title: Characterization of clinical photosensitivity in cutaneous lupus erythematosus.
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).
  
  
  CONCLUSIONS
  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.
authors: Philadelphia Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
authors: Kristen
authors: K
authors: Foering
authors: Aileen Y
authors: AY
authors: Chang
authors: Evan W
authors: EW
authors: Piette
authors: Andrew
authors: A
authors: Cucchiara
authors: Joyce
authors: J
authors: Okawa
authors: Victoria P
authors: VP
authors: Werth
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008178:Lupus Erythematosus, Cutaneous / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010641:Phenotype; D010787:Photosensitivity Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D015995:Prevalence; D011446:Prospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013472:Sunlight / Q000009:adverse effects; D011795:Surveys and Questionnaires
keywords: CLASI; CLE; Cutaneous Lupus Erythematosus Disease Area and Severity Index; LE; PGA; PMLE; PS; Physicians Global Assessment; SELENA; SLE; SLEDAI; Safety of Estrogens in Lupus Erythematosus National Assessment; Systemic Lupus Erythematosus Disease Activity Index; cutaneous lupus erythematosus; dendritic cells; direct sun-induced cutaneous lupus erythematosus flare; directCLE; genCLE; genRxn; genSkin; genSys; general exacerbation of cutaneous lupus erythematosus; general pruritus/paresthesias; immunohistochemistry; lupus erythematosus; mDC; myeloid dendritic cells; photosensitivity; polymorphic light eruption; polymorphic light eruption-like; sun-induced systemic symptoms; systemic lupus erythematosus
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