Antimalarie photoprotection

BACKGROUND: There are very few data addressing the mechanisms of antimalarial treatment benefit locally within the skin of patients with lupus erythematosus, at the level of cytokine messenger RNA (mRNA) expression. OBJECTIVES: The aim of this study was to evaluate whether 3 months of monotherapy with chloroquine influences the mRNA skin expression of interleukin (IL)-1beta, IL-6 and tumour necrosis factor-alpha (TNF-alpha) in nonirradiated and locally ultraviolet B (UVB) irradiated nondiseased skin of patients with systemic lupus erythematosus (SLE)...

INTRODUCTION: Actinic lichen planus (ALP) is a chronic and benign disease that affects young people of the Middle East and Maghreb countries. PURPOSE: To analyse clinical features and prognosis of ALP in children. PATIENTS AND METHODS: A retrospective, descriptive study of cases observed in the department of dermatology of Sfax hospital over a period of 11 years (1995-2005). RESULTS: Our patients were 5 boys and 1 girl...

INTRODUCTION: Discoid lupus erythematosus (DLE) is a chronic autoimmune skin disease that usually affects the sun-exposed skin. Palpebral involvement occurs uncommonly. MATERIAL AND METHOD: The goal of our study was to present the clinical and therapeutic features of a series of nine patients with discoid lupus erythematosus with eyelid involvement. RESULTS: Lesions of discoid lupus were more frequent in the lower eyelids (seven cases). The palpebral location was the only manifestation of the disease in a 34-year-old woman...

Dermatomyositis is one of the idiopathic inflammatory myopathies. It is characterized clinically by progressive symmetrical proximal muscle weakness and a characteristic rash. There are patients with rash who have little or no muscle disease. Although the process primarily attacks the skin and the muscles, it is a systemic disease with frequent manifestations in the gastrointestinal tract and pulmonary system. Dermatomyositis has been linked to internal malignancy in somewhere between 15% and 25%. Therapy for the muscle disease includes systemic corticosteroids with or without an immunosuppressive agent...

Systemic lupus erythematosus (SLE) is an autoimmune disease with a complex pathogenesis. Published data have revealed that serum levels of proinflammatory cytokines are increased in SLE patients. The aim of our study was to evaluate whether monotherapy with chloroquine phosphate affects IL-1beta, IL-6, IL-18 and TNF-alpha serum levels in SLE patients. The study group consisted of 25 SLE patients with mild or moderate disease activity and 25 age- and sex-matched healthy control subjects. In SLE patients the cytokine levels were measured just before and three months after starting chloroquine treatment at a dose of 125 mg twice daily...

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disease with complex pathogenesis, various clinical presentation and chronic course with relapses. Mode of treatment depends on the disease activity and kind of internal organ involvement. In most cases clinical remission could be obtained after antimalarials, nonsteroidal anti-inflammatory drugs, corticosteroids, and photoprotection use. Despite the approved antimalarials therapeutic value, the mechanisms by which they provide benefit in lupus, patients are not fully understood...

Discoid lupus erythematosus (DLE) is rare in childhood. We report the case of a 15-month-old female infant who presented with erythematous telangectatic lesions and photosensitivity involving the sun-exposed areas. Histological examination confirmed the diagnosis of DLE. Direct immunofluorescence (DIF) on lesional skin showed granular IgM deposits along basement membrane zone. Laboratory tests were normal. External photo-protection and topical corticosteroids lead to complete healing. Summer recurrences that responded to topical corticosteroids were noted but there was no progression to systemic lupus erythematosus...

BACKGROUND: Reticular erythematous mucinosis (REM) syndrome is a rare disorder. Its clinical course is cyclic with remissions and exacerbations. In this disease, photosensitivity has previously been noticed but rarely demonstrated. We report three new cases with positive photobiological investigation. CASE REPORTS: Three patients (two males, one female) with a mean age 47 years were seen with reticular erythematous papules on the upper chest and or back. After sun exposure, the lesions were exacerbated...

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O'Brien's actinic granuloma is clinically characterized by annular papules and plaques on sun-exposed areas of skin. These lesions often occur insidiously on a background of severe solar elastosis; however, an acute variant following sunburn has been reported in the literature. We present two cases of acute actinic granuloma precipitated by episodes of sunburn occurring on a background of prolonged doxycycline phototoxicity. Biopsies from both patients showed a histiocytic infiltrate with multinucleate giant cells engulfing elastotic material, with a reduction of elastin towards the centre of the papule...

