This report describes a woman with systemic lupus erythematosus (LE) who worked as a photocopy technician and developed cutaneous LE of the hands, neck, face, and chest. Her skin lesions improved when she discontinued her employment. Testing of several photocopy devices showed emission of small quantities of ultraviolet A (UVA), but no UVB. Phototesting of the patient with UVA and UVB induced skin lesions that were clinically and histopathologically consistent with LE. Thus, the action spectrum of cutaneous LE may be within the UVB range, the UVA range, or both ranges of the solar spectrum, and repeated exposure to short bursts of light may induce clinical disease. This case suggests that occupational sources of UV light should be considered as possible exacerbating factors in LE.The role of sunlight in the induction and exacerbation of systemic and cutaneous lupus erythematosus (LE) is well documented (1). Skin lesions occur preferentially on sun-exposed skin, and photosensitivity is included as 1 of the 11 American College of Rheumatology (formerly, the American Rheumatism Association) criteria for the diagnosis of systemic LE (SLE) (2). Lesions of cutaneous LE can be induced by artificial, as well as natural, sources of ultraviolet (UV) light (3-1 1). However, the action spectrum of light of LE was originally thought to be limited to the UVB range (280-320 nm) ( 4 4 8 ) .Cutaneous L E lesions, which on physical examination have the appearance of persistent erythem- (12)(13)(14). Fluorescent lamps emit radiation in the UVA as well as the UVB range (14,15). Thirteen of 30 sun-sensitive LE patients reported fatigue, headache, rash, or joint pain following exposure to fluorescent light for less than 1 hour (13). Only recently has phototesting of patients with LE been performed in the UVA range as well as the UVB range (9,lO). Skin lesions clinically and histopathologically compatible with those of LE were induced by the UVB range in 33%, by the UVA range in 14%, and by both the UVA range and the UVB range in 53% of the patients tested (9). In another study, 10 of 16 patients with LE showed an abnormal response to UVA as well as UVB light (10).Herein we report a case of occupationally related exacerbation of cutaneous LE of the hands, induced by repeated exposure to UVA radiation from a photocopy machine. Phototesting of responses to UVA and UVB with serial histopathologic examinations at the irradiated sites confirmed that both wavelengths could induce this patient's disease. The UV output from 8 randomly selected photocopy machines was also determined. CASE REPORTThe patient was a 34-year-old woman with a 4-year history of SLE characterized by arthritis, photosensitivity, leukopenia, and hypocomplementemia.

Pruritus remains a significant complication of end-stage renal disease. Its cause in hemodialysis patients is not known. It has been postulated that increased numbers of mast cells occur in these patients and may account for the presence of pruritus. Our objective was to determine if there is a difference in the number of cutaneous mast cells between pruritic and nonpruritic patients. A 3-mm punch biopsy specimen was obtained from pruritic (n = 7) and nonpruritic (n = 6) hemodialysis patients. We observed no significant difference in the quantity of cutaneous mast cells in pruritic and nonpruritic hemodialysis patients. We conclude that the etiology of pruritus in hemodialysis patients is not related to an increase in the number of cutaneous mast cells.

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