Characterization of clinical photosensitivity in cutaneous lupus erythematosus.
J Am Acad Dermatol
; 69(2): 205-13, 2013 Aug.
Article
em En
| MEDLINE
| ID: mdl-23648190
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.Palavras-chave
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
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Transtornos de Fotossensibilidade
/
Lúpus Eritematoso Cutâneo
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adult
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
J Am Acad Dermatol
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Estados Unidos