Phototesting in lupus erythematosus: A 15-year experience

Kuhn, Annegret; Sonntag, Monika; Richter-Hintz, Dagmar; Oslislo, Claudia; Megahed, Mosaad; Ruzicka, Thomas; Lehmann, Percy

doi:10.1067/mjd.2001.114589

Cited by 175 publications

(189 citation statements)

References 47 publications

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“…In recent years, our group has demonstrated that pathologic skin reactions can be induced in 54% of patients with various subtypes of LE, when applying standardized protocols of provocative phototesting (12). Interestingly, as confirmed by other investigators (13)(14)(15), the development of UV light-induced skin lesions is considerably slower and the persistence is longer than in other photodermatoses, such as polymorphous light eruption (PLE).…”

mentioning

confidence: 51%

“…This might be due to the higher sensitivity of patients with CLE to exogenous factors, such as UV light. The mechanisms of photosensitivity and the induction of skin lesions after solar or UV irradiation as an important element in the pathogenesis of CLE have been extensively studied (12,23,27,50,51). It has been proposed that UV light exposure might cause exacerbation of local and systemic autoimmunity by inducing changes in the expression and binding of keratinocyte autoantigens (17,52,53).…”

Section: Discussionmentioning

confidence: 99%

“…This might be due to the experimental conditions of provocative phototesting, in which the dose of UV irradiation is delivered during a relatively short period of time and the skin specimens are obtained as soon as the lesions have developed. Nevertheless, in contrast to other photodermatoses, such as PLE, skin lesions in patients with CLE develop slowly (mean Ϯ SD 8.0 Ϯ 4.6 days after UV light exposure) and persist for several days or weeks (12).…”

Section: Discussionmentioning

confidence: 99%

“…Test areas were evaluated for up to 4 weeks after the last irradiation, until specific skin lesions appeared. Criteria for a positive provocative phototesting result required that 1) induced lesions clinically resemble LE, 2) histologic findings are compatible with LE, and 3) skin lesions develop slowly and persist for several days or weeks (12,27).…”

Section: Methodsmentioning

confidence: 99%

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Accumulation of apoptotic cells in the epidermis of patients with cutaneous lupus erythematosus after ultraviolet irradiation

Kuhn

Herrmann

Kleber

et al. 2006

Arthritis & Rheumatism

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Objective. To examine whether apoptosis contributes to the pathogenesis of skin lesions in patients with cutaneous lupus erythematosus (CLE) after ultraviolet (UV) irradiation.Methods. In situ nick translation and TUNEL were performed to detect apoptosis in 85 skin biopsy specimens from patients with various subtypes of CLE. Specimens from normal healthy donors and patients with polymorphous light eruption were used as controls. In addition to assessment of primary lesions, provocative phototesting was carried out to investigate events occurring secondary to UV irradiation during a very early stage of lesion formation.Results. A significant increase in apoptotic nuclei was found in the upper epidermal layer of primary and UV light-induced skin lesions of CLE patients compared with controls. In tissue sections obtained from control subjects at 24 hours after a single exposure to UV light, a slight increase in the count of epidermal apoptotic nuclei was present as compared with skin tissue from CLE patients obtained under the same conditions before lesion formation. In sections obtained from controls at 72 hours after irradiation, a significant decrease in the apoptotic nuclei count was observed, consistent with a proper clearance of apoptotic cells in the period between 24 and 72 hours after irradiation. In striking contrast, the number of apoptotic nuclei increased significantly within this period in tissue sections from patients with CLE.Conclusion. These data support the hypothesis that apoptotic cells accumulate in the skin of patients with CLE after UV irradiation, as a result of impaired or delayed clearance. The nonengulfed cells may undergo secondary necrosis and release proinflammatory compounds and potential autoantigens, which may contribute to the inflammatory micromilieu that leads to formation of skin lesions in this disease.

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confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Accumulation of apoptotic cells in the epidermis of patients with cutaneous lupus erythematosus after ultraviolet irradiation

Kuhn

Herrmann

Kleber

et al. 2006

Arthritis & Rheumatism

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187

124

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“…We have optimized this standardized photoprovocation protocol by accounting for multiple factors, such as light source, test area of irradiated skin, dose of UV exposure, and frequency of irradiation. In 2001, we previously presented an analysis of 323 CLE patients and reported on our 15-year experience with photoprovocation (19).…”

Section: Introductionmentioning

confidence: 99%

Updated Analysis of Standardized Photoprovocation in Patients With Cutaneous Lupus Erythematosus

Ruland

Haust

Stilling

et al. 2013

Arthritis Care & Research

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Objective. To determine the frequency and reproducibility of standardized photoprovocation in patients with cutaneous lupus erythematosus (CLE) and report our long-term experience. Methods. Photoprovocation using a standardized protocol was evaluated retrospectively in 566 patients. A diagnosis of CLE was clinically and/or histologically confirmed in 431 patients, and 315 patients with polymorphic light eruption (PLE) were additionally included as controls. Data were statistically analyzed using an SPSS database. Results. A total of 61.7% of the 431 CLE patients exhibited a positive photoprovocation, with a significantly longer latency period for the development of skin lesions after ultraviolet (UV) A and/or UVB irradiation than PLE patients (P < 0.001). The frequency of positive photoprovocation varied among the CLE subtypes, and intermittent CLE was the most photosensitive disease entity (74.8%). Subsequent photoprovocation in 35 patients demonstrated that CLE patients with an initial positive result exhibited a significantly higher frequency of a positive photoprovocation at a later time point (P ‫؍‬ 0.013). However, an initial positive photoprovocation did not definitively predict a positive reaction at a later time point. Moreover, patient history of photosensitivity was not a predictor for the photoprovocation outcome. Conclusion. Standardized photoprovocation is a useful tool to reproducibly induce skin lesions and objectively evaluate photosensitivity in patients with CLE. These data further suggest that the reaction to UV light may change during the course of this heterogeneous disease and that photosensitivity should not be excluded in patients with a negative history of photosensitivity.

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