QAre there any special precautions to tell my patients with photo-exacerbated disorders like discoid lupus and cutaneous dermatomyositis?

Patients with skin diseases such as discoid lupus erythematosus and cutaneous dermatomyositis are often unaware of the extent to which UV light can flare their disease. Ultraviolet light can cause a cutaneous flare a week or more after exposure.¹ An important part of patient care for people is teaching about photoprotection and how to integrate habits and practices that avoid UV exposures.  

The first objective is to understand the patient’s prior knowledge of sun protective practices and gauge how much the patient is already doing. Patients with lighter skin who frequently sunburn may be more accustomed to sunscreen use, while those with darker skin tones may be less familiar with sunscreen types and the significance of sun protection factor. ²

A short educational intervention was shown to improve sun protection knowledge in patients with cutaneous lupus erythematosus.² The best protection for patients is sun avoidance. Patients should apply sunscreen with SPF of 30 and broad-spectrum coverage. They should reapply every 2 hours. Sun protective clothing in addition to sunscreen should be emphasized for additional UV protection. Dermatologists should reinforce these recommendations every visit.

References:

1. Kim A, Chong BF. Photosensitivity in Cutaneous Lupus Erythematosus. Photodermatology, photoimmunology & photomedicine. 2013;29(1):4-11. doi:10.1111/phpp.12018.
2. Kaushik A, Laumann A, Nwe S, Kwasny MJ, West DP, Kundu RV. Evaluation of benefit to educational material for photoprotection in those with cutaneous lupus erythematosus. J Drugs Dermatol. 2015 Apr;14(4):355-8.