BACKGROUND: Jessner's lymphocytic infiltration of the skin is a rare and benign disorder. Its clinical course is cyclic with remissions and exacerbations. In this disease, photosensitivity was previously noticed by authors and recently demonstrated. We report four new cases with positive photobiological investigation. CASE REPORTS: Four patients (2 males, 2 females), with a mean age 36 years were seen with erythematous papules or discoid plaques on face, arms and upper trunk...

Actinic prurigo (AP) is a rare acquired idiopathic photodermatosis, reported most often in American Indians, but also in Caucasian and Asian populations. The skin lesions in AP predominantly affect exposed sites but may involve covered areas, and often result in postinflammatory scarring. The diagnosis of AP can be difficult and relies on a combination of history, clinical experience and investigations including phototesting and human leucocyte antigen typing. Twenty-one patients (17 women, four men) diagnosed with AP at the photobiology clinic at St Vincent's Hospital Melbourne were reviewed in this retrospective study...

Antimalarials are arguably the best modality currently available for treating patients with cutaneous lupus erythematosus (LE). Although antimalarials have been used for decades in treating cutaneous LE, the precise mechanisms by which they provide therapeutic benefit are not well defined. The putative mechanisms by which antimalarials might provide therapeutic benefit to patients with cutaneous LE include a number of interrelated anti-inflammatory and immunosuppressive effects that include photoprotection, lysosomal stabilization, suppression of antigen presentation, and inhibition of prostaglandin and cytokine synthesis...

Lupus erythematosus (LE) has many different clinical manifestations including a variety of cutaneous findings. Some of the cutaneous manifestations are not specific for LE, such as photosensitivity reactions, oral ulcers, alopecia, urticaria, vasculitis, vesiculo-bullous lesions, acral changes, cutaneous mucinoses, and cutaneous calcinosis. Other findings are specific for LE in that they are found only in patients who have lupus erythematosus. These LE-specific disorders include acute cutaneous LE, subacute cutaneous LE, and several forms of chronic cutaneous LE, including discoid LE...

Photoprotection, topical steroids, and hydroxychloroquine are the mainstays of therapy of cutaneous LE. In severe and/or refractory disease, antimalarials remain the drugs of choice, and multiple induction and combination strategies can be employed to achieve optimal results with minimal toxicity. Retinoids, dapsone, clofazimine, and thalidomide are effective but more toxic alternatives. Their use dictates frequent and careful monitoring. Retinoids and thalidomide are teratogenic, and thalidomide is not available in the United States...

At present, three classes of compounds are used as systemic photoprotective agents, but only for specific indications, not for general use in healthy individuals. Beta-carotene prevents or lessens photosensitivity in most patients with erythropoietic protoporphyria and in some patients with other photosensitivity diseases. The antimalarial drugs can clear up skin lesions in patients with polymorphous light eruption and solar urticaria who cannot obtain relief with topical sunscreens and in some patients with porphyria cutanea tarda...

The concept of an effective, safe systemic photoprotectant circumvents many of the shortcomings associated with the use of topical agents as a modality preventive of actinic damage. On the other hand, difficulties resulting from systemic metabolism and toxicity complicate this approach. The problems are exemplified by the fact that some agents such as the antimalarials, psoralens, and carotenoids have been successfully employed in the treatment of specific photosensitive diseases but, aside from any potential toxicities, their ameliorative effects appear to be related to the particular pathomechanisms of the responding disease rather than general photoprotection...

Medicinal photoprotection is indicated in photosensitive skin diseases and photodermatoses. Vitamin PP and para-aminobenzoic acid can be tried in benign estival polymorphous light eruptions. Carotinoids are efficient in erythropoietic protoporphyria and useful in idiopathic polymorphous light eruptions and in remanent photosensitization. Immunodepressants may be used against remanent photosensitization.

It is possible in the majority of patients with polymorphic light eruption to produce lesions experimentally. Only the reproduction of the clinical reaction is significant for the diagnosis. Irradiation is carried out in the same test area two or three times with a dose of up to eight times the minimal erythema dose. Sunlight is the best agent for the evaluation of this protocutaneous disorder. A localised area of the skin can be exposed to midday sunshine about half an hour on three consecutive days. But sunlight has the disadvantage of having a variable ultraviolet emission at different times...