Photoprotective effects of a broad-spectrum sunscreen in ultraviolet-induced cutaneous lupus erythematosus: A randomized, vehicle-controlled, double-blind study

Kuhn, Annegret; Gensch, K.; Haust, Merle; Meuth, Anna-Maria; Dupuy, P; Lehmann, Percy; Metze, Dieter; Ruzicka, Thomas

doi:10.1016/j.jaad.2009.12.053

Cited by 110 publications

(84 citation statements)

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“…After standardised phototesting for three consecutive days (60-100 J/cm² UVA and 1.5 MED UVB), 16 (64%) and 14 (56%) of the 25 patients developed specific CLE in the untreated and vehicle-treated test areas, respectively. In contrast, none of the sunscreen-treated test areas revealed any clinical or histologic signs of CLE (12). These findings were basically confirmed in a similar study including 20 patients with CLE and 10 healthy controls (HC) using a liposomal sunscreen registered as medical device in Europe.…”

Section: Accepted For Publication 4 June 2014supporting

confidence: 69%

“…Accumulating evidence exists that CLE lesions in photosensitive patients can be prevented by the use of a highly protective broadspectrum sunscreen (10)(11)(12)(13). A prospective, randomised, doubleblind, vehicle-controlled study evaluated the photoprotective effects of a broad-spectrum (UVA and UVB) sunscreen (sun protection factor 60) in 25 patients with a history of photosensitive CLE.…”

Section: Accepted For Publication 4 June 2014mentioning

confidence: 99%

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Relevant new insights into the effects of photoprotection in cutaneous lupus erythematosus

Kreuter

Lehmann

2014

Experimental Dermatology

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Commentary of 'Ultraviolet light protection by a sunscreen prevents interferon-driven skin inflammation in cutaneous lupus erythematosus'.Abstract: Cutaneous lupus erythematosus (CLE) denotes a heterogeneous spectrum of autoimmune diseases that primarily affect the skin. Ultraviolet irradiation (UV) is one of the most important environmental factors that can trigger skin lesions in CLE or even induce systemic organ manifestation. It has been shown that broad-spectrum sunscreen with high sun protection factors can effectively prevent UV-induced skin lesions in patients with different subtypes of CLE. In a recent issue of Experimental Dermatology, Zahn and colleagues demonstrate that potent photoprotection blocks disease-specific skin lesions in CLE patients by reducing lesional tissue damage and interferon-driven inflammation.Key words: cutaneous lupus erythematosus -interferon-driven inflammation -photoprotection -sunscreen -UVA/UVB irradiation Accepted for publication 4 June 2014Cutaneous lupus erythematosus (CLE) comprises a spectrum of autoimmune disorders of the skin that may present with a variety of clinical manifestations. Four different subtypes of CLE can be distinguished: acute CLE, subacute CLE (SCLE), chronic CLE (including discoid LE, chilblain LE, and LE profundus) and intermittent LE (LE tumidus) (1,2). It is well-known since decades that several stimuli exist that might trigger or aggravate skin lesions in CLE. Among those, drugs, infections, cigarette smoking and ultraviolet (UV) light play the most important role (3-5). The latter can even cause formation or deterioration of systemic organ manifestations (6). Specific CLE skin lesions can be experimentally induced by UV irradiation (7,8). Recently, a large European multicenter study has shown that approximately half of all CLE patients develop skin lesions by using a standardised UVA/UVB photoprovocation protocol. Patients with SCLE and LET had the highest percentage of UV-inducible lesions (57 and 54%, respectively), and most patients (86%) who developed UV-induced lesions were fairskinned (Fitzpatrick's phototypes I or II), and minimal erythema dose (MED) was significantly lower in photosensitive CLE patients than compared to subjects without UV-induced lesions (9).Accumulating evidence exists that CLE lesions in photosensitive patients can be prevented by the use of a highly protective broadspectrum sunscreen (10-13). A prospective, randomised, doubleblind, vehicle-controlled study evaluated the photoprotective effects of a broad-spectrum (UVA and UVB) sunscreen (sun protection factor 60) in 25 patients with a history of photosensitive CLE. After standardised phototesting for three consecutive days (60-100 J/cm² UVA and 1.5 MED UVB), 16 (64%) and 14 (56%) of the 25 patients developed specific CLE in the untreated and vehicle-treated test areas, respectively. In contrast, none of the sunscreen-treated test areas revealed any clinical or histologic signs of CLE (12). These findings were basically confirmed in a similar study including 20 patie...

