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Therapeutic Approach

Actinic prurigo is a rare chronic sunlight-induced pruritic and excoriated papular or nodular eruption with postinflammatory scarring that disproportionately affects indigenous peoples of North and South America. It typically begins in childhood, usually by age 10 and may remit at puberty. Strong association with HLA-DR4 has been identified. Controlled clinical trials are limited. While photoprotection is first-line, actinic prurigo is unique among photodermatoses in its reponse to thalidomide. See Table 91-1.

Table 91-1Actinic Prurigo Treatment Table

Levels of evidence are based on the Journal of the American Academy of Dermatology guidelines: level IA evidence includes evidence from meta-analysis of randomized controlled trials; level IB evidence includes evidence from ≥1 randomized controlled trial; level IIA evidence includes evidence from ≥1 controlled study without randomization; level IIB ...

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