Actinic prurigo (Hutchinson''s summer prurigo)

Actinic prurigo or Hutchinson's summer prurigo is an entirely separate disease from polymorphic light eruption. The former is especially common in Mexico, Central and South America, while the latter is common in Europe. The differences between the two conditions are enumerated. It is emphasized that actinic prurigo is a chronic persistent and recalcitrant eruption which often continues throughout the winter months and affects covered as well as exposed areas of skin. A personal series of 51 patients with actinic prurigo is presented. The efficacy of thalidomide in the treatment of some cases of actinic prurigo is confirmed.     

Case for diagnosis. Actinic prurigo

A 13-year-old black boy had pruritic papular and nodular lesions on his forearms associated to edema of the lower lip, photophobia, conjunctivitis and pterygium. Skin biopsy of the lower lip revealed acanthosis, spongiosis with dermal perivascular mononuclear cell infiltration composed by lymphocytes, plasma cells and eosinophils consistent with actinic prurigo. Lesions improved considerably with the use of thalidomide 100mg/ day.     

Actinic granuloma (O'Brien)

Twelve cases of actinic graculoma (O'Brien) are reported. It is concluded that actinic granuloma is a specific disease characterized by clinical lesions indistinguishable from granuloma annulare, but occurring on solar damaged skin. Histologically, clastic tissue is destroyed by the granulomatous process in actinic granuloma. But not in granuloma annulare. It would appear that actinic granuloma, granuloma multiforme, necrobiosis lipoidica of the face and scalp (Wilson-Jones) and Miescher's granuloma of the face (Mehregan and Altman) are the same desease.     

Chronic pruritic papular dermatitis in adult men: a variant of prurigo.

Chronic recurrent pruritic papular eruptions in which a specific diagnosis cannot be established becomes a baffling experience to the dermatologist. We have met adult male patients with chronic recurrent pruritic papular eruptions, but their clinicopathological features are not described in English language textbooks. Our purpose was to study the clinical and histological features of this entity and review the various existing taxonomy. We conducted a study of 20 patients over a six year period by taking histories, performing skin biopsies, screening patch tests, and doing immunofluoresence studies. The eruptions occurred exclusively in male adults and had a predilection for the trunk and proximal extremities. The lesions were characterized by severely pruritic, nonfollicular, monomorphic, erythematous urticarial papules. There was no evidence of atopic diathesis or history of insect bite. Most patients had normal levels of serum eosinophils and IgE. The predominant histopathologic finding was a presence of perivascular infiltration of mononuclear cells with eosinophils. The patients followed a chronic course of at least six months with waxing and waning; systemic corticosteroids were the only effective treatment. Finally, all other pruritic erythematous papular dermatoses were ruled out. These cases comprise a distinct entity that has previously been mentioned in a few reports. Clear definition of this entity with an appropriate designation is in order to avoid confusion among dermatologists, and we propose the disease name "chronic papular dermatitis in adult men" as a variant of prurigo.     

Vascular Accidents After Actinic (Solar) Exposure

A link may exist between vascular accidents and identifiable episodes of excessive exposure to actinic radiation. If this is so, the explanation may lie in the bizarre behaviour of the temporal arteritis/polymyalgia rheumatica syndrome. In turn, the syndrome itself seems to be based upon actinically induced damage and reactivity in the elastic tissues at the surface of the body.     

The conjunctivitis of solar (actinic) prurigo

Solar (actinic) prurigo (SP) is an abnormal reaction to sunlight that affects mostly the Indian and mestizo populations of America, and is well known in Canada and the United States. It is quite common in Mexico, Central, and South America, although rare in Europe. It usually starts in childhood in both sexes and in about 30-50% of cases involves the oral and ocular mucosa. In this study we present the clinical and histopathologic conjunctival findings in 11 of 105 children with SP. Clinically the most important features were photophobia, some degree of pterygium, and pinguecula, hyperemia, Trantas' dots, hyaline exudate, and follicles. Histopathologically the changes were epithelial, such as epidermoid metaplasia and absence of goblet cells, and stromal changes, which were the most diagnostically relevant. These consisted of lymphocytic inflammatory infiltrates, usually with eosinophils, melanosis, and solar elastosis. We believe this constellation of criteria will be useful for a better characterization of SP.     

(4) Actinic reticuloid: is it pre-malignant?

Actinic reticuloid (AR) is a severe idiopathic, chronic, predominantly eczematous photodermatosis of elderly patients, characterized by marked photosensitivity to both UVB (280-315 nm) and UVA (315–400 nm) spectral wavebands. Cutaneous histopathological changes include a deep, dense lymphohistiocytic infiltrate sometimes containing mononuclear cells with hyperchromatic and convoluted nuclei, giant cells, Pautrier-like micro-abscesses and a resemblance to cutaneous T cell lymphoma. It has been suggested that progression to lymphoma can occasionally occur¹, although this remains controversial. Aneuploidy, the occurrence of abnormal chromosomes, is present in 70–90% of solid malignant tumours and has been observed in pre-malignant conditions such as chronic atrophic gastritis, congenital pigmented hairy naevi and Bowen's disease.² It has not, however, so far been identified in any entirely benign condition and its presence is thus considered implicit of malignancy or malignant potential. Flow cytometry (FCM) using DNA-specific stains permits the analysis of cellular DNA content and thus identification of anomalous chromosomes (aneuploidy). We have performed FCM on biopsies from six male AR patients aged 59–79 years. Formalin-fixed skin was processed with a FACS analyser. Dermal inflammatory cells and keratinocytes were assessed separately. No evidence of aneuploidy was noted in any patient. This suggests that AR is not a pre-malignant condition.     

Actinic reticuloid. A clinical, pathologic, and action spectrum study.

A 54-year-old man suffered from a chronic dermatitis that was more severe on light-exposed areas. Skin biopsy specimens revealed histopathologic findings consistent with those seen in mycosis fungoides. Ultrastructural studies demonstrated the existence of lymphoid cells with hyperconvoluted nuclei, typical of the mycosis fungoides cell or Sézary cell, within the epidermis, dermis, and peripheral blood. Light testing with a monochromator showed abnormal photosensitivity to both short- and long-wave ultraviolet light as well as to the violet, blue, and green wavelengths of visible light. The features of this patient's disease indicate actinic reticuloid.     

Actinic granuloma. A clinical, histopathologic, and immunocytochemical study

Two cases of actinic granuloma are described with emphasis on distinctive clinical and histopathologic features, including immunoperoxidase staining for lysozyme and immunophenotyping of mononuclear leukocytes. Actinic granuloma presents in chronically sun-damaged skin as normally colored to erythematous papules that coalesce to form centrifugally enlarging annular patterns. By light microscopy, a granulomatous infiltrate of giant cells and histiocytes is seen to be intimately related to the presence of elastotic fibers in the upper dermis. Selective localization of lysozyme in the giant cells of the granuloma is apparent by a tertiary antibody immunoperoxidase technique. Determination of mononuclear leukocyte subsets with monoclonal antibodies reveals a predominance of helper T cells in the lymphocytic infiltrate associated with the granuloma. It is postulated that actinic granuloma represents a cell-mediated immune response to weakly antigenic determinants on actinically altered elastotic fibers.