Actinic prurigo of the lip: Two case reports

Abstract

Actinic prurigo is a photodermatosis that can affect the skin, conjunctiva and lips. It is caused by an abnormal reaction to sunlight and is more common in high-altitude living people, mainly in indigenous descendants. The diagnosis of actinic prurigo can be challenging, mainly when lip lesions are the only manifestation, which is not a common clinical presentation. The aim of this article is to report two cases of actinic prurigo showing only lip lesions. The patients were Afro-American and were unaware of possible Indian ancestry. Clinical exam, photographs, videoroscopy examination and biopsy were performed, and the diagnosis of actinic prurigo was established. Topical corticosteroid and lip balm with ultraviolet protection were prescribed with excellent results. The relevance of this report is to show that although some patients may not demonstrate the classical clinical presentation of actinic prurigo, the associated clinical and histological exams are determinants for the correct diagnosis and successful treatment of this disease.

Keywords: Actinic prurigo; Follicular cheilitis; High-altitude; Lip diseases; Photodermatosis.

Figure 1

Case 1. A: Clinical aspect at the first appointment, showing lower lip edema, ulcers and crusts; B: Videoroscopy image showing in detail the presence of ulcer and crust; C: Clinical aspect at the second appointment showing the area of biopsy; D: Clinical aspect one month after treatment, showing remission of the lip edema, ulcers and crusts; E: Histological aspects. Epithelial atrophy and intense diffuse lymphoplasmacytic inflammatory infiltrate extending deep into the fatty tissue (× 10, HE); F: Epithelium showing spongiosis, hydropic degeneration of the basal layer cells and lymphocytic exocytosis. In the connective tissue, lymphocytic inflammatory infiltrate and pigmentary incontinence (arrows) were observed (× 40, HE). G: Secondary lymphoid follicle (× 40, HE); H: Mast cells mainly in the deeper area of the connective tissue (× 20, Giemsa).

Figure 2

Case 2. A: Clinical aspect at the first appointment, showing lower lip edema, dryness and ulcer on the left side of the semimucosa; B: Clinical aspect at the second appointment, showing remission of the ulceration on the left side, and only a small ulcer on the right side of the semimucosa; C: Histological aspects. Lower power view showing epithelial atrophy and ulceration. In the connective tissue, an intense, diffuse inflammatory infiltrate extending deep into the fatty tissue, with some lymphoid follicles was observed (HE); D: Secondary lymphoid follicle (HE).