Exposure to sunlight (UVB radiation) should be avoided by adolescents with SLE. Some patients with SLE will develop scarring photosensitive rashes on UV exposure, and this exposure may also lead to an increase in SLE symptoms. Adolescents should be advised to use a sunscreen with SPF over 30 every day. Although particular care should be taken on sunny days, even a walk to school on an overcast day can be a problem. Use of a hat for facial protection is also advised. Certainly, suntanning is not recommended, and attending a tanning salon is definitely not advised.
Diet is often a concern among adolescents with SLE. This is a particular problem with respect to excessive weight gain frequently seen with high-dose steroid treatment, and poor calcium intake for adolescents on steroids. The use of high-dose corticosteroids is nearly universal when SLE is active, with an increase in appetite and weight gain extremely common. Nutritional counseling, done when the steroids are begun, has been shown to limit the total weight gain for children and adolescents on high-dose steroids (10). This counseling can include recommendations of increasing calcium intake as well. However, physicians and nurses caring for adolescents with SLE should be aware that the weight gain associated with steroids is generally the issue of highest concern to these patients, and desire to avoid weight gain is a frequent contributor to poor compliance with medical recommendations.
Many adolescents may already be tobacco smokers or are exposed to tobacco smoking through friends and family. Smoking can be detrimental to adolescents with SLE for several reasons: it may exacerbate Raynaud's phenomenon; it is not recommended for anyone with pulmonary disease; it provides additional risk for cardiovascular disease; and there is evidence that it may be associated with decreased efficacy of medications such as hydroxychloroquine (11). In one study, patients with SLE who were cigarette smokers had significantly higher disease activity scores, suggesting that exposure to cigarettes should be avoided for all SLE patients (12). Healthcare providers should ask adolescents about possible cigarette use in a confidential setting, and provide options for tobacco cessation if the adolescent is a smoker.
The use of alcohol, marijuana, and other illegal drugs is common amongst adolescents and experimentation is common even amongst those who are not regular users. It is important to establish a nonjudgmental confidential environment in which the health care provider can ask about use of these substances, and provide clear guidance about health implications to the adolescent. For many adolescents, providing factual information about the risks of drug use in the context of their illness is adequate in helping them to make good health choices. (For further discussion of communication strategies with adolescents, see Chapter 4.)
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