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Li TM, Zyulina V, Seltzer ES, Dacic M, Chinenov Y, Daamen AR, Veiga KR, Schwartz N, Oliver DJ, Cabahug-Zuckerman P, Lora J, Liu Y, Shipman WD, Ambler WG, Taber SF, Onel KB, Zippin JH, Rashighi M, Krueger JG, Anandasabapathy N, Rogatsky I, Jabbari A, Blobel CP, Lipsky PE, Lu TT. The interferon-rich skin environment regulates Langerhans cell ADAM17 to promote photosensitivity in lupus. eLife 2024; 13:e85914. [PMID: 38860651 PMCID: PMC11213570 DOI: 10.7554/elife.85914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/10/2024] [Indexed: 06/12/2024] Open
Abstract
The autoimmune disease lupus erythematosus (lupus) is characterized by photosensitivity, where even ambient ultraviolet radiation (UVR) exposure can lead to development of inflammatory skin lesions. We have previously shown that Langerhans cells (LCs) limit keratinocyte apoptosis and photosensitivity via a disintegrin and metalloprotease 17 (ADAM17)-mediated release of epidermal growth factor receptor (EGFR) ligands and that LC ADAM17 sheddase activity is reduced in lupus. Here, we sought to understand how the lupus skin environment contributes to LC ADAM17 dysfunction and, in the process, differentiate between effects on LC ADAM17 sheddase function, LC ADAM17 expression, and LC numbers. We show through transcriptomic analysis a shared IFN-rich environment in non-lesional skin across human lupus and three murine models: MRL/lpr, B6.Sle1yaa, and imiquimod (IMQ) mice. IFN-I inhibits LC ADAM17 sheddase activity in murine and human LCs, and IFNAR blockade in lupus model mice restores LC ADAM17 sheddase activity, all without consistent effects on LC ADAM17 protein expression or LC numbers. Anti-IFNAR-mediated LC ADAM17 sheddase function restoration is associated with reduced photosensitive responses that are dependent on EGFR signaling and LC ADAM17. Reactive oxygen species (ROS) is a known mediator of ADAM17 activity; we show that UVR-induced LC ROS production is reduced in lupus model mice, restored by anti-IFNAR, and is cytoplasmic in origin. Our findings suggest that IFN-I promotes photosensitivity at least in part by inhibiting UVR-induced LC ADAM17 sheddase function and raise the possibility that anifrolumab ameliorates lupus skin disease in part by restoring this function. This work provides insight into IFN-I-mediated disease mechanisms, LC regulation, and a potential mechanism of action for anifrolumab in lupus.
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Affiliation(s)
- Thomas Morgan Li
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
| | - Victoria Zyulina
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Department of Microbiology and Immunology, Weill Cornell Medical CollegeNew YorkUnited States
| | - Ethan S Seltzer
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
| | - Marija Dacic
- David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Physiology, Biophysics, and Systems Biology Program, Weill Cornell Graduate School of Medical SciencesNew YorkUnited States
| | - Yurii Chinenov
- David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery Research InstituteNew YorkUnited States
| | - Andrea R Daamen
- Department of Medicine, AMPEL BioSolutionsCharlottesvilleUnited States
| | - Keila R Veiga
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Pediatric Rheumatology, Department of Medicine, Hospital for Special SurgeryNew YorkUnited States
- Department of Pediatrics, Weill Cornell Medical CollegeNew YorkUnited States
| | - Noa Schwartz
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Rheumatology, Department of Medicine, Hospital for Special SurgeryNew YorkUnited States
| | - David J Oliver
- David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery Research InstituteNew YorkUnited States
| | - Pamela Cabahug-Zuckerman
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
| | - Jose Lora
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Physiology, Biophysics, and Systems Biology Program, Weill Cornell Graduate School of Medical SciencesNew YorkUnited States
| | - Yong Liu
- Department of Dermatology, Weill Cornell Medical CollegeNew YorkUnited States
| | - William D Shipman
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, Weill Cornell Medical CollegeNew YorkUnited States
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical SciencesNew YorkUnited States
| | - William G Ambler
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Pediatric Rheumatology, Department of Medicine, Hospital for Special SurgeryNew YorkUnited States
- Department of Pediatrics, Weill Cornell Medical CollegeNew YorkUnited States
| | - Sarah F Taber
- Pediatric Rheumatology, Department of Medicine, Hospital for Special SurgeryNew YorkUnited States
- Department of Pediatrics, Weill Cornell Medical CollegeNew YorkUnited States
| | - Karen B Onel
- Pediatric Rheumatology, Department of Medicine, Hospital for Special SurgeryNew YorkUnited States
- Department of Pediatrics, Weill Cornell Medical CollegeNew YorkUnited States
| | - Jonathan H Zippin
- Department of Dermatology, Weill Cornell Medical CollegeNew YorkUnited States
| | - Mehdi Rashighi
- Department of Dermatology, University of Massachusetts Medical SchoolWorcesterUnited States
| | - James G Krueger
- Laboratory of Investigative Dermatology, Rockefeller UniversityNew YorkUnited States
| | - Niroshana Anandasabapathy
- Department of Dermatology, Weill Cornell Medical CollegeNew YorkUnited States
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program, Weill Cornell Medical CollegeNew YorkUnited States
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical SciencesNew YorkUnited States
| | - Inez Rogatsky
- Department of Microbiology and Immunology, Weill Cornell Medical CollegeNew YorkUnited States
- David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical SciencesNew YorkUnited States
| | - Ali Jabbari
- Laboratory of Investigative Dermatology, Rockefeller UniversityNew YorkUnited States
| | - Carl P Blobel
- Arthritis and Tissue Degeneration Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Physiology, Biophysics, and Systems Biology Program, Weill Cornell Graduate School of Medical SciencesNew YorkUnited States
- Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Medical CollegeNew YorkUnited States
| | - Peter E Lipsky
- Department of Medicine, AMPEL BioSolutionsCharlottesvilleUnited States
| | - Theresa T Lu
- Autoimmunity and Inflammation Program, Hospital for Special Surgery Research InstituteNew YorkUnited States
- Department of Microbiology and Immunology, Weill Cornell Medical CollegeNew YorkUnited States
- Pediatric Rheumatology, Department of Medicine, Hospital for Special SurgeryNew YorkUnited States
- Department of Pediatrics, Weill Cornell Medical CollegeNew YorkUnited States
- Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical SciencesNew YorkUnited States
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2
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Renaudineau Y, Charras A, Natoli V, Fusaro M, Smith EMD, Beresford MW, Hedrich CM. Type I interferon associated epistasis may contribute to early disease-onset and high disease activity in juvenile-onset lupus. Clin Immunol 2024; 262:110194. [PMID: 38508295 DOI: 10.1016/j.clim.2024.110194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
Pathologic type I interferon (T1IFN) expression is a key feature in systemic lupus erythematosus (SLE) that associates with disease activity. When compared to adult-onset disease, juvenile-onset (j)SLE is characterized by increased disease activity and damage, which likely relates to increased genetic burden. To identify T1IFN-associated gene polymorphisms (TLR7, IRAK1, miR-3142/miR-146a, IRF5, IRF7, IFIH1, IRF8, TYK2, STAT4), identify long-range linkage disequilibrium and gene:gene interrelations, 319 jSLE patients were genotyped using panel sequencing. Coupling phenotypic quantitative trait loci (QTL) analysis identified 10 jSLE QTL that associated with young age at onset (<12 years; IRAK1 [rs1059702], TLR7 [rs3853839], IFIH1 [rs11891191, rs1990760, rs3747517], STAT4 [rs3021866], TYK2 [rs280501], IRF8 [rs1568391, rs6638]), global disease activity (SLEDAI-2 K >10; IFIH1 [rs1990760], STAT4 [rs3021866], IRF8 [rs903202, rs1568391, rs6638]), and mucocutaneous involvement (TLR7 [rs3853839], IFIH1 [rs11891191, rs1990760]). This study suggests T1IFN-associated polymorphisms and gene:gene interrelations in jSLE. Genotyping of jSLE patients may allow for individualized treatment and care.
