title: Failure of physiologic doses of pure UVA or UVB to induce lesions in photosensitive cutaneous lupus erythematosus: implications for phototesting.
abstract: BACKGROUND
  Phototesting studies in cutaneous lupus erythematosus have yielded variable results, with most trials reporting photo-induction of lesions by both UVA and UVB in substantial numbers of patients.
  
  
  OBJECTIVE
  To determine the minimal erythema dose in patients with subacute cutaneous lupus erythematosus (SCLE) and controls.
  
  
  METHODS
  We phototested nine patients with SCLE and 14 skin type-matched controls, using repetitive dosing of UVA1 and UVB, but with filters that removed most of the shorter UVC and longer infrared and visible light. In addition, DNA was isolated from anticoagulated blood to genotype the TNF-alpha 308 region in each patient and control.
  
  
  RESULTS
  We were unable to demonstrate a difference in minimal erythema dose (MED) between patients and controls, or any correlation of MED with either TNF genotype or systemic drug therapy for SCLE. In addition, no SCLE skin lesions were induced in the nine patients with either UVA or UVB, and one patient cleared a skin lesion after low-dose UVA1 irradiation.
  
  
  CONCLUSIONS
  The potential role of wavelengths outside the UVA and UVB range in the photo-induction of cutaneous lupus skin lesions needs to be investigated, and there is a need to standardize phototesting equipment and procedures for patients with cutaneous lupus erythematous.
authors.affiliation: The University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Lokitz
authors.forename: Sara
authors.initials: S
authors.lastname: Billet
authors.forename: Purvisha
authors.initials: P
authors.lastname: Patel
authors.forename: Eun Ji
authors.initials: EJ
authors.lastname: Kwon
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sayre
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Sullivan
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Werth
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008178:Lupus Erythematosus, Cutaneous / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D010787:Photosensitivity Disorders / Q000175:diagnosis* / Q000473:pathology; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D012879:Skin Physiological Phenomena / Q000528:radiation effects; D012882:Skin Tests / Q000592:standards*; D014466:Ultraviolet Rays