By Gary M. White, MD
Actinic prurigo (AP) is a rare photodermatosis of children most common in the Indian and Mestizo populations in Central and South America living at high altitudes, although it has also been reported in whites and Asians.
Intensely itchy papules, plaques, and nodules, along with excoriations and scars occur in the sun-exposed areas. The onset is usually in childhood, but it ranges from 2 to 43 years. The mean age of onset is <10 years of age in a study from the United Kingdom, and at 4 to 5 years of age in the native Amerindian population.
The face, neck, extensor forearms, dorsal surfaces of the hands, and the upper aspect of the chest are most commonly affected. However, in patients described in the United Kingdom, covered sites, including the back and buttocks, have been reported to be affected. Patients frequently complain about pruritus throughout the year with an exacerbation of the symptoms during spring or summer.
Involvement of the lips and the conjunctiva is common, and it causes cheilitis, conjunctivitis, and pseudopterygium. Both the upper and lower lips can be affected, although it is found mainly on the lower lip. Lower lip involvement in some cases can represent the only manifestation of the disease.
Spontaneous remission may occur in adolescence, particularly in patients with onset in childhood, but persistence is common. In Latin American patients living at high altitudes, relocation to a lower altitude area may result in resolution of the disease.
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