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Affiliation(s)
- Yves Renaudineau
- Immunology Department Laboratory, Referral Medical Biology Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France; INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Amandine Charras
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Valentina Natoli
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Università degli Studi di Genova, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, DINOGMI, Genoa, Italy
| | - Mathieu Fusaro
- Immunology Department Laboratory, Referral Medical Biology Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France; INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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3
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Hile GA, Coit P, Xu B, Victory AM, Gharaee-Kermani M, Estadt SN, Maz MP, Martens JWS, Wasikowski R, Dobry C, Tsoi LC, Iglesias-Bartolome R, Berthier CC, Billi AC, Gudjonsson JE, Sawalha AH, Kahlenberg JM. Regulation of Photosensitivity by the Hippo Pathway in Lupus Skin. Arthritis Rheumatol 2023; 75:1216-1228. [PMID: 36704840 PMCID: PMC10313771 DOI: 10.1002/art.42460] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/05/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Photosensitivity is one of the most common manifestations of systemic lupus erythematosus (SLE), yet its pathogenesis is not well understood. The normal-appearing epidermis of patients with SLE exhibits increased ultraviolet B (UVB)-driven cell death that persists in cell culture. Here, we investigated the role of epigenetic modification and Hippo signaling in enhanced UVB-induced apoptosis seen in SLE keratinocytes. METHODS We analyzed DNA methylation in cultured keratinocytes from SLE patients compared to keratinocytes from healthy controls (n = 6/group). Protein expression was validated in cultured keratinocytes using immunoblotting and immunofluorescence. An immortalized keratinocyte line overexpressing WWC1 was generated via lentiviral vector. WWC1-driven changes were inhibited using a large tumor suppressor kinase 1/2 (LATS1/2) inhibitor (TRULI) and small interfering RNA (siRNA). The interaction between the Yes-associated protein (YAP) and the transcriptional enhancer associate domain (TEAD) was inhibited by overexpression of an N/TERT cell line expressing a tetracycline-inducible green fluorescent protein-tagged protein that inhibits YAP-TEAD binding (TEADi). Apoptosis was assessed using cleaved caspase 3/7 and TUNEL staining. RESULTS Hippo signaling was the top differentially methylated pathway in SLE versus control keratinocytes. SLE keratinocytes (n = 6) showed significant hypomethylation (Δβ = -0.153) and thus overexpression of the Hippo regulator WWC1 (P = 0.002). WWC1 overexpression increased LATS1/2 kinase activation, leading to YAP cytoplasmic retention and altered proapoptotic transcription in SLE keratinocytes. Accordingly, UVB-mediated apoptosis in keratinocytes could be enhanced by WWC1 overexpression or YAP-TEAD inhibition, mimicking SLE keratinocytes. Importantly, inhibition of LATS1/2 with either the chemical inhibitor TRULI or siRNA effectively eliminated enhanced UVB-apoptosis in SLE keratinocytes. CONCLUSION Our work unravels a novel driver of photosensitivity in SLE: overactive Hippo signaling in SLE keratinocytes restricts YAP transcriptional activity, leading to shifts that promote UVB apoptosis.
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Affiliation(s)
- Grace A. Hile
- Department of Dermatology, University of Michigan; Ann Arbor, USA
| | - Patrick Coit
- Division of Rheumatology, University of Michigan; Ann Arbor, USA
- Graduate Program in Immunology, University of Michigan; Ann Arbor, USA
- Departments of Pediatrics, Medicine, and Immunology, and Lupus Center of Excellence, University of Pittsburgh; Pittsburgh, USA
| | - Bin Xu
- Division of Rheumatology, University of Michigan; Ann Arbor, USA
| | | | - Mehrnaz Gharaee-Kermani
- Department of Dermatology, University of Michigan; Ann Arbor, USA
- Division of Rheumatology, University of Michigan; Ann Arbor, USA
| | - Shannon N. Estadt
- Graduate Program in Immunology, University of Michigan; Ann Arbor, USA
| | - Mitra P. Maz
- Graduate Program in Immunology, University of Michigan; Ann Arbor, USA
| | | | - Rachael Wasikowski
- Department of Dermatology, University of Michigan; Ann Arbor, USA
- Department of Computational Medicine & Bioinformatics, University of Michigan; Ann Arbor, USA
| | - Craig Dobry
- Department of Dermatology, University of Michigan; Ann Arbor, USA
| | - Lam C. Tsoi
- Department of Dermatology, University of Michigan; Ann Arbor, USA
- Department of Computational Medicine & Bioinformatics, University of Michigan; Ann Arbor, USA
- Department of Biostatistics, University of Michigan; Ann Arbor, MI 48109, USA
| | - Ramiro Iglesias-Bartolome
- Laboratory of Cellular and Molecular Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health; Bethesda, USA
| | - Celine C. Berthier
- Department of Computational Medicine & Bioinformatics, University of Michigan; Ann Arbor, USA
- Department of Biostatistics, University of Michigan; Ann Arbor, MI 48109, USA
| | - Allison C. Billi
- Department of Dermatology, University of Michigan; Ann Arbor, USA
| | | | - Amr H. Sawalha
- Departments of Pediatrics, Medicine, and Immunology, and Lupus Center of Excellence, University of Pittsburgh; Pittsburgh, USA
| | - J. Michelle Kahlenberg
- Department of Dermatology, University of Michigan; Ann Arbor, USA
- Division of Rheumatology, University of Michigan; Ann Arbor, USA
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4
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Barbhaiya M, Hart JE, Malspeis S, Tedeschi SK, VoPham T, Sparks JA, Karlson EW, Laden F, Costenbader KH. Association of Ultraviolet B Radiation and Risk of Systemic Lupus Erythematosus Among Women in the Nurses' Health Studies. Arthritis Care Res (Hoboken) 2022:10.1002/acr.24974. [PMID: 35724272 PMCID: PMC9910058 DOI: 10.1002/acr.24974] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 06/02/2022] [Accepted: 06/16/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Ultraviolet (UV) radiation exposure is associated with photosensitivity, rashes, and flares in systemic lupus erythematosus (SLE). However, it is not known whether UV exposure increases risk of developing SLE. We examined UV exposure and SLE risk in a large prospective cohort. METHODS The Nurses' Health Study (NHS) enrolled 121,700 US female nurses in 1976; in 1989, 116,429 nurses were enrolled in NHS II. Biennial questionnaires collected lifestyle and medical data. Self-reported incident SLE by American College of Rheumatology classification criteria was confirmed by medical record review. Ambient UV exposure was estimated by linking geocoded residential addresses with a spatiotemporal UV exposure model. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) across tertiles of time-varying cumulative average UV. We examined SLE risk overall and stratified by anti-Ro/La antibodies and by cutaneous manifestations from 1976 through 2014 (NHS)/2015 (NHS II), adjusting for confounders. RESULTS With 6,054,665 person-years of exposure, we identified 297 incident SLE cases; the mean ± SD age at diagnosis was 49.8 ± 10.6 years. At diagnosis, 16.8% of women had +anti-Ro/La, and 80% had either +anti-Ro/La or ≥1 cutaneous manifestation. Compared with the lowest UV exposure tertile, risk of overall SLE was increased, but not significantly (HR 1.28 [95%CI 0.96-1.70]). Women in the highest tertile had increased risk of malar rash (HR 1.62 [95% CI 1.04-2.52]). CONCLUSION Cumulative UV exposure was not associated with SLE risk. Higher UV exposure, however, was associated with increased risk of malar rash at presentation. UV exposure may trigger SLE onset with malar rash among susceptible women.