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Section: Accepted For Publication 4 June 2014supporting

confidence: 69%

Section: Accepted For Publication 4 June 2014mentioning

confidence: 99%

Relevant new insights into the effects of photoprotection in cutaneous lupus erythematosus

Kreuter

Lehmann

2014

Experimental Dermatology

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“…These results were confirmed in a retrospective analysis in which one of the sunscreens was applied to 47 CLE patients (36). A recent randomized, double-blind, vehicle-controlled, intraindividual, comparative study demonstrated that the application of a broad-spectrum sunscreen with high protection factors prevented the appearance of lesions in photosensitive CLE patients (22). Therefore, photoprovocation using the standardized protocol is an optimal model for the evaluation of preventive measures in CLE patients.…”

mentioning

confidence: 75%

Updated Analysis of Standardized Photoprovocation in Patients With Cutaneous Lupus Erythematosus

Ruland

Haust

Stilling

et al. 2013

Arthritis Care & Research

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Objective. To determine the frequency and reproducibility of standardized photoprovocation in patients with cutaneous lupus erythematosus (CLE) and report our long-term experience. Methods. Photoprovocation using a standardized protocol was evaluated retrospectively in 566 patients. A diagnosis of CLE was clinically and/or histologically confirmed in 431 patients, and 315 patients with polymorphic light eruption (PLE) were additionally included as controls. Data were statistically analyzed using an SPSS database. Results. A total of 61.7% of the 431 CLE patients exhibited a positive photoprovocation, with a significantly longer latency period for the development of skin lesions after ultraviolet (UV) A and/or UVB irradiation than PLE patients (P < 0.001). The frequency of positive photoprovocation varied among the CLE subtypes, and intermittent CLE was the most photosensitive disease entity (74.8%). Subsequent photoprovocation in 35 patients demonstrated that CLE patients with an initial positive result exhibited a significantly higher frequency of a positive photoprovocation at a later time point (P ‫؍‬ 0.013). However, an initial positive photoprovocation did not definitively predict a positive reaction at a later time point. Moreover, patient history of photosensitivity was not a predictor for the photoprovocation outcome. Conclusion. Standardized photoprovocation is a useful tool to reproducibly induce skin lesions and objectively evaluate photosensitivity in patients with CLE. These data further suggest that the reaction to UV light may change during the course of this heterogeneous disease and that photosensitivity should not be excluded in patients with a negative history of photosensitivity.

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“…The use of a highly protective broad-spectrum (UVB and UVA) sunscreen can effectively prevent skin photosensitive lesions in patients's SLE. (Kuhn et al, 2011;Obermoser & Zelger B, 2008 ;Thumboo & Strand, 2007) …”

Section: Physical Treatmentmentioning

confidence: 99%

Integral Treatment of Systemic Lupus Erythematosus

Parrondo¹

2011

Challenges in Rheumatology

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Photoprotective effects of a broad-spectrum sunscreen in ultraviolet-induced cutaneous lupus erythematosus: A randomized, vehicle-controlled, double-blind study

Cited by 110 publications

References 47 publications

Relevant new insights into the effects of photoprotection in cutaneous lupus erythematosus

Relevant new insights into the effects of photoprotection in cutaneous lupus erythematosus

Updated Analysis of Standardized Photoprovocation in Patients With Cutaneous Lupus Erythematosus

Integral Treatment of Systemic Lupus Erythematosus

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