RATE OF OCCURRENCE OF PHOTOSENSITIVITY IN SYSTEMIC LUPU ERYTHEMATOSUS.

Najah Abdul-Hameed 1 , Mustafa K. Al-Ezzi 2 and Makram Al-Waiz 3 . 1. Specialist Doctor in Rheumatology and Rehabilitation. Al-Yarmouk Teaching Hospital Baghdad/Iraq, 2. Medicine Proff., College of Medicine, University of Baghdad. 3. Dermatology Proff., College of Medicine, University of Baghdad. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 01 October 2018 Final Accepted: 03 November 2018 Published: December 2018


ISSN: 2320-5407
Int. J. Adv. Res. 6 (12), 270-274 271 defined as ''skin rash as a result of unusual reaction to sunlight, by patients' history or physician observation" (6) . In addition to the skin reaction patients may develop exacerbation of their systemic disease with sun exposure (4,5) .
The ultra violet UV portion of the electromagnetic spectrum lies between 200 and 400 no nm. Ultraviolet radiation is often arbitrarily divided into UV-A, UV-B and UV-C. The UV-A portion (320-400 nm) is not strongly absorbed by proteins and nucleic acids and does not cause erythema in normal skin at moderate doses in the absence of photosensitive chemicals. UV-B radiation (290-320 nm) is erythemogenic and present in the terrestrial solar spectrum. UV-C radiation (200-290 nm) (germicidal) is erythemogenic but doesn't reach the earth's surface (5,7,8) . One or more specific chromophores (light absorbing molecules) are involved in each photo biologic response. Photosensitive LE patterns react to UV-B and UV-C radiation and that a possible chromophore in this wavelength range is DNA. The chromophore responsible for UV-A photosensitivity is not known. The mechanism whereby photochemical reaction of the chromophore initiate clinical lesion is not understood (5) . Mechanisms leading to a single disease organ or to a systemic appearance of this disease entity are still not well understood (9) .
This study was designed to evaluate the rate of occurrence of photosensitivity in SLE (non-cutaneous disease) Iraqi patients.

Patients and methods:-
Consecutive unselected patients with SLE who met four or more of the ARA (1982) revised criteria for the classification of SLE, who were attending Baghdad Teaching Hospital both inpatients and out patients were included in the study. The time of the study was between Dec 1995 and May 1996. Examination of the patients was carried out at the rheumatology and dermatology units.
All patients were recruited to participate in the study after obtaining a verbal consent. A questionnaire was constructed for the purpose of the study. Information about sociodemographic variables: name, age, sex, occupation. Information about the disease were also collected: disease duration, medical history, drug therapy, appearance of photosensitive reactions in skin (exposed and unexposed areas) after exposure to sunlight, and whether accompanied by systemic manifestations such as fatigue, weakness, joint pain, fever, mouth ulcers, and hair fall.
Full clinical examination was performed with special attention for the following features: arthritis renal disease (>500 mg proteinuria/24 hr. or 3+ proteinuria or cellular casts), neuropsychiatric manifestations (seizures or psychosis), leucopenia, and thrombocytopenia.
The patients were allocated to one of three groups according to clinical assessment of disease activity (10) . The mild disease activity group: comprised those patients having mild signs and symptoms of the disease, clinical features in these patients included arthralgia, skin rash, mouth ulcers, alopecia, and general malaise. The intermediate group had evidence of moderate disease activity. The severe disease activity group had clinically obvious arthritis, nephritis, or neurologic disorder.
Skin color of the patients was reported:-All patients with SLE were sent for complete blood count, erythrocyte sedimentation rate (ESR), antinuclear antibody testing (ANA), blood urea, serum creatinine, and general urine examination.

Statistical issue:-
Statistical analysis of the results was done by Chi-square test, P-value less than 0.05 was considered significant.

Results:-
The study covered 64 patients with SLE. The age, sex, and disease duration of SLE patients were shown in tables-1. Female were 56(87.5%)which was much higher than male 8(12.5%) giving a ratio of female to male as 7:1. Mean age was 28.1 year for female and 26 years for male. In female the mean duration of the disease was 4.3 years and 2.2 years for male.   Tables-4 showed the skin areas in which a rash developed or worsened after sun exposure. Face was the leading place of photosensitivity 32(94.1%), arms 21(61.7%), and finally 2(5.8%). We had 4 patients with type I skin color (always burn, never tan), 6 patients with type II skin colour (always burn, sometimes tan) 54 patients with type III skin colour (always tan, sometimes burn), photosensitivity was present in 2(50%), 3(50%), and 29(53.7%) of them respectively. There is no significant difference in the prevalence of photosensitivity among different skin colour groups of patients (P = 0.97).
Photosensitivity was reported in 20 (55.5%) patients with severe disease activity and in 6 (42.8%) patients with intermediate disease activity and in 8 (57.1%) patients with mild disease activity. There is no significant difference in the prevalence of photosensitivity in different disease activity groups of patients (P = 0.68).  (11) . In comparison to Iraqi patients a study conducted by AI Raw and co-workers reported photosensitivity in 48% of SLE patients (12) .
In the current study we depended on a questionnaire which was answered by the patients Through the development of standardized tests methods it has become possible to reproduce cutaneous lesions in the UV A and UVB spectrum. These methods allow a better definition of photosensitivity than clinical history did (13) . Because of lack of facilities, we used the method described by Wysenbeek which did not require sophisticated techniques (14) .
We differentiated between cutaneous and systemic symptoms secondary to sun exposure. Patients with SLE described photosensitivity over the face, arms, legs. neck and back in descending order. Petzelbauer et al found highly significant correlation between severe sun sensitivity and the presence of high antinuclear antibody titers (15) . Mond and Rothfield also found a significant correlation. There was no significant association with other SLE criteria (16) .
In conclusion Iraqi patients with SLE has high rate of photosensitivity. Sun protection is vital.