Medication Summary
The primary component of treatment is 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
Class Summary
These agents inhibit key steps responsible for initiating immune activity.
Thalidomide (Thalomid)
Thalidomide is an immunomodulatory agent that may suppress activated lymphocytes or prevent their activation. It also down-regulates excessive production of tumor necrosis factor-alpha and selected cell-surface adhesion molecules involved in leukocyte migration.
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.
Prednisone (Orasone, Meticorten, Sterapred, Deltasone)
Prednisone is an immunosuppressant for the treatment of autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Prednisone stabilizes lysosomal membranes and suppresses lymphocytes.
Betamethasone topical (Diprolene, Maxivate, Alphatrex)
Betamethasone topical is for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. It affects the production of lymphokines and has an inhibitory effect on Langerhans cells.
Antimalarial agents
Class Summary
These agents are used for their anti-inflammatory and photoprotective effects.
Hydroxychloroquine (Plaquenil)
Hydroxychloroquine 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.
Chloroquine phosphate (Aralen Phosphate)
Chloroquine phosphate inhibits chemotaxis of eosinophils and locomotion of neutrophils, and it impairs complement-dependent antigen-antibody reactions. It may also have a photoprotective effect.
Ophthalmics, Other
Class Summary
Topical cyclosporine is used in resistant cases of conjunctivitis and/or pseudopterygium.
Cyclosporine ophthalmic (Restasis)
Cyclosporine ophthalmic is used to relieve dry eyes caused by suppressed tear production secondary to ocular inflammation. It is thought to act as a partial immunomodulator. The exact mechanism of action is not known.
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Itchy plaques mainly on photoexposed areas of the face; these plaques are characteristic of actinic prurigo.
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Photodistribution of lesions over the body. Note the hypopigmented areas of the skin, which are very common after intense scratching in children.
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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.
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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.
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One half of patients have bilateral conjunctivitis. Eye protection is needed to avoid disease progression.
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About 75% of patients have cheilitis, which can take the form of solid lesions or erosions.
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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.
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Histologic examination shows acanthosis, mild spongiosis, edema of the lamina propria, and a moderate-to-dense perivascular lymphocytic inflammatory infiltrate.
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A close-up view shows edema of the lamina propria as well as a lymphocytic inflammatory infiltrate in the dermis.
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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.
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Actinic cheilitis resulting from actinic prurigo.
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Erythematous and very itchy plaques on solar exposure areas of the face and pseudopterygium are commonly observed in actinic prurigo.
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Lichenified plaques, excoriated nodules, and atrophic scars on the dorsal aspect of hands are frequently seen in children.
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Contact dermatitis due to sunscreen in a patient with actinic prurigo.
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Impetiginous area located on the right ear lobe due to intense scratching following an acute relapse.