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Affiliation(s)
- Medha Barbhaiya
- Division of Rheumatology, Hospital For Special Surgery, New York, NY,Departments of Medicine and Population Health Sciences, Weill Cornell Medicine, New York, NY
| | - Jaime E. Hart
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Susan Malspeis
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sara K. Tedeschi
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Trang VoPham
- Epidemiology Program, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Boston, MA
| | - Jeffrey A. Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Elizabeth W. Karlson
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Francine Laden
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Karen H. Costenbader
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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5
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6
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Sim JH, Ambler WG, Sollohub IF, Howlader MJ, Li TM, Lee HJ, Lu TT. Immune Cell-Stromal Circuitry in Lupus Photosensitivity. THE JOURNAL OF IMMUNOLOGY 2021; 206:302-309. [PMID: 33397744 DOI: 10.4049/jimmunol.2000905] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022]
Abstract
Photosensitivity is a sensitivity to UV radiation (UVR) commonly found in systemic lupus erythematosus (SLE) patients who have cutaneous disease. Upon even ambient UVR exposure, patients can develop inflammatory skin lesions that can reduce the quality of life. Additionally, UVR-exposed skin lesions can be associated with systemic disease flares marked by rising autoantibody titers and worsening kidney disease. Why SLE patients are photosensitive and how skin sensitivity leads to systemic disease flares are not well understood, and treatment options are limited. In recent years, the importance of immune cell-stromal interactions in tissue function and maintenance is being increasingly recognized. In this review, we discuss SLE as an anatomic circuit and review recent findings in the pathogenesis of photosensitivity with a focus on immune cell-stromal circuitry in tissue health and disease.
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Affiliation(s)
- Ji Hyun Sim
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021.,Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY 10065
| | - William G Ambler
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021.,Pediatric Rheumatology, Hospital for Special Surgery, New York, NY 10021
| | - Isabel F Sollohub
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021
| | - Mir J Howlader
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021.,Biochemistry and Structural Biology, Cell Biology, Developmental Biology, and Molecular Biology Graduate Program, Weill Cornell Graduate School of Medical Sciences, New York, NY 10065; and
| | - Thomas M Li
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021
| | - Henry J Lee
- Department of Dermatology, Weill Cornell Medical College, New York, NY 10065
| | - Theresa T Lu
- Autoimmunity and Inflammation Program, Hospital for Special Surgery, New York, NY 10021; .,Department of Microbiology and Immunology, Weill Cornell Medical College, New York, NY 10065.,Pediatric Rheumatology, Hospital for Special Surgery, New York, NY 10021
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7
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Ogunsanya ME, Cho SK, Hudson A, Chong BF. Factors associated with quality of life in cutaneous lupus erythematosus using the Revised Wilson and Cleary Model. Lupus 2020; 29:1691-1703. [PMID: 32883161 DOI: 10.1177/0961203320951842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to characterize the impact of cutaneous lupus erythematosus (CLE) in adults and identify the clinical and non-clinical factors associated with quality of life (QoL), using the Revised Wilson and Cleary Model. METHODS 101 patients diagnosed with CLE were included in this cross-sectional study. QoL was measured with the Cutaneous Lupus Erythematosus Quality of Life (CLEQoL) scale and disease activity and damage with the Cutaneous Lupus Activity and Severity Index (CLASI). Patient demographics, clinical, and disease characteristics were also collected. Descriptive statistics were calculated, and multiple regression was employed to determine significant (p < 0.05) predictors of overall QoL. Data were analyzed using SPSS v24. RESULTS The overall regression QoL model was significantly different from zero, (F = 24.96; df = 14, 76; p = <0.001). Disease activity (β = 0.13), pain (β = 0.13), fatigue (β = 0.24), body image (β = 0.62), and side effects (β = -0.13) were significant predictors of overall QoL while controlling for other predictor variables. Patients who experienced higher levels of disease activity, fatigue severity, pain levels, and greater degree of body dissatisfaction had significantly poorer QoL. Fewer side effects experienced from CLE medications were significantly associated with higher QoL. CONCLUSIONS Study findings support the considerable burden associated with CLE. Several modifiable variables such as pain, fatigue, body image, and disease activity were associated with QoL. Therefore, interventions that incorporate these variables may reduce negative impacts on QoL life and improve health outcomes in CLE patients. Furthermore, given the chronic and recurring nature of the condition, strategies focused on improving QoL are needed for this vulnerable population.
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Affiliation(s)
- Motolani E Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sung Kyung Cho
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew Hudson
- Department of Internal Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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8
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Skopelja-Gardner S, An J, Tai J, Tanaka L, Sun X, Hermanson P, Baum R, Kawasumi M, Green R, Gale M, Kalus A, Werth VP, Elkon KB. The early local and systemic Type I interferon responses to ultraviolet B light exposure are cGAS dependent. Sci Rep 2020; 10:7908. [PMID: 32404939 PMCID: PMC7220927 DOI: 10.1038/s41598-020-64865-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/21/2020] [Indexed: 12/31/2022] Open
Abstract
Most systemic lupus erythematosus (SLE) patients are photosensitive and ultraviolet B light (UVB) exposure worsens cutaneous disease and precipitates systemic flares of disease. The pathogenic link between skin disease and systemic exacerbations in SLE remains elusive. In an acute model of UVB-triggered inflammation, we observed that a single UV exposure triggered a striking IFN-I signature not only in the skin, but also in the blood and kidneys. The early IFN-I signature was significantly higher in female compared to male mice. The early IFN-I response in the skin was almost entirely, and in the blood partly, dependent on the presence of cGAS, as was skin inflammatory cell infiltration. Inhibition of cGAMP hydrolysis augmented the UVB-triggered IFN-I response. UVB skin exposure leads to cGAS-activation and both local and systemic IFN-I signature and could contribute to acute flares of disease in susceptible subjects such as patients with SLE.
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Affiliation(s)
| | - Jie An
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Joyce Tai
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Lena Tanaka
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Xizhang Sun
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Payton Hermanson
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Rebecca Baum
- Division of Rheumatology, University of Washington, Seattle, WA, USA
| | - Masaoki Kawasumi
- Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Richard Green
- Department of Immunology, University of Washington, Seattle, WA, USA
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, USA
| | - Michael Gale
- Department of Immunology, University of Washington, Seattle, WA, USA
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, USA
| | - Andrea Kalus
- Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Victoria P Werth
- Dermatology Section, Philadelphia Veterans Affairs Medical Center, Philadelphia, USA
| | - Keith B Elkon
- Division of Rheumatology, University of Washington, Seattle, WA, USA.
- Department of Immunology, University of Washington, Seattle, WA, USA.
