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Actinic Prurigo Workup

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

Laboratory Studies

Actinic prurigo is not a systemic disease, and no anomalous results occur in routine laboratory workup. Laboratory tests are performed to rule out systemic diseases with photosensitivity, such as lupus erythematosus.

Antinuclear antibody levels, anti-Ro and anti-La titers, and porphyrin levels are in the reference range.

Direct immunofluorescence study results are negative. These findings should support the diagnosis on the basis of the clinical picture.

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Other Tests

In a similar way to what happens in PLE, the minimal erythema dose (MED) is decreased in patients with actinic prurigo.

Great variation exists in the literature concerning protocols and results of phototesting for photodermatoses, such as PLE and actinic prurigo. Lesions can be reproduced on healthy skin when it is irradiated with 10-20 times the MED with solar simulated light in 75% of cases. A delayed reading at 4-7 days confirms the presence of induced lesions. Patients in all the series reported from the authors' institution are based on these criteria.[6, 7] Although for routine treatment of patients with actinic prurigo, this phototest protocol may be avoided; however, this protocol may be useful for clinical research studies. See the image below.

A phototest with UV-B light shows reproduction of 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.

Another common phototesting protocol consists of irradiating the volar aspect of the forearm with 0.75 MED for 3-5 consecutive days; the lesions show similar reproduction rates.

Photopatch testing is negative.

A negative phototesting result does not exclude the diagnosis.

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Histologic Findings

Histologic examination shows acanthosis, mild spongiosis, edema of the lamina propria, a moderate-to-dense in a bandlike lymphocytic inflammatory infiltrate, and, occasionally, lymphoid follicles. This latter finding is somewhat more common in the mucosa, the conjunctivae, and the lips (15-20%).[2] Abundant eosinophils are usually present. The affected conjunctivae show epithelial hyperplasia alternating with atrophy. Vacuolization of the basal cell layer and dilated capillaries in the dermis are also noted.[19] When lesions are experimentally reproduced, histopathologic findings are similar those mentioned. See the images below.

Histologic examination shows acanthosis, mild sponHistologic 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 A close-up view shows edema of the lamina propria as well as a lymphocytic inflammatory infiltrate in the dermis.
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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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.

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. 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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