Hasan T, Nyberg F, Stephansson E, Puska P, Häkkinen M, Sarna S, Ros A M, Ranki A
Department of Dermatology, University of Tampere, Finland.
Br J Dermatol. 1997 May;136(5):699-705.
Photosensitivity, one of the presenting symptoms in lupus erythematosus (LE), is still poorly defined and varying prevalence figures have been reported. The possibility of a coexisting photodermatosis, especially polymorphous light eruption (PLE), has often not been taken into account. We report the results of ultraviolet A (UVA) and B (UVB) photoprovocation tests in 67 clinically photosensitive patients who had confirmed discoid LE (DLE), systemic LE (SLE) or subacute cutaneous LE (SCLE). The results are compared with a detailed history of photosensitivity and with clinical and serological findings. A pathological photoprovocation reaction, graded as weak, moderate or strong, was induced with either UVA or UVB in 69% of patients with LE, in 100% of those with SCLE, in 70% of those with SLE and in 64% of those with DLE, but in none of 14 controls. Only 16% of the pathological reactions were strong and long-lasting, resembling LE lesions, while 48% were moderate or weak and transient, clinically like PLE. Fifty-three per cent of the provocation reactions which were biopsied showed a PLE-like histology or a non-specific inflammatory reaction, and most of them were clinically moderate or weak reactions of short duration. In the remaining, mostly clinically strong or long-lasting reactions, the histology was consistent with LE. A history of sunlight sensitivity did not predict a pathological photoprovocation result but a positive association between the presence of SSA/Ro or SSB/La antibodies and a pathological photoprovocation reaction was found. We have shown that PLE coexists with LE and that both PLE- and LE-like lesions can be induced with UV radiation in LE patients.
光敏性是红斑狼疮（LE）的主要症状之一，目前仍定义不清，且报道的患病率数据各不相同。光皮肤病尤其是多形性日光疹（PLE）并存的可能性常常未被考虑在内。我们报告了对67例临床有光敏性的患者进行紫外线A（UVA）和紫外线B（UVB）光激发试验的结果，这些患者已确诊为盘状红斑狼疮（DLE）、系统性红斑狼疮（SLE）或亚急性皮肤型红斑狼疮（SCLE）。将结果与详细的光敏性病史以及临床和血清学检查结果进行了比较。在LE患者中，69%、SCLE患者中100%、SLE患者中70%以及DLE患者中64%的患者经UVA或UVB激发后出现了分级为弱、中或强的病理性光激发反应，但14名对照者均未出现。只有16%的病理性反应强烈且持久，类似LE皮损，而48%为中度或弱度且短暂的反应，临床上类似PLE。经活检的激发反应中，53%显示出类似PLE的组织学或非特异性炎症反应，且大多数为临床上中度或弱度的短期反应。在其余主要为临床上强烈或持久的反应中，组织学与LE一致。阳光敏感史并不能预测病理性光激发结果，但发现抗SSA/Ro或抗SSB/La抗体的存在与病理性光激发反应之间存在正相关。我们已经表明PLE与LE并存，并且在LE患者中紫外线辐射可诱发类似PLE和LE的皮损。
