Skip to main content

Advertisement

SpringerLink
Log in

Actinic conjunctivitis and its relationship with prurigo in an indigenous population from the Highlands of Chiapas, Mexico

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

Actinic conjunctivitis (AC), along with cheilitis (AChe), is part of the clinical spectrum of actinic prurigo (AP), a rare photo dermatosis that affects high-risk populations. We analyzed the clinical manifestations and onset of actinic conjunctivitis (AC), and its relationship with prurigo (AP) in a susceptible population.

Methods

This prospective observational cohort study was performed on Indigenous populations from the highlands of Chiapas, Mexico. Thorough dermatological and ophthalmological examinations were performed in patients attending a primary health care center. The clinical features, labor and environmental factors, onset timing, and clinical staging of AC and AP were analyzed.

Results

Of the 2913 patients studied, 54 patients (108 eyes) (1.8%) had AC, and 14 patients (25.9%) had AP. The mean age at diagnosis was 36.18 ± 18.52 years (6–70 years). The mean residential altitude was 1884 ± 434.2 m above sea level. Mean self-reported sun exposure was 5.14 ± 3.1 h a day (0.5—12 h). A total of 90.7% reported exposure to biomass fuels during cooking, and 50% to farm animals. AC was the sole manifestation in 70% of the cases. All patients had nasal and temporal photo-exposed conjunctiva. Among the eyes, 12.9% were classified as stage-1, 64.8% as stage-2, and 22.2% stage-3. A total of 83.3% of the patients had hyperpigmented lesions, and 35.1% had evaporative dry eye disease.

Conclusions

AC may be the initial or sole manifestation of AP. Most AC cases (87%) were initially observed at the advanced stages of the disease. Although solar exposure was not associated with late AC stages, a positive association was found with farm animal exposure. Evaporative dry eye associated with meibomian gland dysfunction has not been previously reported in patients with AC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

Data may be provided by corresponding author on reasonable request.

References

  1. Valbuena MC, Muvdi S, Lim HW (2014) Actinic prurigo. Dermatol Clin 32:335–344. https://doi.org/10.1016/j.det.2014.03.010

    Article  CAS  PubMed  Google Scholar 

  2. Hojyo-Tomoka T, Vega-Memije E, Granados J, Flores O, Cortés-Franco R, Teixeira F, Dominguez-Soto L (1996) Actinic prurigo: an update. Int J Dermatol 34:380–384. https://doi.org/10.1111/j.1365-4362.1995.tb04435.x

    Article  Google Scholar 

  3. Engel JM, Molinari A, Ostfeld B, Deen M, Croxatto O (2009) Actinic conjunctivitis in children: clinical features, relation to sun exposure, and proposed staging and treatment. J AAPOS 13:161–165. https://doi.org/10.1016/j.jaapos.2008.10.017

    Article  PubMed  Google Scholar 

  4. Magaña M, Mendez Y, Rodriguez A, Mascott M (2000) The conjunctivitis of solar (actinic) prurigo. Pediatr Dermatol 17:432–435. https://doi.org/10.1046/j.1525-1470.2000.01818.x

    Article  PubMed  Google Scholar 

  5. Escalona E, Magaña M (1964) Dermatología. Lo esencial para el estudiante. vol 164. Impresiones Modernas, SA, Mexico

  6. Lopez GG (1961) Solar prurigo. Arch Argent Dermatol 11:301–318

    Google Scholar 

  7. Fletcher DC, Romanchuk KG, Lane PR (1988) Conjunctivitis and pterygium associated with the American Indian type of polymorphous light eruption. Can J Ophthalmol 23:30–33

    CAS  PubMed  Google Scholar 

  8. Calnan CD, Meara RH (1997) Actinic prurigo (Hutchinson’s summer prurigo). Clin Exp Dermatol 2:365–372. https://doi.org/10.1111/j.1365-2230.1977.tb01577.x

    Article  Google Scholar 

  9. Moncada B, Castanedo-Cázares JP, Torres-Alvarez B (2005) Actinic prurigo. Int J Dermatol 44:700–701; author reply 701. https://doi.org/10.1111/j.1365-4632.2005.01978.x

  10. Cuevas-Gonzalez JC, Vega-Memíje ME, Borges-Yáñez SA, Rodríguez-Lobato E (2017) Risk factors associated with actinic prurigo: a case control study. An Bras Dermatol 92:774–778. https://doi.org/10.1590/abd1806-4841.20175105

    Article  PubMed  PubMed Central  Google Scholar 

  11. Vera Izaguirre DS, Zuloaga Salcedo S, González Sánchez PC et al (2014) Actinic prurigo: a case-control study of risk factors. Int J Dermatol 53:1080–1085. https://doi.org/10.1111/ijd.12168

    Article  PubMed  Google Scholar 

  12. Ross G, Foley P, Baker C (2008) Actinic prurigo. Photodermatol Photoimmunol Photomed 24:272–275. https://doi.org/10.1111/j.1600-0781.2008.00375.x

