Actinic Prurigo Workup

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

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  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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