Photoprotective Habits of Patients with Cutaneous Lupus Erythematosus

BACKGROUND/PURPOSE: Ultraviolet radiation is a well-documented trigger of skin lesions in patients with cutaneous lupus erythematosus (CLE). Though CLE patients are advised to practice photoprotection to prevent disease flares, their degrees of adherence to a regular photoprotective regimen can be variable. We sought to determine the relationship between photoprotective habits and various clinical and demographic characteristics of CLE subjects at the University of Texas Southwestern (UTSW) Medical Center. METHODS: A cross-sectional survey on photoprotective habits was administered to 105 CLE subjects at UTSW Medical Center. For each photoprotective method (e.g., applying sunscreen, wearing long-sleeved shirts, hats, and sunglasses, seeking shade), subjects were asked to choose their frequency of use from a 4-point Likert scale (1=rarely, 2=sometimes, 3=often, and 4=always). Overall sun protection habits (SPH) scores were calculated by taking the numerical average. Additional data including demographics, Fitzpatrick skin type, CLE subtype, smoking history, and history of photosensitivity were also collected. Statistical comparisons were performed using Fisher's exact tests for r x c contingency tables, Kruskal-Wallis tests, and Mann-Whitney U tests. p<0.05 was considered statistically significant. RESULTS/CONCLUSIONS: Overall SPH scores were significantly lower in the medium-skinned (skin types III-IV; 2.7±0.7, p=0.01) and dark-skinned (skin types V-VI; 2.5±0.7; p<0.001) CLE patients than the light-skinned CLE patients (skin types I-II; 3.2±0.6) (p=0.001). This disparity may be due to misconceptions that dark-skinned CLE patients have regarding their decreased need for photoprotection. There were also significant differences between groups categorized by age at visit (p=0.04), with the SPH scores of the 61 and older age group (3.1±0.6) significantly higher than those of the 31-40 (2.5±0.7; p=0.01) and the 41-50 (2.5±0.8; p=0.02) age groups. The 31-50 year old age group overlaps with the most common age range for onset of lupus erythematosus, which is between 20 to 40 years of age. This highlights the need for photoprotection education to be targeted towards this specific age group of CLE patients who are likely to be newly diagnosed.