The pathogenesis of AP is unclear, although familial occurrence is often seen, with a strong association with HLA DR4 and in particular HLA DRB1*0407, which is present only rarely in the general population(7,8). [discovery.dundee.ac.uk]

Patients will present with intensely itchy, erythematous papulonodular lesions on predominantly sun-exposed areas of the skin. [ncbi.nlm.nih.gov]

• Falling

  Actinic prurigo falls within the category of idiopathic photosensitive dermatoses, but it has several distinguishing characteristics. Its onset is usually within the first decade of life and it may improve by puberty. [mdedge.com]

  In geographical areas where seasons are well defined, flares usually occur during spring and summer and decrease in the fall [ 9, 15 ]. [obgynkey.com]

  Skin lesions associated with actinic prurigo are infiltrated with T lymphocytes, mostly CD4+, and some of the T-cells express activation markers. [4] Actinic prurigo falls in the category of autoimmune diseases because lymphocytes from patients have been [emedicine.medscape.com]

  If a fall from baseline values of more than 40% on repeat testing is detected, the treatment should be discontinued. Thromboembolic complications have been reported with thalidomide, particularly in patients with cancer. [dermatologyadvisor.com]

• Fatigue

  He was started on methotrexate 15 mg orally once weekly, however, due to gastrointestinal symptoms, not only switched to subcutaneous administration but also discontinued due to extreme fatigue. [journals.sagepub.com]

• Burning Pain

  The lack of vesicles, burning pain, crusting, scarring, or an elevated red blood cell protoporphyrin test ruled out other differential diagnoses, including hydroa vacciniforme and erythropoietic protoporphyria. Dr. [mdedge.com]

• Rigor

  – Every effort should be made to practice rigorous photoprotection. [dermatologyadvisor.com]

• Surgical Procedure

  Medical Treatment Surgical Procedures Physical Modalities Photoprotective measures (seeking shades, sunscreens, appropriate clothing, hats and sunglasses) Phototherapy or photochemotherapy Topical corticosteroids or calcineurin inhibitors. [dermatologyadvisor.com]

• Arthritis

  Similar articles [Polymorphism of human HLA-DRB1 leukocyte antigen alleles and its association to juvenile rheumatoid arthritis in a sample of Colombian mestizo children]. [pubmed.ncbi.nlm.nih.gov]

  Santos-Martinez et al, [6] the presence of transforming growth factor-beta interleukin 13, and interleukin 10 was demonstrated in a non–type-TH1, non–type-TH2 pattern, similar to what has been shown in lesions of psoriasis and in the synovial fluid of rheumatoid arthritis [emedicine.medscape.com]

  However, the majority of systemic autoimmune diseases, such as rheumatoid arthritis, multiple sclerosis, and insulin dependent diabetes mellitus show a Th1 (T-helper 1) reactivity pattern. [ekometal.com.tr]

• Hyperkeratosis

  Histologic Features: Acute lesions (indistinguishable from polymorphous light eruption): Spongiosis Superficial dermal perivascular lymphocytic infiltrate Dermal edema Chronic lesions: Hyperkeratosis Acanthosis Signs of photoadaptation External Links: [dermpedia.org]

  Histology of APC shows hyperkeratosis, scale crusts covering ulcerated areas, mild acanthosis, spongiosis, and mild vacuolar alteration of the basal layer. [obgynkey.com]

  Skin biopsies will show hyperkeratosis, spongiosis, and acanthosis in the epidermis with lymphocytic perivascular infiltration in the dermis. [ncbi.nlm.nih.gov]

• Eczema

  Other historical terms for the disease include solar eczema, prurigo solar, hereditary polymorphic light eruption, and hydroa aestivale. 1 AP occurs throughout much of the world. [accessmedicine.mhmedical.com]

  Photoaggravated atopic dermatitis – assess for personal and family history of atopy, predominance in flexures; should respond to usual eczema treatment. Lymphomatoid papulosis – skin biopsies. [visualdx.com]

