The Behavior, Attitude and Knowledge Toward Photoprotection in Patients with Cutaneous/Systemic Lupus Erythematosus: a comparative study with 526 patients and healthy controls.

Objective: To evaluate the attitude, knowledge and behavior toward sun protection in systemic lupus erythematosus (SLE) patients with and without cutaneous involvement (CLE) compared to non-photosensitive controls and to determine influential factors for photoprotective practices in SLE patients. Methods: A case-control study was performed. Patients and controls completed a self-reported questionnaire. For SLE patients, the presence of organ involvement, disease activity and laboratory data were acquired from physical examination and medical records. Results: A total of 263 SLE patients and 263 healthy controls were recruited. SLE patients had statistically significant better photoprotective practices than controls i.e. exposed to sunlight < 1 hour/day (76.1% vs 48.3%, OR, 3.40; 95%CI, 2.34-4.93, p < 0.001), less outdoor activities (9.8% vs 19.1%, OR, 0.44; 95%CI, 0.26-0.71, p = 0.003), wore long-sleeved shirt (57.0% vs 32.7%, OR, 2.73; 95%CI, 1.92-3.89, p < 0.001) and hat (43.8% vs 26.6%, OR 2.14; 95%CI, 1.49-3.09, p < 0.001). SLE with CLE subgroup had the highest percentage for regular practice in almost all sun protective means compared to SLE without CLE and controls. SLE with CLE patients had more diligent sunscreen application with higher percentage of consistent use (93.7% vs 59.3%, OR, 11.66; 95%CI, 2.57-52.89, p = 0.001) and adequate application (58.1% vs 24.6%, OR, 4.24; 95%CI, 1.93-9.30, p < 0.001) compared to those without CLE. Previous and current CLE were influential factors for adherence to photoprotective methods, while extracutaneous involvement was not. The majority of SLE patients were well acquainted on the harm of sunlight to their diseases (91.6%). However, 40.1% did not perceive that sunlight could escalate their internal flare which may have led to inferior photoprotective practices in patients with extracutaneous involvement. Conclusion: SLE patients had good awareness and practiced better photoprotection than controls. Cutaneous sign is a predictor for superior photoprotective behavior. Education regarding the harm of sunlight and the importance of appropriate photoprotection should be emphasized, especially in SLE cases without cutaneous involvement.