Actinic Prurigo Treatment & Management

Updated: Mar 21, 2022
  • Author: Juan Pablo Castanedo-Cazares, MD, MSc; Chief Editor: Dirk M Elston, MD  more...
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Medical Care

The cornerstone of pharmacologic treatment in adult patients is 100-200 mg/d of thalidomide. [23, 38] Children aged 8-15 usually are treated with 12.5-100 mg/d. [1] Studies have shown that this drug modulates its effect on actinic prurigo through suppression of tumor necrosis factor-alpha synthesis and modulation of interferon-gamma–producing CD3+ cells. [39] Thalidomide can be gradually reduced to the minimal dose that can alleviate symptoms (eg, 25-50 mg/wk) and then reinstituted in cases of relapse. Women in their childbearing years must use at least 2 contraceptive methods because of the teratogenic potential of thalidomide. On some occasions, topical steroids or immunosuppressors are indicated, especially in acute exacerbations. Once the skin lesions remit, sunscreens should be used. [1, 38, 40]

Other medications frequently used with moderate results, because of their anti-inflammatory action, are antimalarials and pentoxifylline, [41] 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. [34]  Cyclosporine A was successfully used as a systemic treatment in a Scandinavian girl with actinic prurigo, the first native of the region with the disease to be recorded. The patient had the HLA DRB1*0407 subtype which is present in just 1% of her population. [29]

Perz et al reported the case of a 42-year-old Latino male with actinic prurigo that responded well to thalidomide. However, the patient developed severe polyneuropathy, so thalidomide was discontinued. Dupilumab was then begun at an initial 600 mg subcutaneous injection and subsequent 300 mg injections every 2 weeks with excellent control of symptoms. [42]  Dupilumab was also reportedly successful in clearing actinic prurigo symptoms in a pediatric patient. [43]

Less favorable results are obtained with antihistamines, beta-carotenes, and psoralen plus UVA light.

If complications (eg, secondary infection, eczema) occur, patients can be treated with oral antibiotics or topical Burrow solution.

The need for inpatient care for patients with actinic prurigo is extremely infrequent.




Long-term precautions are important to avoid worsening of the condition. Therefore, patients should be aware of the sunniest months of the year to reduce outbreaks.

Photoprotection is important. Explaining the nature of the disease to patients is mandatory because they must protect themselves from the sun with sunglasses, hats, umbrellas, long sleeves, high neck shirts, and appropriate clothing on a daily basis. Patients must also avoid sun exposure between 9:00 am and 6:00 pm, even during the winter.

Sunscreens are only an adjunctive treatment. They do not represent a reliable control treatment. Physical sunscreens could be better than chemical sunscreens, especially in cases where excoriation is present and a burning sensation can be elicited.

Outdoor shade is not enough to provide photoprotection. Regularly, trees reduce ultraviolet light only by half.

Staying indoors could also be unsafe because window glasses do not filter long wavelengths (UVA 315-400 nm). This is especially problematic when people who are affected work close to windows.