  Actinic prurigo may look very like atopic dermatitis ( eczema ) but is more severe on sun-exposed sites. Areas affected include: Sun-exposed areas of the face such as the cheeks, nose, forehead, chin and earlobes. [dermnetnz.org]

  The eruption produced tends to resemble eczema (atopic dermatitis) but is usually more severe. [ekometal.com.tr]

• Skin Thickening

  Since the lesions are intensely pruritic, excoriations, skin thickening, scarring, and hyper- or hypopigmentation may occur. Actinic cheilitis has been described as a hallmark finding in patients with actinic prurigo. [ncbi.nlm.nih.gov]

• Peripheral Neuropathy

  Treatment with thalidomide has a major limiting side effect profile which includes peripheral neuropathy and teratogenicity. Treatment with thalidomide is contraindicated during pregnancy or in individuals trying to become pregnant. [ncbi.nlm.nih.gov]

• Headache

  Adverse effects include drowsiness, headache and weight gain. Nerve conduction studies should be performed regularly to assess for peripheral neuropathy, another side-effect of thalidomine treatment. [clinuvel.com]

  He responded well, but azathioprine was eventually stopped due to gastrointestinal side-effects and headache. Patient 6 was treated with azathioprine for a few months, but this was stopped due to side-effects. [ijdvl.com]

Chronic actinic dermatitis: clinical cases, diagnostic workup, and therapeutic management. J Cutan Med Surg 2009 ; 13(3): 121 – 128. Google Scholar | SAGE Journals | ISI 3. DeKoven, JG, Warshaw, EM, Belsito, DV. [journals.sagepub.com]

• Monocytes Decreased

  decreases TNF alfa serum levels and modulates the IFN gamma producing CD3+ cells). [dermatologyadvisor.com]

• Lymphocytic Infiltrate

  Histologic Features: Acute lesions (indistinguishable from polymorphous light eruption): Spongiosis Superficial dermal perivascular lymphocytic infiltrate Dermal edema Chronic lesions: Hyperkeratosis Acanthosis Signs of photoadaptation External Links: [dermpedia.org]

  Histopathology The microscopic picture of skin lesions shows hyperkeratosis, foci of parakeratosis, acanthosis, thickening of the basement membrane, and a superficial perivascular inflammatory infiltrate of lymphocytes. [obgynkey.com]

  The basal cells are vacuolised with lymphocytic infiltration in the sub-mucosal follicles. Eosinophils are conjunctival pigmentation are common findings. [clinuvel.com]

  Common histopathological features of AP are hyperkeratosis, parakeratosis, acanthosis, thickening of the basement membrane, perivascular inflammatory, lymphoid follicles, or nodular lymphocytic infiltrate, as well as eosinophils, mast cells, and angiogenesis [ijpmonline.org]

  The dermis had increased superficial perivascular lymphocytic infiltrates. Three other biopsies showed non-specific changes. All patients were treated with a combination of sunscreens and potent topical corticosteroids. [ijdvl.com]

• HLA-DR4

  The pathogenesis of AP is unclear, although familial occurrence is often seen, with a strong association with HLA DR4 and in particular HLA DRB1*0407, which is present only rarely in the general population(7,8). [discovery.dundee.ac.uk]

  However, in Cree Indians from Saskatchewan, Canada, [14] the most common antigens were HLA-A24 and HLA-Cw4. Other studies have shown a strong association with HLA-DR4. [emedicine.medscape.com]

  Pivotal in the diagnosis of the boy was a positive association with an HLA DR4 test subtype: DRB1 Similarly, Mexican mestizos with actinic prurigo are likely to test positive to HLA A29-B39, and Canadian Cree First Nations people tend to test positive [mdedge.com]

  Some medical experts use the term actinic prurigo to denote a rare photodermatosis that develops in childhood and is chronic and persistent; this rare photodermatosis, associated with the human leukocyte antigen HLA-DR4, is often called "Familial polymorphous [en.wikipedia.org]

