Evaluation of Benefit to Educational Material for Photoprotection in Those With Cutaneous Lupus Erythematosus
April 2015 | Volume 14 | Issue 4 | Original Article | 355 | Copyright © 2015
Anshika Kaushik BA,a Anne Laumann MBChB MRCP (UK),b Steven Nwe DO,c
Mary J. Kwasny ScD,d Dennis P. West PhD,b and Roopal V. Kundu MDb
aFeinberg School of Medicine, Northwestern University, Chicago, IL
bDepartment of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
cJohn H. Stroger, Jr. Hospital of Cook County, Chicago, IL
dDepartment of Preventive Medicine, Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
BACKGROUND: Photosensitivity (PS) in cutaneous lupus erythematosus (CLE) contributes to decreased quality of life (QoL).
AIMS: We aimed to assess baseline knowledge about sun protection in persons with CLE and identify knowledge differences by race. Additionally, we aimed to determine the impact of a verbal educational intervention on photoprotection and CLE.
METHODS: 31 adults with CLE were recruited from an academic-based dermatology clinic and completed a 17-item questionnaire about CLE and sun protection at three time points: pre- intervention (PR-I), post-intervention (PO-I), and 3-month phone follow up (3MF). An educational intervention using American Academy of Dermatology CLE and sun protection education materials was delivered between PR-I and PO-I.
RESULTS: 31 subjects participated at PR-I and PO-I, and 25 subjects (81%) at 3MF. Baseline CLE-related PS and photoprotection knowledge differed significantly by race, with non-Caucasians demonstrating less knowledge (P= 0.049). Knowledge about sun exposure being linked to lupus increased from 81% to 97% (P=0.25) between PR-I and PO-I. At PR-I, 19% agreed that smoking was linked to lupus compared to 90% PO-I (P<0.001). There was increased knowledge of lupus risk for non-Caucasians, UV exposure indoors, and photo-avoidance during peak daytime (P<0.001).
CONCLUSION: There is a baseline disparity in knowledge related to PS and photo protection in CLE by race. A short educational intervention successfully improved immediate lupus-related PS and sun exposure knowledge, but knowledge was not retained long-term. It appears educational materials must be improved.
J Drugs Dermatol. 2015;14(4):355-358.
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Cutaneous involvement occurs in up to 70% of people with systemic lupus erythematosus (SLE).1 The impact of cutaneous lupus erythematosus (CLE) on quality of life is comparable to other dermatologic diseases such as acne, nonmelanoma skin cancer, and alopecia, along with chronic systemic diseases such as hypertension, type 2 diabetes mellitus, myocardial infarction, and congestive heart failure.2 Quality of life assessments in CLE have demonstrated that patients are concerned about the effects of spending time outdoors, as well as losing hair and worsening of their skin disease.2-3 The increased risk of photosensitivity in lupus and the subsequent worse quality of life necessitates more diligent use of photoprotection compared to the general population.3-6 Photoprotection decreases the incidence of and flaring of lupus specific skin lesions (eg, malar rash and discoid rash).5,7 Using broad-spectrum sunscreens, photoprotective clothing, and general photoavoidance is known to decrease morbidity related to lupus.3,7
In the US, African Americans, Hispanics/Latinos, Asian Americans, Native Americans, Native Hawaiians, and Pacific Islanders have a higher prevalence, an earlier age of onset, and greater disease severity of lupus than the Caucasian population.8-12 Photosensitivity is a well-acknowledged trigger for lupus flares.
Patient education has been useful in improving treatment compliance and outcome in other dermatologic diseases. Patients have demonstrated an improved quality of life after undergoing a short educational component about their condition. Knowledge empowers, leading to better clinical outcomes and thus improves quality of life.13 The objective of this study is to compare baseline knowledge of sun protection amongst Caucasian and non-Caucasian CLE patients and behavioral change in photoprotective measures after education is provided.
In the summer of 2012, subjects with CLE were recruited from Northwestern University’s Dermatology clinic in Chicago, IL. Potential subjects were also recruited through clinic records and referrals. Inclusion criteria included diagnosis of CLE and age older than 18 years. Subjects who were not proficient in English were excluded from the study. Specifically, Caucasian and African-American, Asian, and Hispanic patients were recruited to evaluate on a population specific basis. Northwestern University Institutional Review Board approved the study. All participants gave written informed consent and received a small compensation.