Ask the Expert: Photosensitivity in Cutaneous Lupus
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1 Ask the Expert: Photosensitivity in Cutaneous Lupus Victoria P. Werth, MD Department of Dermatology & Medicine University of Pennsylvania ; Philadelphia VA Hospital
2 Overview Definition Impact of photosensitivity on quality of life Types of photosensitivity Testing for photosensitivity Treatment of photosensitivity
3 ACR Lupus Criteria Definition of Photosensitivity Skin rash as a result of unusual reaction to sunlight by patient history or physician observation
4 ACR Lupus Criteria Definition of Photosensitivity Photosensitivity is not specific for SLE Observed in other conditions - Polymorphous light eruption (PLE) - Photoallergic contact dermatitis - Dermatomyositis - Porphyria The ACR criteria may overestimate the occurrence of SLE
5 Cutaneous LE Progressing to SLE Criteria Percentage (n) Photosensitivity 92.3 (12) Discoid Rash 84.6 (11) Malar Rash 30.8 (4) ANA 69.2 (9) Oral Ulcers 53.8 (7) Arthritis 46.2 (6) Hematologic 30.7 (4) Anti-dsDNA, Anti-Sm, antiphospholipid 23.1 (3) Renal 15.4 (2) 13/77 pts Wieczorek and Werth, JAMA Derm, in press
6 Overview Defintion Impact of photosensitivity on quality of life Types of photosensitivity Photosensitivity in subtypes of lupus Testing for photosensitivity Treatment of photosensitivity
7 QoL in Photosensitivity Foering et al, JAAD 2:220-8, 2011
8 QoL in Photosensitivity Foering et al, JAAD 2:220-8, 2011
9 Overview Defintion Impact of photosensitivity on quality of life Types of photosensitivity Photosensitivity in subtypes of lupus Testing for photosensitivity Treatment of photosensitivity
10 5 Clinical Photosensitivity Phenotypes Identified Foering K, et al. Photosensitivity in CLE. JAAD 2013; 69:
11 Epidemiology of Photosensitivity 83% of patients reported one or more photosensitivity phenotypes with 60% having multiple Over 50% of patients with photosensitivity reported direct induction of cutaneous lupus lesions from sun exposure 1/3 rd reported arthralgias, weakness, fatigue, or headache Many patients have more than one type of photosensitivity
12 Percentages of Photosensitivity Phenotypes Foering K, et al. Characterization of clinical photosensitivity in cutaneous lupus erythematosus. JAAD 2013; 69:
13 Timing of Photosensitivity Early within minutes to next day Transient same day to within 1 week Late within 1 week, lasting weeks to months
14 Timing of Photosensitivity Reactions Cutaneous lupus lesions - Most commonly occurred within minutes to days of exposure - 50% resolved within one week - 50% lasting longer than a week Nonspecific reactions (arthralgias, weakness, fatigue or headache) : typically early and transient - More prevalent in patients with combination of CLE and SLE
15 Development & Resolution of Reactions
16 Photosensitivity Phenotype Associated with SLE Diagnosis
17 Photosensitivity in CLE Definition of types of photosensitivity is the first step to beginning to dissect the differences in pathophysiology Hypothesize differences in resident and migrating cells in skin
18 Overview Defintion Impact of photosensitivity on quality of life Types of photosensitivity Photosensitivity in subtypes of lupus Testing for photosensitivity Treatment of photosensitivity
19 Phototesting Studies have used UVB and/or UVA to induce skin lesions of cutaneous lupus 50-60% of patients with cutaneous lupus experience positive phototesting Not always reproducible results over time
20 Overview Definition Impact of photosensitivity on quality of life Types of photosensitivity Photosensitivity in subtypes of lupus Testing for photosensitivity Treatment of photosensitivity
21 Treatment of Photosensitivity Sun avoidance Sunscreen (UVB + UVA blockers) Photoresistant clothing Antimalarials - Hydroxychloroquine - Chloroquine - Quinacrine
22 Ask a Question! As part of the Ask the Expert series remember to submit your question on Photosensitivity by May 15, 2014 to Check back in June for answers to 15 selected questions If you are viewing this at a later date we encourage you to call our Health Educators at for any further questions.
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