Significance of Photosensitivity

Photosensitivity is a common feature in various subsets of CLE. LE-specific skin lesions often develop on sun-exposed skin and may be provoked by UV light irradiation. The reported prevalence of photosensitivity varies in the different types of CLE. Photosensitivity has been reported in 69%-90% of patients with DLE and in 52%-100% of patients with SCLE (Beutner et al. 1991, Callen 1985, Callen et al. 1986, Sontheimer et al. 1979). The lack of uniform criteria for photosensitivity may explain the broad scale of differences in prevalence. A pathologic photoprovocation test with UVA and UVB was found in 60%-70% of patients with CLE (DLE or SCLE) (Hasan et al. 1997, Kuhn et al. 2001,Lehmann et al. 1990, van Weelden et al. 1989). The presence of anti-Ro/SSA antibodies and of positive photoprovocation test results was found strongly associated (Hasan et al. 1997).

However, it seems likely that a personal history of polymorphous light eruption (PLE) is of predictive value for the development of CLE. Murphy and Hawk (Murphy and Hawk 1991) first suggested a possible relationship between PLE and LE in 1991, when they reported that 10% of their series of 142 patients with PLE had raised titers of ANAs or anti-Ro/SSA antibodies. PLE and lupus symptoms consistent with PLE were reported in 50%-61% of patients with DLE and in 33%-55% of patients with SCLE. In most cases, PLE preceded the development of CLE by several years (Millard et al. 2001, Nyberg et al. 1997). A significantly higher PLE prevalence was found in relatives of patients with LE than in the general population (Millard et al. 2001).

Therefore, patients with PLE should be carefully monitored for the development of CLE, especially those with positive ANA titer and anti-Ro/SSA antibodies.

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