- Center for Innate Immunity and Immune Disease, University of Washington, Seattle, WA, USA.
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9
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Walburn J, Sarkany RP. Quality of life in the photodermatoses: the hidden toll of photosensitivity. Br J Dermatol 2020; 182:1077. [DOI: 10.1111/bjd.18804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica Walburn
- School of Cancer and Pharmaceutical Sciences Faculty of Life Sciences and Medicine King's College London London U.K
| | - Robert P.E. Sarkany
- Photodermatology and National Xeroderma Pigmentosum Services St John's Institute of Dermatology Guy's and St Thomas’ NHS Foundation Trust London U.K
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10
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Liu SW, Tkachenko E, Lam C, Alsarheed A, Cobos G, Lo K, Femia A, Qureshi AA, Vleugels RA. Willingness-to-pay stated preferences in cutaneous lupus erythematosus: a pilot study. Arch Dermatol Res 2019; 312:527-531. [PMID: 31773259 DOI: 10.1007/s00403-019-02006-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 10/19/2019] [Indexed: 11/25/2022]
Abstract
Cutaneous lupus erythematosus (CLE) is a chronic skin disease that significantly impacts quality of life (QOL). This study tested a novel method to measure QOL in CLE using willingness-to-pay (WTP) stated preferences, and aimed to determine which of nine domains of life are most affected by CLE. Twenty-one participants with CLE ranked the domains in order of impact on CLE-related QOL, and then stated how many United States dollars they would be willing to pay for a hypothetical cure for each domain. Eighty-one percent of participants were female; mean age was 42.4 years. Photosensitivity was ranked highest by 71.4% of respondents. Participants were willing to pay the most for a hypothetical cure for CLE specific to photosensitivity (median = $200,000), the least for a cure specific to self-care (median = $0). Participants were willing to pay a median of $1,000,000 for an overall cure for CLE. Limitations include a small sample size for this pilot study and that willingness-to-pay may be influenced by individual perception of money and socioeconomic factors. This study successfully pilot-tested a WTP method and ranking task for health-related QOL. Photosensitivity was the domain of life most affected by CLE, which is a domain unique to our novel tool.
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Affiliation(s)
- Stephanie W Liu
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Elizabeth Tkachenko
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Christina Lam
- Department of Dermatology, Boston University, Boston, MA, USA
| | - Abeer Alsarheed
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Gabriela Cobos
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Kelly Lo
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA
| | - Alisa Femia
- Department of Dermatology, New York University, New York, NY, USA
| | - Abrar A Qureshi
- Department of Dermatology, Brown University, Providence, RI, USA
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Boston, MA, 02115, USA.
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11
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Rutter KJ, Ashraf I, Cordingley L, Rhodes LE. Quality of life and psychological impact in the photodermatoses: a systematic review. Br J Dermatol 2019; 182:1092-1102. [PMID: 31278744 DOI: 10.1111/bjd.18326] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The photodermatoses affect large proportions of the population but their impact on quality of life (QoL) and psychological health has not been reviewed. Several tools are available to evaluate QoL and psychological impacts. OBJECTIVES To systematically review current literature to identify tools used to assess QoL and psychological impacts in patients with photodermatoses, and to summarize the reported findings. METHODS A systematic search of PubMed, OVID Medline, PsycInfo and CINAHL was performed for articles investigating QoL and/or psychological impact in patients with photodermatoses, published between 1960 and September 2018. RESULTS Twenty studies were included: 19 incorporated QoL assessment while three evaluated psychological morbidity. Six QoL tools were found to be used: Dermatology Life Quality Index (DLQI), Children's DLQI, Family DLQI, Skindex (16- and 29-item versions), Erythropoietic Protoporphyria Quality of Life (EPP-QoL) and EuroQol. Between 31% and 39% of photosensitive patients reported a very large impact on QoL (DLQI > 10). Employment and education, social and leisure activities, and clothing choices were particularly affected. Only one tool was specifically designed for a photodermatosis (EPP-QoL). Four tools were used to evaluate psychological impact: the Hospital Anxiety and Depression Scale, Fear of Negative Evaluation, brief COPE and Illness Perception Questionnaire-Revised. Levels of anxiety and depression were approximately double British population data. Patients with facial involvement, female gender and younger age at onset showed more psychological morbidity. CONCLUSIONS Several tools have been used to assess QoL in the photodermatoses, and confirm substantial impact on QoL. Development of specific, validated QoL measures would address their unique impacts. Research delineating their psychological comorbidity is sparse and requires further exploration. What's already known about this topic? The photodermatoses negatively impact quality of life (QoL) and cause psychological distress, but no reviews of this area appear in the literature. What does this study add? Few studies have explored the psychological and social impacts of the photodermatoses. There are no fully validated QoL tools specific to the photodermatoses. Around one-third of adult and child patients with photosensitivity experience very or extremely large impact on QoL, with particular effect on clothing choices, employment and social and leisure activities. Studies suggest anxiety and depression levels in these patients are around double those in the U.K. general population. More attention is required on these 'hidden' conditions.
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Affiliation(s)
- K J Rutter
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - I Ashraf
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - L Cordingley
- Health Psychology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - L E Rhodes
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
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12
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Wolf SJ, Estadt SN, Theros J, Moore T, Ellis J, Liu J, Reed TJ, Jacob CO, Gudjonsson JE, Kahlenberg JM. Ultraviolet light induces increased T cell activation in lupus-prone mice via type I IFN-dependent inhibition of T regulatory cells. J Autoimmun 2019; 103:102291. [PMID: 31248690 DOI: 10.1016/j.jaut.2019.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
Ultraviolet (UV) light is a known trigger of skin and possibly systemic inflammation in systemic lupus erythematosus (SLE) patients. Although type I interferons (IFN) are upregulated in SLE skin after UV exposure, the mechanisms to explain increased UVB-induced inflammation remain unclear. This paper compares the role of type I IFNs in regulating immune cell activation between wild-type and lupus-prone mice following UVB exposure. 10-week old female lupus-prone (NZM2328), wild-type (BALB/c) and iNZM mice (lack a functional type I IFN receptor on NZM2328 background) were treated on their dorsal skin with 100 mJ/cm2 of UVB for 5 consecutive days. Following UVB treatment, draining lymph node cell populations were characterized via flow cytometry and suppression assays; treated skin was examined for changes in expression of type I IFN genes. Only NZM2328 mice showed an increase in T cell numbers and activation 2 weeks post UVB exposure. This was preceded by a significant increase in UVB-induced type I IFN expression in NZM2328 mice compared to BALB/c mice. Following UVB exposure, both BALB/c and iNZM mice demonstrated an increase in functional T regulatory (TReg) cells; however, this was not seen in NZM2328 mice. These data suggest a skewed UVB-mediated T cell response in lupus-prone mice where activation of T cells is enhanced secondary to a type I IFN-dependent suppression of TReg cells. Thus, we propose type I IFNs are important for UVB-induced inflammation in lupus-prone mice and may be an effective target for prevention of UVB-mediated flares.