    Article  PubMed  Google Scholar 

  13. Gambichler T, Al-Muhammadi R, Boms S (2009) Immunologically mediated photodermatoses: diagnosis and treatment. Am J Clin Dermatol 10:169–180. https://doi.org/10.2165/00128071-200910030-00003

    Article  PubMed  Google Scholar 

  14. Wiseman MC, Orr PH, Macdonald SM, Schroeder ML, Toole JW (2001) Actinic prurigo: clinical features and HLA associations in a Canadian Inuit population. J Am Acad Dermatol 44:952–956. https://doi.org/10.1067/mjd.2001.112579

    Article  CAS  PubMed  Google Scholar 

  15. Valverde López J, Querevalú Eche FM, Tincopa Wong OW (2005) Fotodermatosis: rasgos clínicos y epidemiológicos en un hospital general. Dermatol peru 113–120

  16. Stratigos AJ, Antoniou C, Papathanakou E, Daboudi M, Tranaka K, Tsara K, Katsambas AD (2003) Spectrum of idiopathic photodermatoses in a Mediterranean country. Int J Dermatol 42:449–454. https://doi.org/10.1046/j.1365-4362.2003.01725.x

    Article  PubMed  Google Scholar 

  17. Bernal JE, Duran de Rueda MM, de Brigard D (1988) Human lymphocyte antigen in actinic prurigo. J Am Acad Dermatol 18:310–312. https://doi.org/10.1016/s0190-9622(88)70045-6

    Article  CAS  PubMed  Google Scholar 

  18. Menagé HDP, Vaughan RW, Baker CS, Page G, Proby CM, Breathnach SM, Hawk JL (1996) HLA-DR4 may determine expression of actinic prurigo in British patients. J Invest Dermatol 106:362–367. https://doi.org/10.1111/1523-1747.ep12343141

    Article  Google Scholar 

  19. Hojyo-Tomoka T, Granados J, Vargas-Alarcón G et al (1997) Further evidence of the role of HLA-DR4 in the genetic susceptibility to actinic prurigo. J Am Acad Dermatol 36:935–937. https://doi.org/10.1016/s0190-9622(97)80276-9

    Article  CAS  PubMed  Google Scholar 

  20. Suárez A, Valbuena MC, Rey M, de Porras QL (2006) Association of HLA subtype DRB10407 in Colombian patients with actinic prurigo. Photodermatol Photoimmunol Photomed 22:55–58. https://doi.org/10.1111/j.1600-0781.2006.00205.x

    Article  PubMed  Google Scholar 

  21. Zuloaga-Salcedo S, Castillo-Vazquez M, Vega-Memije E et al (2007) Class I and class II major histocompatibility complex genes in Mexican patients with actinic prurigo. Br J Dermatol 156:1074–1075. https://doi.org/10.1111/j.1365-2133.2007.07801.x

    Article  CAS  PubMed  Google Scholar 

  22. Grabczynska SA, McGregor JM, Kondeatis E, Vaughan RW, Hawk JL (1999) Actinic prurigo and polymorphic light eruption: common pathogenesis and the importance of HLA-DR4/DRB1*0407. Br J Dermatol 140:232–236. https://doi.org/10.1046/j.1365-2133.1999.02654.x

    Article  CAS  PubMed  Google Scholar 

  23. Hiramoto K, Tanaka H, Yanagihara N, Sato EF, Inoue M (2004) Effect of 17beta-estradiol on immunosuppression induced by ultraviolet B irradiation. Arch Dermatol Res 295:307–311. https://doi.org/10.1007/s00403-003-0437-0

    Article  CAS  PubMed  Google Scholar 

  24. Widyarini S, Domanski D, Painter N, Reeve VE (2006) Estrogen receptor signaling protects against immune suppression by UV radiation exposure. Proc Natl Acad Sci USA 103:12837–12842. https://doi.org/10.1073/pnas.0603642103

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

  25. Lane PR, Hogan DJ, Martel MJ, Reeder B, Irvine J (1992) Actinic prurigo: clinical features and prognosis. J Am Acad Dermatol 26:683–692. https://doi.org/10.1016/0190-9622(92)70093-u

    Article  CAS  PubMed  Google Scholar 

  26. Valbuena MC, Rolon Cadena M (2020) Epidermal Langerhans cells resistance to solar-simulated radiation in actinic prurigo patients with low minimal erythema dose. Photodermatol Photoimmunol Photomed 36:105–110. https://doi.org/10.1111/phpp.12514

    Article  PubMed  Google Scholar 

  27. Santos-Martínez L, Llorente L, Baranda L, Richaud-Patin Y, Torres-Alvarez B, Moncada B, González-Amaro R (1997) Profile of cytokine mRNA expression in spontaneous and UV-induced skin lesions from actinic prurigo patients. Exp Dermatol 6:91–97. https://doi.org/10.1111/j.1600-0625.1997.tb00153.x

    Article  PubMed  Google Scholar 

  28. González-Amaro R, Baranda L, Salazar-Gonzalez JF, Abud-Mendoza C, Moncada B (1991) Immune sensitization against epidermal antigens in polymorphous light eruption. J Am Acad Dermatol 24:70–73. https://doi.org/10.1016/0190-9622(91)70013-r

