 4-aminoquinoline derivatives; psoriasis; retinal and visual field changes attributable to 4-aminoquinolines
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hepatic disease, G-6-PD deficiency, psoriasis, or porphyria; not recommended for long-term use in children; perform periodic ophthalmologic examinations; test for muscle weakness; retinopathy, tinnitus, nerve deafness, skin eruption, headache, anorexia, nausea, vomiting, and diarrhea may occur
Chloroquine phosphate (Aralen Phosphate)
Inhibits chemotaxis of eosinophils and locomotion of neutrophils, and impairs complement-dependent antigen-antibody reactions. May also have photoprotective effect.
Adult
250-600 mg PO qd
Pediatric
Not established; 4 mg/kg/d PO can be used
Cimetidine may increase serum levels of chloroquine (possibly other 4-aminoquinolones); magnesium trisilicate may decrease absorption of 4-aminoquinolones
Documented hypersensitivity; psoriasis; retinal and visual field changes attributable to 4-aminoquinolones
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hepatic disease, G-6-PD deficiency, psoriasis, or porphyria; not recommended for long-term use in children; perform periodic ophthalmologic examinations; test for muscle weakness; retinopathy, tinnitus, nerve deafness, skin eruption, headache, anorexia, nausea, vomiting, and diarrhea may occur
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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Further Reading
Keywords
actinic prurigo, AP, polymorphous light eruption of prurigo type, PLE, solar prurigo, solar dermatitis of the high plains
