How Lupus Affects the Skin

Lupus can cause skin-related changes such as rashes and scarring

psoriasis on man's elbow
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People with lupus know the disease can affect various parts of their body, both inside and out, in a variety of ways. Though lupus is known to affect the joints, kidneys, heart, and lungs, one of the clearest diagnostic signs of lupus can be seen within your skin. These abnormal skin conditions are referred to as skin, or cutaneous, disease.

There are three main types of lupus skin disease: chronic cutaneous (discoid lupus), subacute cutaneous, and acute cutaneous.

Some people with discoid lupus may never develop the systemic version of the disease (systemic lupus erythematosus). And those with subacute cutaneous lupus may develop arthritis. Meanwhile those with acute cutaneous lupus typically have active SLE.

Chronic Cutaneous Lupus (Discoid Lupus)

Discoid lupus distinguishes itself from systemic lupus erythematosus based on the way rashes present themselves. People with SLE may develop a malar rash, a butterfly-shaped rash that appears across the bridge of the nose and cheeks, or red rashes appear after the skin is exposed to sunlight. People with discoid lupus, on the other hand, have chronic inflammatory sores on their face, ears, scalp, and other areas of the body.

When lesions become very thick scales, they are referred to as hypertrophic (thickened) or verrucous (wart-like) discoid lesions.

Some patients have scarring on the scalp, making hair re-growth impossible in those areas.

A skin biopsy is often used to diagnose discoid lupus in these cases, as other diseases can look similar but have different treatments.

Lupus can affect many organs besides the skin. When it does, it's called SLE. About 10 percent of discoid lupus patients develop SLE. As with other forms of lupus, it is a case of the body attacking normal skin.

The exact cause of this form is unknown, although women are more likely to have it and it has been shown to run in families. Cigarette smoking and sunlight have been shown to exacerbate the condition.

Lesions can be treated with the application of corticosteroid creams, ointments, gels, tapes, and solutions.

Subacute Cutaneous Lupus

Subacute cutaneous lesions are defined by their two clinical forms:

  • Psoriasis-like lesions with red scaly patches on the arms, shoulders, neck, and trunk and fewer patches on the face
  • A red ring-shaped lesion with a slight scale on the edges

Those with subacute cutaneous lupus should avoid natural sunlight and tanning beds as this photosensitivity will exacerbate the disease.

As with discoid lupus, lesions can be treated with the application of corticosteroid creams, ointments, gels, tapes, and solutions.

Acute Cutaneous Lupus

Lesions associated with acute cutaneous lupus appear as flattened areas of red skin on the face, reminiscent of a sunburn (butterfly rash). These lesions can appear on the arms, legs, and body, and are photosensitive.

Though they may discolor the skin, they do not scar. Those with active SLE often have these lesions.

Acute cutaneous lupus, since it often occurs with body-wide lupus (SLE) is often treated with drugs such as prednisone, or in combination with other immunosuppressants.

Other Skin Conditions Seen in People With Lupus

There are other skin diseases that can occur in lupus and in other autoimmune diseases. Those include vasculitis and alopecia (hair loss). Mucosal ulcers in the nose or mouths are another common symptom of lupus. Like other symptoms, ulcers can come and go as the disease flares.

Vasculitis. This condition causes inflammation of the blood vessels, which appears as red bumps or spots on the skin. Vasculitis, commonly seen in the lower legs, occurs because of damage to the blood vessels in the skin. Occasionally, larger knots (nodules) and ulcers can develop, and the disease can be hive-like or produce small red or purple lines in fingernail folds or on fingertips. This usually occurs in patients with active SLE. You can have vasculitis without having lupus.

Alopecia (hair loss). Severe lupus flares can result in fragile hair that breaks easily or temporary hair loss, which is eventually replaced by new hair growth. Broken hair often looks ragged and is sometimes termed “lupus hair.” When discoid lupus involves the scalp, prompt treatment is encouraged since hair follicle damage can cause irreversible hair loss.

Lupus patients should be aware of dangers of prolonged exposure to sunlight, tanning booths, and certain light bulbs (photosensitivity). Protect yourself from sun damage by using sunscreens with SPFs above 30 that protect against from both UVA and UVB rays, and apply every two hours. Consider appropriate clothing that can protect against the sun as well.

Consult a dermatologist for further information on choosing the right treatment, as well as proper selection and use of sunscreens.

Sources:

Lupus and the Skin. American Academy of Dermatology. December 2006.
Symptoms The Lupus Foundation of America. June 2007.

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