    Article  PubMed  Google Scholar 

  29. Moncada B, González-Amaro R, Baranda ML, Loredo C, Urbina R (1984) Immunopathology of polymorphous light eruption. T lymphocytes in blood and skin. J Am Acad Dermatol 10:970–973. https://doi.org/10.1016/s0190-9622(84)80316-3

    Article  CAS  PubMed  Google Scholar 

  30. Grabczynska SA, Hawk JL (1997) What is actinic prurigo in Britain? Photodermatol Photoimmunol Photomed 13:85–86. https://doi.org/10.1111/j.1600-0781.1997.tb00119.x

    Article  CAS  PubMed  Google Scholar 

  31. Schwarz A, Schwarz T (2010) UVR-induced regulatory T cells switch antigen-presenting cells from a stimulatory to a regulatory phenotype. J Invest Dermatol 130:1914–1921. https://doi.org/10.1038/jid.2010.59

    Article  CAS  PubMed  Google Scholar 

  32. Gambichler T (2015) T regulatory cells in polymorphic light eruption. Br J Dermatol 173:330–331. https://doi.org/10.1111/bjd.13996

    Article  CAS  PubMed  Google Scholar 

  33. Urbinati F, Borroni D, Rodríguez-Calvo-de-Mora M et al (2022) Pseudopterygium: an algorithm approach based on the current evidence. Diagnostics (Basel) 12:1843. https://doi.org/10.3390/diagnostics12081843

    Article  PubMed  Google Scholar 

  34. Bustamante-Arias A, Ruiz Lozano RE, Rodriguez-Garcia A (2022) Dry eye disease, a prominent manifestation of systemic autoimmune disorders. Eur J Ophthalmol 32:3142–3162. https://doi.org/10.1177/11206721221088259

    Article  PubMed  Google Scholar 

  35. Mauriello JA Jr, Napolitano J, McLean I (1995) Actinic keratosis and dysplasia of the conjunctiva: a clinicopathological study of 45 cases. Can J Ophthalmol 30:312–316

    PubMed  Google Scholar 

  36. Berner A (2005) Aktinisk keratose og utvikling av plateepitelkarsinom i hud [Actinic keratosis and development of cutaneous squamous cell carcinoma]. Tidsskr Nor Laegeforen 16:1653–1654

    Google Scholar 

  37. Nanji AA, Mercado C, Galor A, Dubovy S, Karp CL (2017) Updates in ocular surface tumor diagnostics. Int Ophthalmol Clin 57:47–62. https://doi.org/10.1097/IIO.0000000000000174

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors thank the administrative staff, language interpreters, and medical personnel at Clinica Esquipulas for their support.

Funding

This research project received a partial support from Fundacion Esquipulas, A.C. and The Immuneye Foundation of Monterrey, Mexico.

Author information

Authors and Affiliations

  1. Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico

    Jimena Alamillo-Velazquez, Gustavo Ortiz-Morales, Daniel F. Lopez-Altamirano & Alejandro Rodríguez-Garcia

  2. Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico

    Jimena Alamillo-Velazquez & Gustavo Ortiz-Morales

  3. Department of Dermatology, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey, Mexico

    Sergio E. Gonzalez-Gonzalez

  4. Clinical Pathology Department, Hospital San Jose Tec Salud, Monterrey, Mexico

    Daniel F. Lopez-Altamirano

  5. Institute of Ophthalmology and Visual Sciences, Hospital Zambrano-Hellion TecSalud. Av, Batallon de San Patricio No. 112, Col. Real de San Agustin, CP. 66270, San Pedro Grarza Garcia, Nuevo León, Mexico

    Alejandro Rodríguez-Garcia

Authors
  1. Jimena Alamillo-Velazquez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gustavo Ortiz-Morales
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sergio E. Gonzalez-Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel F. Lopez-Altamirano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alejandro Rodríguez-Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors read the complete text, edited corresponding sections, and accepted the final manuscript draft. JAV: ophthalmologic examinations, data collection, analysis, first draft writing and editing. GOM: data collection and analysis, writing and editing. SGG: dermatologic examinations, data collection, protocol advice, writing and editing. DFLA: data collection, histopathologic analysis, interpretation, reporting, and image of conjunctival biopsies. ARG: original idea, project coordination and supervision, patients’ evaluations, data analysis, writing and editing, clinical image selections, and editing.

Corresponding author

Correspondence to Alejandro Rodríguez-Garcia.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethics statement

This manuscript is the authors’ original work and has not been previously published elsewhere. All authors reviewed, accepted, and assumed responsibility for the data in this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 550 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alamillo-Velazquez, J., Ortiz-Morales, G., Gonzalez-Gonzalez, S.E. et al. Actinic conjunctivitis and its relationship with prurigo in an indigenous population from the Highlands of Chiapas, Mexico. Int Ophthalmol 44, 4 (2024). https://doi.org/10.1007/s10792-024-02925-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10792-024-02925-0

Keywords

Search

Navigation