Photosensitivity in Lupus Erythematosus12

Percy Lehmann, Annegret Kuhn

Photosensitivity is a characteristic feature of all forms and subsets of lupus erythematosus (LE) that has been recognized since the first phenomenologic descriptions of this complex disease. In 1881, Cazenave (Cazenave 1881) described exacerbations of the disease related to "cold, heat, fire, and direct action of the air", and Hutchinson (Hutchinson 1888) reported in 1888 that patients with LE did not tolerate the sun well. At the beginning of the 19th century, several physicians had already realized that environmental factors, such as sun exposure, play a role in the induction of LE (Pusey 1915, Macleod 1924, Freund 1929). Pusey (Pusey 1915) described in 1915 a young lady who had her first outbreak of cutaneous LE (CLE) a few days after extensive golfing in the summertime. The lesions disappeared after strict avoidance of the sun, but another exacerbation occurred during the next summer, again after a golf tournament. In 1929, Freund (Freund 1929) could clearly demonstrate in a large series of patients with LE (n=507), which he followed between 1920 and 1927, that inductions and exacerbations of this disease showed significant clustering in the spring and summer months. In agreement with earlier observations by Haxthausen from Kopenhagen, he concluded that the increasing intensity of ultraviolet (UV) irradiation in spring and summer was responsible for the deterioration and outbreak of LE. In the same year, Fuhs (Fuhs 1929) described a specifically sun-sensitive form of LE, which occurred in a 27-year-old woman. For 10 years he had regularly observed a subacute onset of the erythematosquamous lesions in the springtime subsequent to the first periods of sunny weather, and he termed this exquisitely photosensitive subset "LE subacutus".

Whereas these and other observations delineated natural physical agents as triggering factors in LE, artificial light sources were also already recognized as causative inductors of specific LE symptoms by the second decade of the 20th century. Jesionek (Jesionek 1916), a German pioneer of phototherapy, wrote in 1916 the "guidelines for the modern applications of phototherapy". He enthusiastically described several skin diseases that responded excellently to phototherapy. In contrast, he cautioned not to irradiate patients with LE, since he had observed deterioration of the disease on irradiation, and he even described two patients with discoid LE (DLE) who developed systemic manifestations of the disease after having been irradiated with therapeutic artificial lamps. Subsequently, the induction of skin lesions by artificial lamps in patients with LE was reported in a lecture delivered to the Royal Danish Medical Association. In 1929, Fuhs (Fuhs 1929) was the first to perform experimental light testing with different wavelengths to characterize the UV sensitivity in a patient with a photosensitive form of LE. He could demonstrate a high sensitivity toward unfil-

tered quartz lamps but was unable to determine further wavelength-dependent sensitivity by using different filters in these early phototesting experiments.

The appearance of suntanning parlors in the past decades led to the occurrence of inductions and exacerbations of LE by artificial irradiation units that were not medically controlled but run by commercially oriented individuals. Several reports on such events have been published, such as by Stern and Drocken (Stern and Drocken 1986) and Tronnier et al. (Tronnier et al. 1988), who described the outbreak of severe systemic LE (SLE) after the visits to suntanning parlors. Today it is generally accepted that natural and artificial UV irradiation can induce and exacerbate LE and, furthermore, that it may exert specific effects on the complex pathophysiology of this disease.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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