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Affiliation(s)
- Sonya J Wolf
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Immunology Program, University of Michigan, Ann Arbor, MI, USA
| | - Shannon N Estadt
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Immunology Program, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Theros
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyson Moore
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jason Ellis
- Immunology Program, University of Michigan, Ann Arbor, MI, USA; Div. of Allergy and Immunology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jianhua Liu
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tamra J Reed
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chaim O Jacob
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - J Michelle Kahlenberg
- Div. of Rheumatology, Dept. of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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13
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Ogunsanya ME, Cho SK, Hudson A, Chong BF. Validation and reliability of a disease-specific quality-of-life measure in patients with cutaneous lupus erythematosus. Br J Dermatol 2019; 180:1430-1437. [PMID: 30637718 DOI: 10.1111/bjd.17636] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) is a potentially disfiguring, chronic autoimmune disease with variable skin manifestations, negatively affecting patients' quality of life (QoL). Patient-reported outcome (PRO) measures assessing QoL in patients with CLE have been generic or developed without input from patients. OBJECTIVES To demonstrate the reliability and validity of a disease-specific QoL measure for CLE - the cutaneous lupus erythematosus quality of life (CLEQoL). METHODS One hundred and one patients with CLE were recruited, and each patient was asked to complete the CLEQoL. Internal consistency was used as a measure of reliability. Validity was measured in two ways - structural validity via exploratory factor analysis and convergent validity via Spearman correlations between CLEQoL and the Short Form 36 (SF-36), visual analogue scales and clinical variables. Patient demographic and disease characteristics were collected. RESULTS The mean ± SD age of patients with CLE was 48 ± 13 years, with discoid lupus (n = 72; 71.3%) being the most predominant CLE subtype. Patients were mostly female (n = 88; 87·1%) and African American/Black (n = 59; 58·4%). Internal consistency ranged from 0·67 to 0·97. Five domains (functioning, emotions, symptoms, body image/cosmetic effects and photosensitivity) were extracted with a total explained variance of 71·1%. CLEQoL-related domains correlated with SF-36 domains (r range -0·39 to -0·65). CONCLUSIONS The CLEQoL was found to be a valid and reliable PRO measure for assessing QoL in patients with CLE. Demonstrating that the CLEQoL has strong psychometric properties is an important step towards the development of a disease-specific PRO measure that future clinical trials can use.
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Affiliation(s)
- M E Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, U.S.A
| | - S K Cho
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, U.S.A
| | - A Hudson
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, U.S.A
| | - B F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, U.S.A
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14
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Affiliation(s)
- Stephanie Jessica Wan
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Irene Lara-Corrales
- 1 University of Toronto, Toronto, Ontario, Canada.,2 The Hospital for Sick Children, Toronto, Ontario, Canada
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15
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Pagenkopf AC, Liang Y. A New Driver for Lupus Pathogenesis is conserved in Humans and Mice. LUPUS (LOS ANGELES) 2019; 4:144. [PMID: 32030371 PMCID: PMC7004413 DOI: 10.35248/2684-1630.19.4.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Adam C Pagenkopf
- Department of Medical Microbiology and Immunology, University of Wisconsin, Wisconsin, USA
| | - Yun Liang
- Department of Medical Microbiology and Immunology, University of Wisconsin, Wisconsin, USA
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16
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Abdul Kadir WD, Jamil A, Shaharir SS, Md Nor N, Abdul Gafor AH. Photoprotection awareness and practices among patients with systemic lupus erythematosus and its association with disease activity and severity. Lupus 2018; 27:1287-1295. [PMID: 29665756 DOI: 10.1177/0961203318770016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective The objective of this paper is to determine photoprotection awareness, knowledge, practices, and its relationship with disease activity and damage in patients with systemic lupus erythematosus (SLE). Methods A cross-sectional study was performed. Data were acquired from in-person interviews and medical records. Results A total of 199 (89.6%) females and 23 (10.4%) males were recruited. Median age was 39.00 (interquartile range (IQR) 18) years, disease duration 12.12 (IQR 8) years, Fitzpatrick skin phototype III 119 (53.6%) and IV 81 (36.5%). Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) was 2.95 (IQR 4) while Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC-ACR DI) was 1.20 (IQR 2). The majority 205 (92.3%) were aware of sun exposure effects on SLE. Photoprotection methods were shade seeking 209 (94.1%), sun avoidance 212 (95.5%), long pants 168 (75.7%), long sleeves 155 (69.8%), sunscreen 116 (52.3%), sunglasses 114 (51.4%) and head cover 103 (46.4%). Significantly higher photoprotection practice scores (PPS) were observed in females, Malays, and individuals with higher education level and internet accessibility. PPS were not significantly correlated with SLICC-ACR DI and SLEDAI-2 K. Independent predictors for good photoprotection practice (GPP) were ethnicity (OR = 3.66, 95% CI 1.78-7.53), awareness (OR = 3.77, 95% CI 1.09-13.08) and cutaneous involvement (OR = 2.43, 95% CI 1.11-5.28). Photoprotection methods and GPP were not predictors for disease activity or damage. Conclusion Photoprotection awareness and knowledge was good. Shade seeking and sun avoidance were the common photoprotection methods practised. The use of sunscreen requires improvement. Photoprotection awareness and cutaneous manifestation were predictors for GPP. Neither photoprotection methods nor GPP were associated with disease activity or damage.
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Affiliation(s)
- W D Abdul Kadir
- 1 Department of Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - A Jamil
- 2 Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - S Sazliyana Shaharir
- 2 Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - N Md Nor
- 2 Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - A H Abdul Gafor
- 2 Department of Medicine, University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
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17
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Ogunsanya ME, Brown CM, Lin D, Imarhia F, Maxey C, Chong BF. Understanding the disease burden and unmet needs among patients with cutaneous lupus erythematosus: A qualitative study. Int J Womens Dermatol 2018; 4:152-158. [PMID: 30175217 PMCID: PMC6116830 DOI: 10.1016/j.ijwd.2018.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/24/2022] Open
Abstract
Background Cutaneous lupus erythematosus (CLE) is a rare dermatologic autoimmune disease marked by photosensitive lesions that can vary in appearance depending on the subtype. The extent to which CLE affects a patient’s quality of life (QoL) has not been fully characterized. Focus groups were conducted to explore patients’ perspectives of how CLE has affected their lives and to understand the unmet needs in regards to CLE treatment and care. Methods This qualitative study involved three focus groups with a total of 19 patients with CLE. A moderator guide containing open-ended questions was used to assess how CLE affects overall QoL. The focus groups were audio-recorded with notetaking. Data were content-analyzed to identify emergent themes. Results Four themes emerged as important to patients with CLE: disease sequelae, social interactions, functioning, and unmet needs. Most patients reported decreased QoL due to signs and symptoms such as dyspigmentation and scarring. Having CLE negatively affected patients’ mental health and personal relationships and led to negative coping strategies, such as recreational drug use. Issues related to body image were also elicited by patients. Patients cited unmet needs including lack of treatments to improve chronic skin lesions of CLE and inadequate patient education on living with CLE. Conclusions Providers can look for signs of QoL impairment in patients with CLE by asking questions related to body image, mental health, social isolation, and coping mechanisms. Future QoL measures can include the effect of CLE-specific attributes such as scarring and dyspigmentation to empower patients’ voices in determining therapeutic efficacy in future clinical trials. Findings from our study have added a new understanding of daily experiences that were elicited directly from patients with CLE.
