Lupus and the Sun

For those with lupus, exposure to the sun or certain artificial light can mean a flare-up of symptoms, including rash. Here's how you can protect yourself or a loved one.

A woman towelling off on a beach
Photo: Stocksy / Anna Malgina

Our immune system is supposed to protect us from infection—or at least try to protect us. But in people who are diagnosed with lupus, a chronic disease marked by inflammation, rashes, and generalized pain, the body's immune system attacks perfectly healthy tissue.

This brings on a host of symptoms that can range from headaches and fatigue to joint pain and fever. Another symptom associated with lupus is photosensitivity. This is when you have a strong sensitivity to sunlight and certain indoor lights. Exposure to such light could cause a range of adverse effects for many people with lupus.

Here's what you need to know about sensitivity to the sun or other light sources if you or a loved one is living with lupus.

Sun Sensitivity and Lupus

As many as 40% to 70% of people diagnosed with lupus are extra sensitive to the ultraviolet (UV) rays delivered by sunlight or artificial lighting like fluorescent and halogen bulbs, according to the Lupus Foundation of America (LFA).¹

Everyone experiences some level of UV damage. When it happens, the skin and other cells go through a dying process known as apoptosis.² But experts believe that this process happens more often than it should in the skin of people with lupus, potentially leading to inflammation and other complications.

Once the cells have gone through apoptosis, the body gets rid of the dead cells. But experts also believe that, in lupus, the immune system clears UV-damaged cells less efficiently.¹ That means the dead cells linger, leading to an immune reaction.

Certain drugs that people with lupus sometimes take can further increase photosensitivity, according to the LFA.¹ These include:

  • Antibiotics (including doxycycline and tetracycline)
  • Anti-inflammatories (ibuprofen)
  • Blood pressure medications (hydrochlorothiazide and lisinopril)
  • Immunosuppressives (methotrexate)

How the Sun Can Affect People With Lupus

UV exposure can activate lupus flares, leading to rashes, lesions, and other symptoms, according to the American College of Rheumatology

Patients with lupus who reported being photosensitive recorded the symptoms that sun exposure led them to develop for a small 2013 study published in the Journal of the American Academy of Dermatology. The skin-related effects that they experienced include:

  • Malar rash, or butterfly-shaped cheek rashes
  • Discoid rash, or red rashes with raised patches
  • Itching
  • Stinging
  • Burning
Image of a woman affected by lupus "butterfly" rash around cheeks, nose and eye area from DermNetNZ
Courtesy of DermNet NZ

UV exposure can also lead to lupus flares that bring on symptoms below the surface of the skin, known as systemic symptoms. About one in three people in the study reported the following symptoms after sun exposure:

  • Weakness
  • Fatigue
  • Headaches
  • Joint pain

Someone with lupus who is sensitive to UV rays may also develop a fever and flu-like symptoms, per the LFA.⁵

The reactions—which vary from person to person—can kick in as far as three weeks after exposure and can last for several days or even weeks, according to a 2013 article in the journal Photodermatology, Photoimmunology, & Photomedicine.

Your healthcare provider can evaluate your symptoms. They can determine whether you need treatment to reduce inflammation and help your immune system simmer down, which can help clear up your skin, according to the American Academy of Dermatology Association.⁷

How to Protect Yourself Against the Sun

While it would be virtually impossible to shield yourself from every UV ray, there are a host of protective measures you can take to reduce your UV exposure and, in turn, your risk of a lupus flare.

Here are some steps you or a loved one can take to protect against the sun or indoor lighting:

  • Wear protective clothing: Covering your head with a wide-brimmed hat, your arms with long sleeves, and your legs with long pants can go a long way in shielding you from direct contact with the sun or artificial light—particularly when your wardrobe contains UV-protective or tightly woven clothing.
  • Cover exposed skin with sunscreen: Whether the sun is shining bright or there are clouds overhead, a generous slathering of sunscreen will help protect you. Remember, UV rays can peak through cloud cover. So every day you'll be spending more than a few minutes outside, use sunscreen of SPF 70 or higher with protection against UVA and UVB rays, according to the LFA.5 You'll want to reapply at least every two hours or even more frequently when sweating or swimming, according to the American Cancer Society (ACS).8 Make sure to get those areas that lupus frequently affects: the neck, forehead, and ears. And if you are sensitive to indoor lighting, the LFA suggests wearing sunscreen even when you're spending your day indoors.9
  • Minimize midday sun exposure: The sun's rays tend to be strongest between 10 a.m. and 4 p.m., particularly during spring and summer months, according to the ACS.8 While you can certainly cover up, ducking inside during these hours is an even safer bet.
  • Be particularly careful around certain surfaces: Whether you're on the beach, boat, or ski slopes, recreational activities near sand, water, or snow can increase your UV intake, per the ACS.8 Make sure to use extra caution when in these conditions.
  • Cover your windows with UV-blocking shades and car windows with tinting: This will help keep sunlight exposure to a minimum while indoors, according to the LFA.1
  • Use light shields or filters over halogen and fluorescent bulbs: Look for shields with readings of 380 to 400 nanometers that filter UV light effectively, according to the LFA.9
  • Swap your bulbs for Light Emitting Diode (LED) bulbs: While more research is needed, the LFA says that some people with lupus report that LED light leads to fewer flares.9
  • Don't visit tanning salons: The UV exposure delivered by tanning beds is a sure risk to those with lupus. As the LFA points out, the UV rays from a tanning bed can cause new or worsening lupus skin lesions.10

Several tips include avoiding the sun. If that makes you concerned about a lack of vitamin D, talk to your healthcare provider about alternate ways of getting the vitamin, like by taking a vitamin D supplement or by eating foods with vitamin D.

Recap

The sun's UV rays can be damaging for anyone. But those with lupus who have photosensitivity should be extra careful when it comes to protecting themselves against the sun, as well as certain artificial lights. That's because UV exposure can lead to new or worsening lupus symptoms.

If you or a loved one has been diagnosed with lupus and experiences photosensitivity, sun exposure may be a cause of concern. But there are ways to avoid a UV-related flare. That means that you have some control over your lupus management and can take steps to live your best life.

Sources:

  1. Lupus Foundation of America. UV exposure: What you need to know.
  2. Lupus Foundation of America. Research on photosensitivity among people with lupus.
  3. American College of Rheumatology. Lupus.
  4. Foering K, Chang AY, Piette EW, Cucchiara A, Okawa J, Werth VP. Characterization of clinical photosensitivity in cutaneous lupus erythematosus. J Am Acad Dermatol. 2013;69(2):205-213. doi:10.1016/j.jaad.2013.03.015
  5. Lupus Foundation of America. What is photosensitivity?
  6. Kim A, Chong BF. Photosensitivity in cutaneous lupus erythematosus: Photosensitivity in cutaneous lupus erythematosus. Photodermatol Photoimmunol Photomed. 2013;29(1):4-11. doi:10.1111/phpp.12018
  7. American Academy of Dermatology Association. Lupus and your skin: Diagnosis and treatment.
  8. American Cancer Society. How do I protect myself from ultraviolet (UV) rays?
  9. Lupus Foundation of America. Decreasing UV exposure from fluorescent lights.
  10. Lupus Foundation of America. Are tanning beds safe for people with lupus?
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