You can help by adding to it. ( May 2018 ) Treatment [ edit ] Currently there is no cure for actinic prurigo, and treatment focuses on relieving the dermatologic symptoms, by way of topical steroid creams or systemic immunosuppressants. [en.wikipedia.org]

Treatment with thalidomide has a major limiting side effect profile which includes peripheral neuropathy and teratogenicity. Treatment with thalidomide is contraindicated during pregnancy or in individuals trying to become pregnant. [ncbi.nlm.nih.gov]

The prognosis for AP is poor as it tends to run a chronic course with suboptimal response to treatment. [ FULL TEXT ] [ PDF ]* [ijdvl.com]

Immunocompromised patients have much poorer prognosis. The rate of developing congenital varicella syndrome is low. [clinuvel.com]

By means of the children's dermatology life quality index (CDLQI), children with actinic prurigo show high scores and closer to those obtained in children with xeroderma pigmentosum. [28] Prognosis The prognosis is poor, with frequent relapses, especially [emedicine.medscape.com]

Characteristics and prognosis of idiopathic solar urticaria: a cohort of 87 cases. Arch Dermatol. 2003;139(9):1149–54. https://doi.org/10.1001/archderm.139.9.1149. Article Google Scholar 46. [link.springer.com]

Only 19 variables were found to be statistically significant ( P P Conclusions Multiple epidemiologic, geographic, clinical, and immunologic factors are involved in the etiology of AP. [onlinelibrary.wiley.com]

Clinical Features: Familial photodermatosis of unknown etiology, most often affecting Native Americans Most commonly presents on the face with coarsening of facial features There is often an associated cheilitis, called follicular cheilitis or actinic [dermpedia.org]

Without treatment, this disease course remains chronic and can persist into adulthood. [1] [2] [3] Etiology The etiology remains unclear, but there is a strong genetic component suggesting an autoimmune basis for actinic prurigo. [ncbi.nlm.nih.gov]

Only 19 variables were found to be statistically significant ( P P Conclusions Multiple epidemiologic, geographic, clinical, and immunologic factors are involved in the etiology of AP. [onlinelibrary.wiley.com]

However, in Latin America, AP is considered a separate entity, with characteristic epidemiologic, clinical, and histopathologic features. Immunohistochemical studies of Mexican patients showed that keratinocytes contain abundant TNF alfa. [dermatologyadvisor.com]

The human leukocyte antigen DR4 allele variant is present in 90% of cases, especially the DR4 subtype DRB1*0407 which is seen in 60% of cases. [4] Epidemiology Actinic prurigo is a rare photodermatosis in the United States. [ncbi.nlm.nih.gov]

The presence of increased levels of IgE, eosinophils, and mast cells suggests a hypersensitivity reaction as one of the mechanisms in the pathophysiology of AP [ 25 ]. [obgynkey.com]

Some studies suggest an increased prevalence of actinic prurigo in certain geographic areas with dry, warm climates at an altitude of at least 1000 meters above sea level. [5] [6] [7] Pathophysiology The pathophysiology of actinic prurigo remains largely [ncbi.nlm.nih.gov]

A similar vaccine is also available to prevent herpes zoster. Treatment is required for all patients with herpes zoster. [clinuvel.com]

Association with HLA-DR4, specifically the HLA- DRB1*0407 and DRB1*0401 variants Prevention through avoidance of sunlight is the first-line therapy; thalidomide or other immunosuppressive agents may be required. [accessmedicine.mhmedical.com]

Photoprotection Taking measures to avoid sunlight exposure is important to prevent its occurrence and may require major adjustments to a person’s lifestyle. [skinsupport.org.uk]

The main goal is prevention by avoiding sun exposure. Patients must realise their condition will worsen during the sunniest months of the year and they must adhere to sun protection strategies to avoid or reduce outbreaks. [dermnetnz.org]