Actinic prurigo

Actinic prurigo is a rare, UV-induced papular or nodular, itchy and usually excoriated eruption.

This chapter is set out as follows:

• Rare in Europe but common amongst some populations in the Americas
• Commoner in children, especially girls
• Often starts in the first decade of life
• Lesions are usually very itchy
• Symptoms most apparent in summer, when most affected people are aware of distinct flares related to UV exposure. Often fails to clear completely in the winter
• Often improves over time and may resolve by teenage years or early adulthood, occasionally persisting into adult life

Distribution

• The face and distal limbs predominate although non-exposed sites can be affected

• Phototesting (available in some dermatology departments) is usually required to confirm the diagnosis 

Step 1: general

• Provide a patient information leaflet on UV protection

Step 2: milder cases

• Can be managed by appropriate UV protection measures (including window film), emollients and potent to super-potent topical steroids

Step 3: moderate to severe cases

• Referral for phototherapy, to be commenced in early Spring, can help promote tolerance
• If refractory to treatments, Thalidomide (in those who are not of child‐bearing potential) or immunosuppressive drugs such as azathioprine may be required