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Characterization of clinical photosensitivity in cutaneous lupus erythematosus - 17/07/13

Doi : 10.1016/j.jaad.2013.03.015 
Kristen Foering, MD a, b, c, Aileen Y. Chang, MD a, b, Evan W. Piette, MD a, b, Andrew Cucchiara, PhD c, Joyce Okawa, RN a, b, Victoria P. Werth, MD a, b,
a Philadelphia Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania 
b Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 
c Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania 

Reprint requests: Victoria P. Werth, MD, Department of Dermatology, Hospital of the University of Pennsylvania, PCAM Suite 1-330S, 3400 Civic Center Blvd, Philadelphia, PA 19104.

Abstract

Background

Photosensitivity (PS) in lupus erythematosus (LE) is frequently determined by patient report.

Objective

We sought to characterize self-reported PS in cutaneous LE (CLE).

Methods

The PS survey was used to classify subject responses into 5 phenotypes: direct sun-induced CLE flare (directCLE); general exacerbation of CLE (genCLE); polymorphic light eruption–like reactions (genSkin); general pruritus/paresthesias (genRxn); and sun-induced systemic symptoms (genSys). In all, 91 subjects with CLE alone or with CLE and systemic LE were interviewed.

Results

In all, 81% ascribed to 1 or more PS phenotypes. CLE-specific reactions (direct sun-induced CLE flare or general exacerbation of CLE) were reported by 86% of photosensitive subjects. Higher CLE disease activity (measured by CLE Disease Area and Severity Index activity scores) was suggestive of direct sun-induced CLE flare reactions (P = .09). In all, 60% of photosensitive subjects described CLE-nonspecific reactions: polymorphic light eruption–like rash and general pruritus/paresthesias. These phenotypes often co-occurred with CLE-specific reactions and were predicted by more systemic disease activity as measured by Physicians Global Assessment (PGA) scores in regression analyses (genSkin, P = .02) and (genRxn, P = .05). In all, 36% of subjects reported systemic reactions and higher PGA scores were predictive of the sun-induced systemic symptoms phenotype (P = .02); a diagnosis of systemic LE was not (P = .14).

Limitations

PS was inferred from patient report and not directly observed.

Conclusions

Characterization of self-reported PS in LE reveals that patients experience combinations of CLE-specific, CLE-nonspecific, and systemic reactions to sunlight. Sun-induced CLE flares are associated with more active CLE disease. Polymorphic light eruption–like, generalized pruritus/paresthesias, and systemic reactions are associated with more active systemic disease. Recognition of PS phenotypes will permit improved definitions of clinical PS and allow for more precise investigation into its pathophysiology.

Le texte complet de cet article est disponible en PDF.

Key words : cutaneous lupus erythematosus, dendritic cells, immunohistochemistry, photosensitivity, polymorphic light eruption, systemic lupus erythematosus

Abbreviations used : CLASI, CLE, directCLE, genCLE, genRxn, genSkin, genSys, LE, mDC, PGA, PMLE, PS, SELENA, SLE, SLEDAI


Plan


 This material is based upon work supported by the National Institutes of Health, including NIH K24-AR 18 02207 (Dr Werth); National Center for Advancing Translational Research TL1RR024133, which is now National Center for Advancing Translational Science TL1TR00138 (Drs Foering and Cucchiara); and Department of Veterans Affairs, Veteran Health Administration, Office of Research and Development, Biomedical Laboratory Research and Development.
 Conflicts of interest: None declared.


© 2013  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 69 - N° 2

P. 205-213 - août 2013 Retour au numéro
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