INNSBRUCK, Austria—Physicians need to step up their efforts to convince lupus patients to protect themselves from the sun, according to Gerlinde Obermoser, MD, and Bernhard Zelger, MD, of Innsbruck Medical University in Austria, in an editorial in Lupus.¹

"Patients with lupus have a triple need for photoprotection," the authors write. "Photoprotection begins with patient awareness and modified behavior." Lupus patients are more photosensitive than their nonlupus counterparts and run the same risks for photoaging of the skin, ultraviolet (UV) immunosuppression, and skin cancer. What’s more, they are further endangered by many systemic immunosuppressive treatments, which can further increase the risk of nonmelanoma skin cancer.

Photoprotection for lupus patients begins (but doesn't necessarily end) with

• avoiding sun exposure between 11 am and 3 pm, especially during the summer
• avoiding tanning salons
• wearing hats and protective clothing. "Dark and tightly woven fabrics are more efficient in blocking UV light or special UV protection clothing."
• wearing UV protective sunglasses and lip balms
• choosing vacation seasons and destinations carefully
• applying broad spectrum sunscreens with a sun protection factor (SPF) of ≥30 and a high degree of UVA blockers 30 minutes before going into the sun
• applying sunscreen liberally using one third spoonful for an adult face and a handful to cover the entire body
• reapplying sunscreen regularly even if it says "waterproof" because water, sweating, toweling, and sand reduce the amount on the skin

"Depending on patient factors like disease activity and degree of photosensitivity, and on external factors like time of the day and 'reflective' environment (snow and water), application of sunscreens may be necessary even on cloudy days," the editorialists point out.

Translating research into practice

Two leading New York City dermatologists agree with the advice dispensed in the editorial and, in certain instances, take it one step further by expanding the time frame in which lupus patients should avoid the sun and increasing the SPF in sunscreens.

"Lupus is a condition that goes with sun sensitivity, and most lupus patients burn very easily, so they must protect their skin from sun in the summer and winter," said Judith Hellman, MD, an assistant professor of dermatology at Mount Sinai Medical Center in New York City.  "They need to be counseled to…use proper protection even on a cloudy day because a lot of sun comes through the clouds," she told MSKreport. "Clothing lets through some of the sun, so lupus patients should apply sunscreen before they put on clothes, and reapply it periodically."

Neil Sadick, MD, a clinical associate professor of dermatology at New York Presbyterian Hospital-Cornell Medical Center agrees. "Lupus patients need to be extra-careful because they are more photosensitive," he said. "They need to…use a broad spectrum UVA-UVB sunscreen, to step up the SPF to 45, and to wear sun-protective clothing," he told MSKreport.com. "If they are taking sun-sensitizing medications, they should stay out of the sun."

Reference

1. Obermoser G, Zelger B. Triple need for photoprotection in lupus erythematosus. Lupus. 2008;17:525-527.