408 Sunscreen use and photosensitivity in lupus patients

Ultraviolet radiation (UVR) exacerbates cutaneous lupus (CLE) and systemic lupus (SLE) symptoms. Patients are instructed to avoid UVR exposure and to use sunscreen daily. Most sunscreens contain organic UVR filters that can penetrate skin, enter systemic circulation and cause unintended biological effects. There is little known about sunscreen use by patients or the determinants that drive its use. A survey was conducted to determine if the frequency of sunscreen use differed between patient types and heathy controls (HC) and if the type of sunscreen (organic or mineral) used correlated with experiencing adverse effects (AE) from sun exposure (rash, flares, feeling sick). Subjects were recruited from clinics (RSRB# 35516) and database mailings (RSRB# 35516). We received 132 surveys between August 2018 and June 2019; 32.1% were HC and 67.9% were patients (29.2% CLE, 70.8% SLE). The survey elicited information on race, Fitzpatrick skin type, sunscreen type, SPF value, whether subjects experienced AE and their frequency of sunscreen use; where frequent use was defined as daily or at least 1x per week. Results find that the frequency of use differed between CLE and SLE patients and HC and whether or not patients reported suffering AE from the sun exposure. 71.8% of all patients suffer AE but frequent sunscreen use varied by race suggesting an opportunity to improve clinical care. HC that report using sunscreen frequently do so to prevent skin cancer whereas patients report usage based on physician advice as well as to prevent skin cancer. Frequent sunscreen users prefer products with SPF >30. Patients with AE are 2x more likely to use organic-based sunscreen. Patients without AE are 3x more likely to use mineral-based sunscreen. Since systemic levels of organic filters rise over time with daily use, it is plausible that sunscreen may contribute to disease pathology. Our on-going studies seek to examine if and how UVR filters contribute to immune cell abnormalities in lupus.