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Phototesting in lupus erythematosus: A 15-year experience,☆☆,

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Abstract

It has long been observed that sun exposure can induce or exacerbate skin lesions in patients with certain forms of lupus erythematosus. Despite the frequency of photosensitivity in these patients, the mechanism by which ultraviolet radiation alters the pathogenic course of this disease remains poorly understood. After development of standardized test methods, our group demonstrated in 1986 that skin lesions in patients with lupus erythematosus can be experimentally reproduced by UVA and UVB irradiation. In the following years, phototesting has received much attention as a valid model to study photosensitivity of different forms of lupus erythematosus and the pathogenetic mechanism of this disease. Further investigations have also made it possible to find genetic and immunologic factors associated with photosensitivity and have helped to identify the pathophysiologic steps involved in the induction of such skin lesions. We present phototesting results and clinical correlations of more than 400 patients with different forms of lupus erythematosus and discuss the recent advances in provocative phototesting. (J Am Acad Dermatol 2001;45:86-95.)

Section snippets

Patients

Photoprovocation tests were performed in 405 white patients (139 men [34%] and 266 women [66%]) with different forms of LE seen at the Department of Dermatology, Heinrich-Heine-University, Düsseldorf, Germany (Table I). The study included 94 patients with discoid LE (DLE); 70 with LET; 81 with subacute CLE (SCLE); 133 with various other forms of CLE, such as LE profundus, hypertrophic/verrucous LE, and chilblain LE; and 27 with SLE. Diagnosis of the forms of CLE was based on clinical and

Erythematous and pigmentary reactions

The MED-UVB in 405 patients with different forms of LE was 99.5 ± 36.1 mJ/cm2, compared with 97.4 ± 39.2 mJ/cm2 in 540 patients in the control group (Table I). For UVA, the IPD threshold dose was 38.8 ± 21.9 J/cm2 and the MTD was 48.8 ± 22.5 J/cm2 in patients with LE compared with 36.4 ± 21.2 J/cm2 and 47.9 ± 22.4 J/cm2, respectively, in the control group. Statistical analysis revealed no significant differences in the time course with respect to the different clinical subtypes of LE or between

Discussion

In 1986, our group8 established standardized methods for testing photosensitive diseases, and, moreover, we showed that the action spectrum of LE included UVA in addition to UVB.9, 17 Further studies by other groups followed, confirming that skin lesions in this disease might also occur after UVA irradiation (Table IV).18, 19, 20, 21, 22, 23, 24

. Phototesting in lupus erythematosus: Review of the literature since 1986

Empty CellEmpty CellPositive phototest reactions in different subtypes of LEEmpty Cell
YearAuthorsTested

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    Supported by a Lise-Meitner scholarship and a research grant of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany (to A. Kuhn).

    ☆☆

    Reprint requests: Annegret Kuhn, MD, Institute of Cell Biology, ZMBE, Westfälische Wilhelms-University, Von-Esmarch-Strasse 56, D-48149 Münster, Germany.

    J Am Acad Dermatol 2001;45:86-95

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