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Affiliation(s)
- M E Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - C M Brown
- College of Pharmacy, The University of Texas at Austin, Texas
| | - D Lin
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - F Imarhia
- College of Pharmacy, The University of Texas at Austin, Texas
| | - C Maxey
- College of Natural Sciences, The University of Texas at Austin, Austin, Texas
| | - B F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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18
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Pilch M, Scharf SN, Lukanz M, Wutte NJ, Fink-Puches R, Glawischnig-Goschnik M, Unterrainer HF, Aberer E. Spiritual well-being and coping in scleroderma, lupus erythematosus, and melanoma. J Dtsch Dermatol Ges 2018; 14:717-28. [PMID: 27373247 DOI: 10.1111/ddg.12715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Religious/spiritual (R-S) well-being is associated with greater vitality and lower depression scores. In this study, we investigated strategies for coping with disease and the role of religiosity/spirituality with respect to improving subjective well-being. PATIENTS AND METHODS One hundred and forty-nine patients (107 women), 44 of whom with systemic sclerosis (SSc), 48 with lupus erythematosus (LE), and 57 with stage I or II malignant melanoma (MM) were surveyed using a self-designed questionnaire, which addressed subjective well-being and disease-related circumstances, as well as the Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB). RESULTS At the time of diagnosis, disease burden is greater in LE patients than in patients with SSc and MM. Only after several years are SSc and LE patients able to accept their disease. Compared with healthy individuals, the overall score of R-S well-being is significantly lower in LE patients. In LE, photosensitivity and joint pain are inversely correlated with the ability to forgive. SSc patients with facial lesions and pulmonary involvement show greater religiosity. MM patients display significantly higher values for transcendental hope. CONCLUSION Talks about the disease and psychological support are the most important needs of patients with SSc, LE, and MM. At present, programs aimed at improving R-S coping skills do not seem to play a significant role, but could be an important resource that should be addressed in the future.
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Affiliation(s)
- Michaela Pilch
- Department of Dermatology, Medical University Graz, Austria
| | | | - Martin Lukanz
- Department of Psychology, Karl-Franzens University Graz, Austria
| | | | | | | | - Human-Friedrich Unterrainer
- Department of Psychology, Karl-Franzens University Graz, Austria.,Center for Integrative Addiction Research (Grüner Kreis), Vienna, Austria
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19
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Aminoleveulinate photodynamic therapy (ALA-PDT) for Bowen’s disease in a SLE patient: Case report and literature review. Photodiagnosis Photodyn Ther 2017; 18:20-23. [DOI: 10.1016/j.pdpdt.2017.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/02/2017] [Accepted: 01/06/2017] [Indexed: 01/29/2023]
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20
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Szczęch J, Samotij D, Werth VP, Reich A. Trigger factors of cutaneous lupus erythematosus: a review of current literature. Lupus 2017; 26:791-807. [PMID: 28173739 DOI: 10.1177/0961203317691369] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
It is currently believed that autoimmune conditions are triggered and aggravated by a variety of environmental factors such as cigarette smoking, infections, ultraviolet light or chemicals, as well as certain medications and vaccines in genetically susceptible individuals. Recent scientific data have suggested a relevant role of these factors not only in systemic lupus erythematosus, but also in cutaneous lupus erythematosus (CLE). A variety of environmental factors have been proposed as initiators and exacerbators of this disease. In this review we focused on those with the most convincing evidence, emphasizing the role of drugs in CLE. Using a combined search strategy of the MEDLINE and CINAHL databases the following trigger factors and/or exacerbators of CLE have been identified and described: drugs, smoking, neoplasms, ultraviolet radiation and radiotherapy. In order to give a practical insight we emphasized the role of drugs from various groups and classes in CLE. We also aimed to present a short clinical profile of patients with lesions induced by various drug classes.
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Affiliation(s)
- J Szczęch
- 1 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - D Samotij
- 1 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - V P Werth
- 2 Corporal Michael J. Crescenz (Philadelphia) Veterans Affairs Medical Center and Department of Dermatology University of Pennsylvania School of Medicine Philadelphia, PA, USA
| | - A Reich
- 1 Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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21
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Ogunsanya ME, Kalb SJ, Kabaria A, Chen S. A systematic review of patient-reported outcomes in patients with cutaneous lupus erythematosus. Br J Dermatol 2016; 176:52-61. [PMID: 27416958 DOI: 10.1111/bjd.14868] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2016] [Indexed: 12/31/2022]
Abstract
Cutaneous lupus erythematosus (CLE) is a chronic dermatological autoimmune disease marked by photosensitive lesions that can lead to hyperpigmentation changes, scarring and hair loss. Health-related quality of life (HRQoL) in patients with CLE is severely impaired. Given the heterogeneous nature of CLE, health perceptions of patients can differ significantly from those of clinicians. It is important to use subjective measures, such as patient-reported outcomes (PROs), to capture HRQoL data in patients with CLE. We conducted a systematic review of published PRO instruments used in measuring HRQoL in patients with CLE. Also, we examined the disease burden on HRQoL in patients with CLE. To identify studies, PubMed/MEDLINE, Web of Science and CINAHL were searched using 'CLE/cutaneous lupus erythematosus' in combination with PRO-related keywords such as 'quality of life', 'self-report' and 'instrument'. English-language articles published between 2003 and 2014 were identified. A total of 482 citations were identified in the initial search. Eleven studies met our inclusion criteria, and five PRO instruments were found to be used: Skindex (versions 16 and 29), Dermatology Life Quality Index, 36-Item Short-Form Health Survey, and visual analogue scales for pain and pruritus. Patients with CLE reported having poor quality of life and experienced symptoms ranging from pain, pruritus and fatigue to photosensitivity. There is a limited number of studies examining PRO in patients with CLE. While our findings suggest that quality of life in patients with CLE is poor, further studies are needed to understand better the impact of CLE from patients' perspectives.
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Affiliation(s)
- M E Ogunsanya
- Health Outcomes and Pharmacy Practice Division, College of Pharmacy, The University of Texas at Austin, Austin, TX, 78712, U.S.A
| | - S J Kalb
- Biogen, Cambridge, MA, 02142, U.S.A
| | - A Kabaria
- College of Pharmacy, The University of Texas at Austin, Austin, TX, 78712, U.S.A
| | - S Chen
- Biogen, Cambridge, MA, 02142, U.S.A
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22
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Pilch M, Scharf SN, Lukanz M, Wutte NJ, Fink-Puches R, Glawischnig-Goschnik M, Unterrainer HF, Aberer E. Spirituelles Wohlbefinden und Coping bei Sklerodermie, Lupus erythematodes und malignem Melanom. J Dtsch Dermatol Ges 2016; 14:717-29. [PMID: 27373246 DOI: 10.1111/ddg.12715_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HINTERGRUND UND ZIELE Religiös-spirituelles Wohlbefinden ist verbunden mit höherer Vitalität und verminderter Depressionsneigung. In unserer Studie untersuchten wir die Strategien zur Krankheitsbewältigung und die Rolle von Religiosität-Spiritualität (R-S) zur Verbesserung des subjektiven Wohlbefindens. PATIENTEN UND METHODIK 149 Patienten (107 Frauen), 44 mit systemischer Sklerodermie (SKL), 48 mit Lupus erythematodes (LE) und 57 mit malignem Melanom (MM), Stadium I-II, wurden mittels eines selbstentwickelten Fragebogens zum subjektiven Wohlbefinden, zu den mit der Erkrankung einhergehenden Umständen sowie mit dem Multidimensionalen Inventar (MI-RSB) zu R-S befragt. ERGEBNISSE LE-Patienten sind zum Zeitpunkt der Diagnosestellung stärker belastet als SKL- und MM-Patienten. SKL- und LE-Patienten können erst nach Jahren die Erkrankung akzeptieren. Der Gesamtscore des religiös-spirituellen Befindens liegt bei LE-Patienten signifikant unter dem Wert der Normalbevölkerung. Fotosensitivität und Gelenksschmerzen sind bei LE-Patienten negativ assoziiert mit der Fähigkeit Vergeben zu können. SKL-Patienten mit Gesichtsveränderungen und Lungenbeteiligung zeigen höhere allgemeine Religiosität. MM-Patienten haben höhere Werte für transzendente Hoffnung. SCHLUSSFOLGERUNGEN Vorträge über die Krankheit und psychologische Betreuung sind die wichtigsten Bedürfnisse von Patienten mit SKL, LE und MM an ihre Betreuer. Religiös-spirituelle Angebote zur Krankheitsverarbeitung scheinen derzeit eine untergeordnete Rolle zu spielen, könnten aber eine wichtige Ressource sein, der man in Zukunft mehr Aufmerksamkeit schenken sollte.
