Phototesting in Lupus Erythematosus Tumidus—Review of 60 Patients¶

Abstract

Photosensitivity is an important characteristic feature of several forms of lupus erythematosus (LE), and induction of skin lesions by UV-A and UV-B irradiation has been proved to be an optimal model for evaluating light sensitivity in patients with this disease. Because lupus erythematosus tumidus (LET) has rarely been documented in the literature and is often difficult to differentiate from other photodermatoses such as polymorphous light eruption, we performed photoprovocation tests in 60 patients with LET according to a standardized protocol. Areas of uninvolved skin on the upper back were irradiated with single doses of UV-A (100 J/cm2) and/or UV-B (1.5 minimal erythema dose) daily for three consecutive days. Interestingly, patients with LET are more photosensitive than those with subacute cutaneous lupus erythematosus, and in our study experimental phototesting revealed characteristic skin lesions in 43 patients (72%). Because of the latency period in developing positive phototest reactions, it might be difficult for these patients to link sun exposure with their skin lesions. Furthermore, our data revealed a positive correlation of antinuclear antibodies and positive provocative phototest reactions in these patients as seen for other forms of LE. In conclusion, the high incidence of positive phototest reactions in correlation with the clinical findings, history of photosensitivity and antinuclear antibodies enable the classification of LET as the most photosensitive type of LE.

Photosensitivity in patients with lupus erythematosus: a clinical and photobiological study of 100 patients using a prolonged phototest protocol

“…This is unlike the results of other studies, which generally reported a higher photosensitivity of patients with SCLE 7,[9][10][11][12][13][14][15][16] and also with the recently described subset of LET. 27 All the patients in our study who reacted to visible light also had a reaction to UVR, either UVA and ⁄ or UVB. Ten patients showed no response to UVA but were provoked by UVB and six patients reacted to UVA but not to UVB.…”

“…Another photosensitive subset of LE, LE tumidus (LET), was described recently, with 72% of the patients reacting to UV photoprovocation. 27 These different rates of photosensitivity in patients with the various subtypes of LE may indicate variation in underlying pathophysiological processes in LE, although at the moment no evidence exists for this and further investigation is required. There was no significant difference in photosensitivity among the subtypes of LE in our study.…”

Lupus erythematosus tumidus: a series of 26 cases

“…A phototest study performed in 60 patients with LET revealed characteristic skin lesions in 72% of cases. 11 Around 50% of cases reacted to UV-A, 50% reacted to UV-B, and 63% reacted to combined UV-A and UV-B. In some cases, specific skin lesions in these phototests appeared up to 4 weeks after the last irradiation.…”

“…Photosensitivity studies in LET have revealed that 50% of cases are induced by UV-B radiation. 11,12 • We described a case with initial findings of reticular erythematous mucinosis, without epidermal changes, that developed criteria for SLE. A repeated biopsy performed in the same area revealed the epidermal changes of lupus erythematosus.…”

UVA1 and UVB irradiated skin investigated by optical coherence tomography in vivo: a preliminary study

“…UV irradiation was performed in accordance with an established phototesting protocol. 7 The minimal erythema dose (MED) for broadband UVB (Fig. 1a) and broadband UVA ( Fig.…”