. May not be reproduced in any form without permission from the publisher, except fair uses permitted under Lupus Erythematosus 31
any very bright light. Precautionary measures may be warranted, including amber window
film or blinds, which screen out blue spectrum light. Certain types of sunblock are also
available on prescription for lupus patients [105-107]. Sunblocks which screen out visible
light as well are available by prescription, or over the counter. Clinically, it is always best to
be on the lowest possible dose of steroids; thus, avoiding UV light and wearing sunblock is
important even for patients on steroids. Hydroxychloroquine (Plaquenil) seems to be
particularly helpful for preventing rashes, arthritis and pleuritic pain; however, this theapy is
also not a replacement for sunlight avoidance. Other agents (such as azathioprine,
methotrexate and cyclophosphamide) which are often used for more serious disease or to
minimize steroid dosages may also reduce the risks of sunlight induced flares. Sunblock
should be sun protection factor (SPF) 25 or greater, and effective against both UVA and UVB
light. It should be applied in the morning and reapplied during the day (at least once or twice),
as it tends to get rubbed off or sweated away [105-107]. Sunblock should be used even on
cloudy days by light-sensitive people because UV light can penetrate the cloud layer.
[108-112]. However, the improvement is often of short duration, and the treatment usually
needs to be supplemented by oral medication. The most common oral medications utilized are
antimalarials, and specifically hydroxychloroquine is frequently employed. These
medications are effective in reducing joint pain and inflammation over a long period of time,
but can take up to three months to become maximally effective. Oral steroids are also
effective in controlling joint pain, and are commonly used. Sometimes joint pain and
inflammation can be particularly problematic and stronger agents such as azathioprine,
methotrexate and cyclosporine may be prescribed [108-112]. Surgery may be helpful for
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