Prurigo actinicL56.4

Author:Prof. Dr. med. Peter Altmeyer

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Last updated on: 09.08.2023

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Synonym(s)

actinic prurigo; Actinic Prurigo; Familial actinic prurigo; Hereditary polymorphic light dermatosis; Hutchinson's prurigo; Hutchinson's summer eruption; hydroa aestivale; solar prurigo

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HistoryThis section has been translated automatically.

Hutchinson 1878; Haxthausen 1918; Fox 1939; Escalona 1959; Lopez-Gonzales 1961;

DefinitionThis section has been translated automatically.

.

ClassificationThis section has been translated automatically.

Two forms are distinguished by some authors:

Occurrence/EpidemiologyThis section has been translated automatically.

Common among Indians (prevalence among Mexicans is up to 5% of the population), mestizos and Eskimos; sporadically also occurring in Europe.

EtiopathogenesisThis section has been translated automatically.

The disease is regarded as a variant of polymorphic light dermatosis and is therefore considered a delayed-type hypersensitivity reaction to a photoinduced antigen. Depending on ethnicity, different HLA-restrictions (e.g. HLA-A28, HLA-B39, HLA-DR4) were observed. The action spectrum for provocation of pathological skin reactions lies in both the UVB and UVA range with a predominance of UVA.

ManifestationThis section has been translated automatically.

Predominantly occurring in childhood or adolescence (average age of first manifestation: 10-18 years), less frequently in adults. 5-7 times more frequent in women than in men.

LocalizationThis section has been translated automatically.

Areas that are particularly chronically exposed to the sun: face (centrofacial, especially lips and conjunctiva), ears, neck, forearms and back of the hands.

Clinical featuresThis section has been translated automatically.

Immediately after radiation exposure, development of an early urticarial phase. This slowly changes into a persistent, lichenified dermatitis. Subsequently, or overlapping, the typical pruriginous skin changes develop in the light-exposed areas, as well as scattered reactions. Mostly a year-round course with worsening in summer. Conjunctivitis and cheilitis of the lower lip have been described.

HistologyThis section has been translated automatically.

Papular efflorescence: acanthosis, focal spongiosis; epidermotropic lympho-histiocytic perivascular infiltrate. Eosinophilia is possible.

DiagnosisThis section has been translated automatically.

Clinic. Photoprovocation test: Triggering of the typical morphs especially after provocation with UVA light. The MED may be lowered.

Differential diagnosisThis section has been translated automatically.

Polymorphic light dermatosis; atopic eczema; porphyria; lupus erythematosus; airborn contact dermatitis; photoallergic eczema or phototoxic dermatitis; chronic actinic dermatitis;

Complication(s)This section has been translated automatically.

Pseudopterygium

External therapyThis section has been translated automatically.

Physical, especially textile light protection. See also light protection agent.

Radiation therapyThis section has been translated automatically.

Photo(chemo)therapy is only effective in individual cases.

Internal therapyThis section has been translated automatically.

In severe, therapy-resistant cases, immunosuppressive treatment with azathioprine 100 mg/day or with glucocorticoids such as prednisolone (e.g. Solu-Decortin H) 40-60 mg/day Thalidomide 200 mg/day ( off-label use) seems to be effective.

Progression/forecastThis section has been translated automatically.

Chronic course with persistent exacerbations, initially seasonal, later perennial. In adulthood spontaneous improvement in 25% of cases.

LiteratureThis section has been translated automatically.

  1. Arrese JE et al (2001) Effectors of inflammation in actinic prurigo. J Am Acad Dermatol 44: 957-961
  2. Escalona PE, Magana LM (1959) Dermatologfaia: Io esencial para el estudiante, 2nd ed., Mexico, pp. 174-178
  3. Fox H (1939) Diseases of the skin in Oklahoma Indians. Arch Dermatol 40: 544-546
  4. Hutchinson J (1878) Summer Prurigo, prurigo aestivalis, seu prurigo adolescentium, seu acne-prurigo.Medical Times and Gazette (London) 1: 161
  5. Hojyo-Tomoka MT et al (2003) Diagnosis and treatment of actinic prurigo. Dermatol Ther 16: 40-44
  6. Kuno Y et al (2003) Actinic prurigo: a 10 years follow-up study by questionnaire. Br J Dermatol 149(Suppl 64): 48-49
  7. Lane PR et al (1992) Actinic prurigo: Clinical features and prognosis. J Am Acad Dermatol 26: 683-692
  8. Millard TP et al (2001) A candidate gene analysis of three related photosensitivity disorders: cutaneous lupus erythematosus, polymorphic light eruption and actinic prurigo. Br J Dermatol 145: 229-236
  9. Neumann NJ et al (2004) Actinic prurigo. STDG 2: 373-375
  10. Umana A et al (2002) Lymphocyte subtypes and adhesion molecules in actinic prurigo: observations with cyclosporin A. Int J Dermatol 41: 139-145

Authors

Last updated on: 09.08.2023

Author: Prof. Dr. med. Peter Altmeyer