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Affiliation(s)
- Michaela Pilch
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Austria
| | | | - Martin Lukanz
- Abteilung für Psychologie, Karl-Franzens-Universität Graz, Austria
| | - Nora Johanna Wutte
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Austria
| | - Regina Fink-Puches
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Austria
| | | | - Human-Friedrich Unterrainer
- Abteilung für Psychologie, Karl-Franzens-Universität Graz, Austria.,Center for Integrative Addiction -Research (Grüner Kreis) Wien, Austria
| | - Elisabeth Aberer
- Universitätsklinik für Dermatologie, Medizinische Universität Graz, Austria
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Kuhn A, Wenzel J, Bijl M. Lupus erythematosus revisited. Semin Immunopathol 2015; 38:97-112. [PMID: 26637330 DOI: 10.1007/s00281-015-0550-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022]
Abstract
Lupus erythematosus (LE) is a multifactorial autoimmune disease with clinical manifestations of differing severity. The exact pathomechanisms and interactions resulting in the inflammatory and immunological processes of this heterogeneous disease remain elusive. Approaches in the understanding of the pathomechanisms revealed that the clinical expression of LE is predisposed by susceptibility genes and that various environmental factors are responsible for an abnormal immune response. Several studies demonstrated that ultraviolet (UV) light is one of the major factors in the pathogenesis of the disease. Standardized photoprovocation in patients with LE has been shown to be a safe and efficient model for evaluating the underlying pathomechanisms which lead to the production of autoantibodies and immune complexes. In particular, interferons were defined as important players in the early activation of the immune system and were observed to play a specific role in the immunological interface between the innate and the adaptive immune system. Abnormalities or disturbances in the different processes of cell death, such as apoptosis or necrosis, have also been recognized as crucial in the pathogenesis of LE. Although each process is different and characterized by unique features, the processes are interrelated and result in a complex disease.
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Affiliation(s)
- Annegret Kuhn
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
- Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Joerg Wenzel
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Marc Bijl
- Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, Netherlands
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Verma SM, Okawa J, Propert KJ, Werth VP. The impact of skin damage due to cutaneous lupus on quality of life. Br J Dermatol 2014; 170:315-21. [PMID: 24111880 DOI: 10.1111/bjd.12653] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with more severe cutaneous lupus erythematosus (CLE) have a poorer quality of life (QoL). Racial and ethnic disparities have been reported in disease activity and outcomes in systemic lupus erythematosus, but similar information is not available for CLE. OBJECTIVES To evaluate the impact of lupus-related skin damage on skin-specific QoL, and to analyse differences stratified by ethnic background. METHODS Data collected included sex, race, diagnosis and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and Skindex-29 scores. These parameters were analysed at the initial and last visits. CLASI damage scores (dyspigmentation and scarring) and activity scores were collected, grouped by ethnicity, and correlated with Skindex-29. Overall, 223 patients were analysed at baseline, with 141 completing more than one study visit. RESULTS The majority of patients were white (63·7%), followed by African American (29·1%) and Asian American (4·0%). African American patients accounted for a disproportionate percentage of both localized (50%) and generalized discoid lupus erythematosus (DLE) (49%). Median CLASI damage scores differed significantly between the African American, white and Asian American patients, at both the first (8·5, 4·0, 7·0, respectively; P < 0·0001) and last visit (10·0, 6·0, 8·5, respectively; P < 0·01). CLASI damage scores in African Americans correlated with CLASI activity scores (Spearman r = 0·45, P = 0·0003). CONCLUSIONS There was no significant correlation between CLASI damage scores and Skindex domains overall. Individually, dyspigmentation and scarring also did not have a significant effect on QoL. Ethnic differences in patients with CLE were found: African American patients exhibited a high rate of DLE and experienced damage early in their disease course, frequently in conjunction with disease activity.
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Affiliation(s)
- S M Verma
- Department of Dermatology, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, U.S.A; Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A
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25
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Abstract
The discipline that investigates the biologic effects of ultraviolet radiation on the immune system is called photoimmunology. Photoimmunology evolved from an interest in understanding the role of the immune system in skin cancer development and why immunosuppressed organ transplant recipients are at a greatly increased risk for cutaneous neoplasms. In addition to contributing to an understanding of the pathogenesis of nonmelanoma skin cancer, the knowledge acquired about the immunologic effects of ultraviolet radiation exposure has provided an understanding of its role in the pathogenesis of other photodermatologic diseases.
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Affiliation(s)
- Craig A Elmets
- Department of Dermatology, UAB Skin Diseases Research Center, UAB Comprehensive Cancer Center, Birmingham VA Medical Center, University of Alabama at Birmingham, EFH 414, 1720 2nd Avenue South, Birmingham, AL 35294-0009, USA.
| | - Cather M Cala
- Department of Dermatology, University of Alabama at Birmingham, EFH 414, 1720 2nd Avenue South, Birmingham, AL 35294-0009, USA
| | - Hui Xu
- Department of Dermatology, UAB Skin Diseases Research Center, UAB Comprehensive Cancer Center, Birmingham VA Medical Center, University of Alabama at Birmingham, EFH 414, 1720 2nd Avenue South, Birmingham, AL 35294-0009, USA
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Fenton L, Dawe R, Ibbotson S, Ferguson J, Silburn S, Moseley H. Impact assessment of energy-efficient lighting in patients with lupus erythematosus: a pilot study. Br J Dermatol 2014; 170:694-8. [DOI: 10.1111/bjd.12719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- L. Fenton
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - R. Dawe
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - S. Ibbotson
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - J. Ferguson
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - S. Silburn
- Rheumatology; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
| | - H. Moseley
- The Photobiology Unit; Ninewells Hospital and Medical School; Dundee DD1 9SY U.K
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Ishiguro M, Hashizume H, Ikeda T, Yamamoto Y, Furukawa F. Evaluation of the quality of life of lupus erythematosus patients with cutaneous lesions in Japan. Lupus 2013; 23:93-101. [DOI: 10.1177/0961203313509293] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The quality of life (QOL) of lupus erythematosus (LE) patients with skin manifestations is impaired, but little is known about Japanese patients. We assessed whether the skin symptoms in LE are associated with the QOL using the Japanese versions of the Skindex-29 and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). In all, 54 LE patients with cutaneous lesions completed the Japanese version of the Skindex-29, and physicians assessed the severity of their eruptions using the CLASI before and after treatment. The QOL of the LE patients was better after the therapeutic intervention using the Skindex-29 questionnaire. We tested several factors for an independent association with the QOL. A significant risk factor for a poor QOL was a female gender in “Functioning” before treatment. In addition, a poor QOL tended to be correlated with a female gender in “Emotions” and older current age in “Symptoms” before treatment, and with a longer duration of SLE in “Functioning” after treatment. In the CLASI analysis, skin manifestation activity in the acute phase correlated with a poor emotional and functional QOL rather than a symptomatic QOL. To the best of our knowledge, this is the first report evaluating the QOL of Japanese LE patients, despite the small cohort.
