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Lupus

Sun Exposure & Lupus Patients

Sun Exposure & Lupus Patients

The sun is essential for all life on this planet. Primitive cultures were aware of this and primitive people often worshipped the sun. Even during the Middle Ages, themomentary “absence” of the sun during a solar eclipse was a terrifying event. Why is i tthen, in the 21st century, we advise lupus patients to avoid the sun? Because lupus is an auto immune disease and the harmful ultraviolet (UV) radiation found in sun light can adversely affect the regulation of the immune system.

The primary function of the immune system is to protect the host against microbial infections. Oneofthemajor weapons in the immune arsenal responsible for killing infectious agents is the antibody molecule. Normally, antibodies are like guided missiles that bind to and destroy bacteria in a highly selective and specific manner. In an auto immunedisease such as lupus, autoantibodies are formed. The guidance system of auto antibodies is faulty. Rather than seeking out and destroying foreign invaders such as bacteria, auto antibodies seek out and destroy “self,” the cells and tissues of your own body. One of the major characteristics of lupus is the formation of a variety of auto antibodies, particularly the antinuclear antibodies which are usually found deep within the cells, in the nucleus,where they are in accessible to attack.

One reason that lupus patients are advised to stay out of sunlight is because UV radiation appears to alter the location of the targets of the anti-nuclear auto antibodies in skin cells. Exposing skin cells to low to moderate doses of UV radiation causes movement of the targets from deep within the cell to the surface, where they become accessible to attack by the anti-nuclear auto antibodies. The auto antibodies bind to the targets now on the surface of the skin cells and kill the cells. This may explain why sunlight accentuates the skin lesions and facial rash seen in lupus patients.

In higher doses UV is toxic; by itself it will kill cells. A sunburn is visual evidence of cellular damage caused by UV radiation. As a result, the cells break apart and the contents of the cells, including the nuclear targets of the auto antibodies, such as DNA, are released. The anti-nuclear auto antibodies bind to the DNA and form DNA-antibody complexes. These complexes are carried through the blood and deposited in the kidneys and joints and are instrumental in the development of the kidney damage and arthritis seen in some lupus patients. By damaging cells and causing the release of the target DNA into the bloodstream, UV promotes the formation of antibody-DNA complexes.

UV radiation is also a carcinogen and is the primary cause of skin cancer. While it is prudent for everyone to minimize their exposure to UV radiation, it is especially important for lupus patients to avoid the UV radiation found in sunlight. In addition to being a carcinogen, UVradiation also suppresses the immune response, and studies using mice have demonstrated a close association between the immuno suppressive effects of UV radiation and its ability to produce skin cancer, Because UV radiation is immuno suppressive, at first glance you may think that anything that suppresses the immune response would be beneficial in treating an auto immune disease such as lupus.

This however, is not true with UV radiation because of the types of immune reactions suppressed by UV Unlike the immuno-suppressive drugs used to treat lupus, UV exposure does not inhibit the production of the auto antibodies, but rather suppresses other types of immune reactions such as anti-cancer immunity and some types of antibacterial immune reactions, thus predisposing patients to skin cancer development and perhaps increasing the chance for bacterial and viral infections. Fortunately small changes in your lifestyle can help minimize your exposure to UV radiation. Avoid the most intense sunlight during mid-day (noon to 3:00 PM). Wear protective clothing, especially broadbrimmed hats to protect your face.

Use a sunscreen with a minimum SPF (sun protection factor) of 15 to protect your skin from the harmful effects of UV radiation. Remember that early detection and treatment is the key to fighting cancer, and skin cancer is the easiest type of cancer to detect. Get into the habit of self examination. Look for changes, reddish patches or irritated areas of skin that don’t heal, bleed or have uneven, raised or crusty borders.

Pay close attention to moles. If they change color, increase in size or if their borders become uneven and scalloped, see your dermatologist. Also remember that although lupus makes you more susceptible to the harmful effects of UV radiation, everyone should restrict their sun exposure. Make sure that your kids and other family members are putting on hats and sunscreen. Get everyone involved in detecting the early signs of skin cancer. And leave the mid-day sun to mad dogs and Englishmen.