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. May not be reproduced in any form without permission from the publisher, except fair uses permitted under 30 Ana Maria Abreu Velez and Michael S. Howard

noted, in discoid lupus disease scars may leave permanent bald areas. Also, sometimes
medication therapy may make the hair thin in lupus patients. Medication hair thinning occurs
in some people undergoing steroid treatment, and in most people when cytotoxic drugs such
as cyclophosphamide are used. In both cases, the hair should regrow when the drug is
discontinued [90-101]. Approximately 60% of people with lupus will be sensitive to sunlight.
Sunlight may cause 1) exacerbation of skin rashes, 2) a generalized burning of the skin and 3)
increased activity of lupus in other organs within the body. The lupus band test is classically
found when performing direct and/or indirect immunofluorescence for lupus patients. The
lupus band represents linear deposits of immunoglobulins at the DEJ, combined with a
thickened basement membrane in lesional skin of LE patients [96-99]. A number of
treatments are available for the skin in lupus. These can be divided into topical, injection and
oral treatments. Topical treatments tend to consist of steroid creams and ointments. These can
contain mild steroids such as hydrocortisone, or stronger steroids such as betamethasone
[102-104]. These topical therapies may sometimes be adequate to control mild lupus rashes;
however, they should not be used for extended periods, particularly on the face. In discoid
lupus, particularly troublesome skin areas can be injected with long acting steroids under the
skin to promote healing. Over time, most people will require oral treatment to control their
skin problems. The antimalarials such as chloroquine, hydroxychloroquine, mepacrine and
mycophenolate mofetil are all very useful in controlling skin rashes [102-104]. They tend to
work slowly, and need to be taken for a number of months before any effect is seen. Other
oral treatments include steroids, which may also be given intravenously if the skin lesions are
very severe. Oral and intravenous steroids obviously have a number of side effects; thus,
these options are usually reserved for skin problems that have not responded to topical
treatments and antimalarial agents [102-104]. Occasionally, skin rashes cannot be controlled
with the above treatments or they recur on steroid dose reduction. In these people, other
medications such as azathioprine or cyclosporin can be used. These drugs are often reserved
for noncutaneous problems in lupus such as kidney disease; however, they may be given for
the skin alone in difficult cases. One important way that those with lupus can help themselves
is to avoid sun exposure [102-104]. Thus, patients should be encouraged to cover up their
skin with long sleeves and trousers in the sunlight, and wear a hat if exposed to the sun for
extended periods. The use of UV screening film on windows may also be helpful for those
who are particularly sun sensitive. Also, sun block cream with a minimum sun protection
factor (SPF) of 25, should be applied to exposed areas of skin, although many patients will
require higher SPF level protection.

Lupus and the Sun

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As previously noted, lupus lesions may be exacerbated after exposure to sunlight.

The resultant rashes are titled photosensitive rashes, and represent classic clinical lesions of
lupus. In addition, patients with these rashes may develop migraine headaches, nausea or joint
pains. The joints may become tender to touch and swollen. Other clinical aspects of lupus
may also be exacerbated after sun exposure, including fever, pleuritic pain (chest pain on
inhalation), kidney disease and neurologic problems. Patients with severe light sensitivity
may further be adversely affected by fluorescent and halogen lighting, energy-saving bulbs or

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