ACTINIC PRURIGO: CLINICOPATHOLOGIC AND THERAPEUTIC FEATURES

Abstract

A 61-year-old black woman was referred to the stomatology clinic presenting severe ulcerated cheilitis lasting 5 years. She reported the lesion was associated with pruritus, tingling, and pain of vermillion border of the lower lip. Clinical examination revealed an inflammatory edema with desquamation and ulceration. Clinical diagnosis included actinic cheilitis and oral squamous cell carcinoma; an incisional biopsy was performed. Histologic analysis of the specimen stained with hematoxylin and eosin revealed a stratified squamous epithelium showing acanthosis, spongiosis, and basal cell vacuolation and the presence of edema in the lamina propria, a lymphocytic inflammatory infiltrate, lymphoid follicles, and a variable amount of eosinophils and melanophages in the connective tissue. Diagnosis was actinic prurigo. Management included a combination of topical steroids, 0.1% tacrolimus, and sublesional injections of betamethasone with good response. The lesion may appear as the only manifestation of this specific photodermatosis and must be included in differential diagnosis of lip lesions. A 61-year-old black woman was referred to the stomatology clinic presenting severe ulcerated cheilitis lasting 5 years. She reported the lesion was associated with pruritus, tingling, and pain of vermillion border of the lower lip. Clinical examination revealed an inflammatory edema with desquamation and ulceration. Clinical diagnosis included actinic cheilitis and oral squamous cell carcinoma; an incisional biopsy was performed. Histologic analysis of the specimen stained with hematoxylin and eosin revealed a stratified squamous epithelium showing acanthosis, spongiosis, and basal cell vacuolation and the presence of edema in the lamina propria, a lymphocytic inflammatory infiltrate, lymphoid follicles, and a variable amount of eosinophils and melanophages in the connective tissue. Diagnosis was actinic prurigo. Management included a combination of topical steroids, 0.1% tacrolimus, and sublesional injections of betamethasone with good response. The lesion may appear as the only manifestation of this specific photodermatosis and must be included in differential diagnosis of lip lesions.