title: Photosensitivity in lupus erythematosus, UV photoprovocation results compared with history of photosensitivity and clinical findings.
abstract: Photosensitivity, one of the presenting symptoms in lupus erythematosus (LE), is still poorly defined and varying prevalence figures have been reported. The possibility of a coexisting photodermatosis, especially polymorphous light eruption (PLE), has often not been taken into account. We report the results of ultraviolet A (UVA) and B (UVB) photoprovocation tests in 67 clinically photosensitive patients who had confirmed discoid LE (DLE), systemic LE (SLE) or subacute cutaneous LE (SCLE). The results are compared with a detailed history of photosensitivity and with clinical and serological findings. A pathological photoprovocation reaction, graded as weak, moderate or strong, was induced with either UVA or UVB in 69% of patients with LE, in 100% of those with SCLE, in 70% of those with SLE and in 64% of those with DLE, but in none of 14 controls. Only 16% of the pathological reactions were strong and long-lasting, resembling LE lesions, while 48% were moderate or weak and transient, clinically like PLE. Fifty-three per cent of the provocation reactions which were biopsied showed a PLE-like histology or a non-specific inflammatory reaction, and most of them were clinically moderate or weak reactions of short duration. In the remaining, mostly clinically strong or long-lasting reactions, the histology was consistent with LE. A history of sunlight sensitivity did not predict a pathological photoprovocation result but a positive association between the presence of SSA/Ro or SSB/La antibodies and a pathological photoprovocation reaction was found. We have shown that PLE coexists with LE and that both PLE- and LE-like lesions can be induced with UV radiation in LE patients.
authors.affiliation: Department of Dermatology, University of Tampere, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Hasan
authors.forename: F
authors.initials: F
authors.lastname: Nyberg
authors.forename: E
authors.initials: E
authors.lastname: Stephansson
authors.forename: P
authors.initials: P
authors.lastname: Puska
authors.forename: M
authors.initials: M
authors.lastname: Häkkinen
authors.forename: S
authors.initials: S
authors.lastname: Sarna
authors.forename: A M
authors.initials: AM
authors.lastname: Ros
authors.forename: A
authors.initials: A
authors.lastname: Ranki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000150:complications*; D008179:Lupus Erythematosus, Discoid / Q000150:complications; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010787:Photosensitivity Disorders / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D012867:Skin / Q000528:radiation effects; D013997:Time Factors; D014466:Ultraviolet Rays
chemical_list: D001323:Autoantibodies