{"doi":"10.1111/srt.13247","title":"New concepts on abnormal UV reactions in systemic lupus erythematosus and a screening tool for assessment of photosensitivity","abstract":"Dear Editors, Systemic lupus erythematosus (SLE) is a multisystem autoimmune recurrent inflammatory condition that most often manifests as a mixture of mucocutaneous, musculoskeletal, and hematologic involvements. SLE is subdivided into acute, subacute, and chronic forms.1, 2 As many as 90% of SLE patients develop mucocutaneous symptoms at some point during the course of their disease, and up to 25% have cutaneous involvement at the time of diagnosis.1, 3 The presentation of mucocutaneous symptoms range in severity and frequency and are often triggered and intensified by ultraviolet radiation (UVR).3 The resulting cutaneous lesions can occur with or without SLE.3 SLE can run many courses clinically and as such has a classification that separates the 47 forms that have cutaneous involvement from the overall systemic involvement of the disease. SLE Diagnostic Criteria, as described by the American College of Rheumatology (ACR) and European League Against Rheumatism in 2019, pose the new criteria that appear to have an increased specificity and sensitivity compared to previous diagnostic criteria models.4 SLE affects 62.2–84.8 per 100 000 in the United States with an estimated prevalence of 4.6–5.6 per 100 000 per year.2 SLE is 3–4× more prevalent in Black women, 1.5–2× more likely in Asian and Hispanic women than in White women, with evidence that there are disparities due socioeconomic factors that play a role in the diagnosis and treatment of SLE.5, 6 Black women tend to develop SLE earlier in life and have a higher mortality rate.6 The risk for skin damage is higher in Black people with lupus than in Whites and Hispanics.6, 7 The incidence of cutaneous lupus erythematosus (CLE) is 4 cases per 100 000, and the prevalence is 73 cases per 100 000 persons.8 SLE is not a reportable diagnosis, and thus, it is likely that number of people with this condition is greater than estimated. Broadly, photosensitivity (PSN) is an abnormal reaction to sunlight/UVR exposure that leads to a rash or lesion formation as determined by a practitioner. Photosensitivity is one of the 11 classification criteria for SLE, and the ACR defines it as “a skin rash as a result of unusual reaction to sunlight.” Between 23% and 83% of patients with SLE are reported to be sensitive to UVR.3 True photosensitive reactions to UVR can occur up to 3 weeks after exposure and may present with fatigue and arthralgias.2, 3 Following UV exposure, skin reactions are often delayed (more than a week after testing). It is critical that practitioners ask patients about recent prolonged exposures and symptoms such as fatigue, especially toward the end of the summer season. Patients often mistake these rashes for sunburn, acne, or rosacea, which further delays treatment.1, 3, 8, 9 Ensuring patient understanding of the risks related to unprotected sun exposure can help reduce the skin lesion formation, exacerbation, and further systemic involvement. Based on these findings, we support expanding the definition of photosensitivity to include a skin rash or lesion that appears in a delayed mechanism, days to weeks after excessive sun exposure and persisting further for days to weeks. Regarding the mechanisms for the photosensitivity associated with lupus erythematosus, several recent reviews have been published.10, 11 In this review, we will summarize the relationship of photosensitivity, with a particular emphasis on CLE lesion formation, and provide novel preclinical murine data suggesting that subcellular microvesicle particles (MVP) could play a role in the photosensitivity response. Finally, we propose a simple tool to categorize photosensitivity in patients. Adaptive skin pigmentation is a normal protective measure and the skin's first line of defense against UVR. Typically, UV light induces the activation of repair mechanisms while delaying keratinocyte cell growth.12, 13 Keratinocytes and melanocytes coordinate the increased production of melanin that is used to protect ne","journal":"Skin Research and Technology","year":2023,"id":342374,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":14,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.962,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":780258,"name":"Lea Christian","orcid":"0000-0001-6895-4765","position":1,"is_corresponding":false},{"id":657230,"name":"Christine M. Rapp","orcid":"0000-0001-7114-7796","position":2,"is_corresponding":false},{"id":657222,"name":"Langni Liu","orcid":"0000-0001-8069-6711","position":3,"is_corresponding":false},{"id":657227,"name":"Craig A. Rohan","orcid":"0000-0002-4268-4311","position":4,"is_corresponding":false},{"id":381163,"name":"Jeffrey B. Travers","orcid":"0000-0001-7232-1039","position":5,"is_corresponding":false},{"id":1078875,"name":"Danielle A. Corbin","orcid":"0000-0002-9107-3517","position":0,"is_corresponding":true}],"reference_count":55,"raw_metadata":null,"created_at":"2026-07-19T01:11:12.506815Z","pmid":"36973991","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}