UV hardening therapy: a novel intervention in patients with photosensitive cutaneous lupus erythematosus.
BACKGROUND
Patients with cutaneous lupus erythematosus (LE) and a history of disease- related photoaggravation, confirmed by phototesting, may not respond to photoprotection and/or medical intervention. Ultraviolet B-hardening therapy may improve tolerance for environmental ultraviolet radiation (UVR) in photosensitive disorders.


OBJECTIVE
We studied the effect of UVB hardening on the cutaneous manifestations of patients with LE and their tolerance for UVR.


METHODS
A retrospective study of continuous, home-based, UVB-hardening therapy in 44 patients with cutaneous LE (systemic LE: 9 patients; chronic LE: 21 patients; subacute cutaneous LE: 10 patients; cutaneous LE not specified: 4 patients) who had confirmed photosensitivity. Exposure to the UVB source was performed year-round, 3 times weekly, with increasing doses to a maximum of 10 minutes per session. Tolerance for environmental UVR was established through questionnaires, phototesting, and assessment of disease activity by physician and patient.


RESULTS
Of 44 patients, 35 were able to gradually increase their monthly UVB doses. Nine patients dropped out because of insufficient efficacy or skin irritation, or were unable to adhere to the hardening regimen. Of the 35 patients who succeeded in hardening their skin with UVB, 28 patients reported an improved tolerance for environmental UVR. This outcome was confirmed by repeat phototesting in a subgroup. In only 5 patients, an improvement of cutaneous LE symptoms was noted by either physician or patient. No serious adverse events were encountered.


CONCLUSIONS
This was a retrospective study and no control group was used.


CONCLUSIONS
This is the first report that describes UVB hardening as a potential therapy in patients with cutaneous LE and confirmed photosensitivity. This intervention may lead to improved tolerance for environmental UVR and, in a minority of patients, even to decreased cutaneous activity of LE.
Sanders
Cornelus J G
CJ
Department of Dermatology/Allergology, University Medical Centre, Utrecht, The Netherlands. c.sanders@umcutrecht.nl
Lam
Hooyin Y
HY
Bruijnzeel-Koomen
Carla A F M
CA
Sigurdsson
Vigfus
V
van Weelden
Huib
H
D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000150:complications / Q000532:radiotherapy*; D008297:Male; D010787:Photosensitivity Disorders / Q000150:complications / Q000532:radiotherapy*; D012189:Retrospective Studies; D014467:Ultraviolet Therapy / Q000379:methods*