Photosensitivity in lupus

Abstract

A wide variety of skin conditions may present in patients with lupus erythematosus (LE). These can be broadly divided into three main groups: cutaneous forms of LE ('LE-specific skin disease'), non-specific cutaneous manifestations of SLE ('LE non-specific skin disease') and cutaneous complications of drug treatments for LE. This review examines clinical photosensitivity in LE, a trait most commonly associated with cutaneous forms of LE but which may also manifest in SLE. All humans are photosensitive, developing reddening of the skin if exposed to sufficient ultraviolet radiation (UVR). Therefore we define photosensitivity in clinical practice as an abnormal cutaneous response to UVR. Abnormal photosensitivity in LE may manifest in a number of different forms. The lesions of LE-specific skin disease may be induced or exacerbated by UVR. Patients with LE who are prescribed photosensitizing medications such as thiazide diuretics, neuroleptics and tetracyclines may also develop phototoxic reactions which usually present as easy sunburn. Photosensitivity may also, rarely, manifest as fragile skin and blistering in patients with both LE and porphyria cutanea tarda. Several other photosensitive disorders have been reported in association with LE, including solar urticaria and erythropoetic protoporphyria (EPP), but these appear to be chance associations. Assessment of patients with LE and photosensitivity requires a careful history and examination. Phototesting and photoprovocation tests may be used to demonstrate photosensitivity in some cases, but these are rarely required for diagnosis. Photosensitive patients should be advised about sun avoidance, photoprotection and sunscreen use as a first line treatment.

Ultraviolet light protection by a sunscreen prevents interferon‐driven skin inflammation in cutaneous lupus erythematosus

“…UV irradiation induces various effects in the skin of CLE patients, such as cell death and inflammation (6)(7)(8), and several molecules, such as type I and III interferons (IFNs) and myxovirus protein A (MxA), an IFN-induced human protein expressed in CLE skin lesions, have been shown to be important biomarkers in the pathogenesis of the disease (9-13). In addition, recruitment of lymphocytes such as dendritic cells (DC), plasmacytoid DC (pDC) and macrophages via release of chemokines such as CXCL9 and CXCL10 in the epidermal layer can be observed during the chronic phase of CLE skin lesions (7,14).…”

Efficacy of mycophenolate mofetil in antimalarial-resistant cutaneous lupus erythematosus

“…Photosensitivity is generally prevalent in patients with CLE, 22 making daily sunscreen application and sun avoidance imperative for effective treatment. In addition, patients should be encouraged to abstain from smoking.…”

Sweet Syndrome in a Patient With Systemic Lupus Erythematosus Flare.

“…Cutaneous manifestations make up 3 of the 11 American College of Rheumatology (ACR) criteria to diagnose SLE, which are the classic malar rash, discoid rash or photosensitivity rash. Approximately half of the patients with SLE developed the malar rash, up to 25% develop the discoid rash and several studies have reported photosensitivity rash in 57% to 73% of SLE patients [4]. The presence of the SS rash during an SLE flare is so rare that epidemiologic data is scarcely available to report its concurrence, however, a few studies have suggested only three cases being reported so far [5].…”