Millard T P, Hawk J L, McGregor J M
Department of Photobiology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
Lupus. 2000;9(1):3-10. doi: 10.1177/096120330000900103.
A wide variety of skin conditions may present in patients with lupus erythematosus (LE). These can be broadly divided into three main groups: cutaneous forms of LE ('LE-specific skin disease'), non-specific cutaneous manifestations of SLE ('LE non-specific skin disease') and cutaneous complications of drug treatments for LE. This review examines clinical photosensitivity in LE, a trait most commonly associated with cutaneous forms of LE but which may also manifest in SLE. All humans are photosensitive, developing reddening of the skin if exposed to sufficient ultraviolet radiation (UVR). Therefore we define photosensitivity in clinical practice as an abnormal cutaneous response to UVR. Abnormal photosensitivity in LE may manifest in a number of different forms. The lesions of LE-specific skin disease may be induced or exacerbated by UVR. Patients with LE who are prescribed photosensitizing medications such as thiazide diuretics, neuroleptics and tetracyclines may also develop phototoxic reactions which usually present as easy sunburn. Photosensitivity may also, rarely, manifest as fragile skin and blistering in patients with both LE and porphyria cutanea tarda. Several other photosensitive disorders have been reported in association with LE, including solar urticaria and erythropoetic protoporphyria (EPP), but these appear to be chance associations. Assessment of patients with LE and photosensitivity requires a careful history and examination. Phototesting and photoprovocation tests may be used to demonstrate photosensitivity in some cases, but these are rarely required for diagnosis. Photosensitive patients should be advised about sun avoidance, photoprotection and sunscreen use as a first line treatment.
红斑狼疮（LE）患者可能出现多种皮肤状况。这些状况大致可分为三大类：LE的皮肤形式（“LE特异性皮肤病”）、SLE的非特异性皮肤表现（“LE非特异性皮肤病”）以及LE药物治疗的皮肤并发症。本综述探讨了LE中的临床光敏性，这一特征最常与LE的皮肤形式相关，但也可能在SLE中表现出来。所有人都具有光敏性，如果暴露于足够的紫外线辐射（UVR）下，皮肤会发红。因此，我们在临床实践中将光敏性定义为对UVR的异常皮肤反应。LE中的异常光敏性可能以多种不同形式表现出来。LE特异性皮肤病的皮损可能由UVR诱发或加重。服用噻嗪类利尿剂、抗精神病药物和四环素等光敏药物的LE患者也可能发生光毒性反应，通常表现为容易晒伤。光敏性在患有LE和迟发性皮肤卟啉症的患者中也可能很少表现为皮肤脆弱和水疱。还报告了其他几种与LE相关的光敏性疾病，包括日光性荨麻疹和红细胞生成性原卟啉症（EPP），但这些似乎是偶然关联。对患有LE和光敏性的患者进行评估需要仔细询问病史和进行检查。在某些情况下，光试验和光激发试验可用于证明光敏性，但诊断很少需要这些检查。应建议光敏患者避免日晒、采取光防护措施并使用防晒霜作为一线治疗方法。