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Affiliation(s)
- M Ishiguro
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - H Hashizume
- Department of Dermatology, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - T Ikeda
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Y Yamamoto
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - F Furukawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
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Ruland V, Haust M, Stilling RM, Metze D, Amler S, Ruzicka T, Kuhn A. Updated analysis of standardized photoprovocation in patients with cutaneous lupus erythematosus. Arthritis Care Res (Hoboken) 2013; 65:767-76. [PMID: 23044659 DOI: 10.1002/acr.21867] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 09/28/2012] [Indexed: 11/10/2022]
Abstract
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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Chang YC, Werth VP. Update on Epidemiology and Clinical Assessment Tools of Cutaneous Lupus Erythematosus and Dermatomyositis. CURRENT DERMATOLOGY REPORTS 2013; 2:48-57. [PMID: 33585073 PMCID: PMC7880122 DOI: 10.1007/s13671-012-0037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cutaneous Lupus Erythematosus (CLE) and Dermatomyositis (DM) are cutaneous autoimmune diseases that have been among the least systematically studied, due in part to the lack of validated outcome instruments in the past. More recent epidemiologic studies have elucidated the incidence and prevalence of these diseases and their subtypes. In addition, the advent of validated clinical outcome measures, including the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), has led to an objective means of measuring activity and damage of the disease. These outcome measures have established the framework for evaluating responsiveness and therapeutic efficacy in clinical trials as well as longitudinal studies to study disease course.
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Affiliation(s)
- Yunyoung C Chang
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Victoria P Werth
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
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Kim A, Chong BF. Photosensitivity in cutaneous lupus erythematosus. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:4-11. [PMID: 23281691 PMCID: PMC3539182 DOI: 10.1111/phpp.12018] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ultraviolet radiation (UVR) is a well-known exacerbating factor for cutaneous lupus erythematosus (CLE), with photosensitivity comprising one of the American College of Rheumatology (ACR) diagnostic criteria for systemic lupus erythematosus (SLE). However, discerning true photosensitivity in this population is difficult due to the broad language utilized by the ACR and the delayed-onset nature of photosensitive lupus lesions. AIMS The objective of this report is to provide a review of photosensitivity, photoprovocation, and phototherapy in the context of CLE patients. METHODS A literature review in PubMed was conducted using the terms 'ultraviolet light,' 'lupus erythematosus,' 'photoprovocation,' or 'photosensitivity.' RESULTS Self-patient reporting of photosensitivity and the broad definition of photosensitivity have led to the wide range of photosensitivity rates in CLE patients. Photoprovocation testing provides a more objective method to measure photosensitivity, but even these trials demonstrate significant differences due to protocol variations. Despite UVR's deleterious effect on lupus patients, ultraviolet A (UVA)-1 may have therapeutic benefits as shown by observations on murine models and human lupus subjects. CONCLUSIONS Accurately discerning photosensitivity has diagnostic implications for SLE and provides motivation for greater patient adherence to photoprotective methods.
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Affiliation(s)
- Andrew Kim
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin F. Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Photosensitivity disorders in children: part II. J Am Acad Dermatol 2013; 67:1113.e1-15; quiz 1128, 1127. [PMID: 23158622 DOI: 10.1016/j.jaad.2012.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 07/29/2012] [Indexed: 11/21/2022]
Abstract
Photosensitivity disorders in children encompass a diverse group of diseases. Some inherited disorders manifest with photosensitivity early in life. Specific extracutaneous association may be the clue to diagnosis in this group of pediatric photodermatoses. Part II of this 2-part review covers hereditary photodermatoses caused by defects in nucleotide excision repair, double strand break repair, or localized or systemic biochemical abnormalities. Diagnosis and management of photoaggravated dermatoses are also discussed. Sun protection strategies are required in all patients with evidence of photosensitivity. Early recognition and prompt diagnosis is essential to minimize the long-term complications associated with inadequate photoprotection.
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Kiss F, Anstey AV. A review of UVB-mediated photosensitivity disorders. Photochem Photobiol Sci 2013; 12:37-46. [DOI: 10.1039/c2pp25275a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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33
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Weinstein PK. The face of lupus. Nurse Pract 2012; 37:38-45. [PMID: 23165135 DOI: 10.1097/01.npr.0000422207.69679.f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Systemic lupus erythematosus--a chronic, complex autoimmune disease without a definitive diagnostic test--often requires burdensome procedures to confirm diagnosis. Nurse practitioners must understand lupus' clinical and serologic manifestations to make a diagnosis; some cases may not be identified using only the American College of Rheumatology's criteria.
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Grönhagen CM, Fored CM, Granath F, Nyberg F. Increased risk of cancer among 3663 patients with cutaneous lupus erythematosus: a Swedish nationwide cohort study. Br J Dermatol 2012; 166:1053-9. [PMID: 22175767 DOI: 10.1111/j.1365-2133.2011.10773.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Other autoimmune diseases have been associated with higher risks for cancer, and numerous case reports of cutaneous lupus erythematosus (CLE) and different cancer types are available. OBJECTIVES To estimate the overall and specific cancer risks in a nationwide cohort study of patients diagnosed with CLE in Sweden and compare that risk with that in a control cohort without CLE. METHODS A cohort of 3663 individuals with CLE and a matched control cohort from the general population (three controls to each CLE case) without a diagnosis of CLE were derived from the Swedish National Patient Register, 1997-2007, and were electronically linked to the Swedish Cancer Register and the Swedish Cause of Death Register. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to compare the observed vs. the expected numbers of cancers. RESULTS A total of 183 incident cancers occurred within the observation interval, yielding a HR of 1·8 (95% CI 1·5-2·2) for cancer overall. Median follow-up was 4·1 years. About a fourfold risk increase was seen for buccal cancer, lymphomas, respiratory cancer and nonmelanoma skin cancer. CONCLUSIONS Patients with CLE appear to have an elevated risk for certain cancer types, an increase that remains when excluding patients also diagnosed with systemic lupus erythematosus. Our findings point to the importance of counselling about not smoking and sun avoidance, and underscore the need for specialized monitoring of this patient group along with bench-to-bedside research efforts to clarify pathogenesis.
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Affiliation(s)
- C M Grönhagen
- Department of Clinical Sciences, Karolinska Institutet, Dandery Hospital, Stockholm, Sweden.
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Smith E, Kiss F, Porter RM, Anstey AV. A review of UVA-mediated photosensitivity disorders. Photochem Photobiol Sci 2011; 11:199-206. [PMID: 22127510 DOI: 10.1039/c1pp05191a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A number of skin conditions are characterised by photosensitivity to UVA. Some of these are exclusively UVA-mediated conditions, while others include UVA in the action spectrum which also include UVB and/or visible light. This review aims to describe this diverse range of conditions for non-dermatologist scientists with an interest in this topic. As such, clinical details, including treatments, are brief and succinct. Recent advances in understanding the pathogenesis of these conditions is highlighted.
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Affiliation(s)
- E Smith
- Cardiff and Vale University Health Board, Heath Park, Cardiff, United Kingdom CF14 4XN
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