Skin rashes lupus

When skin rashes could be signs of Lupus

Lupus is a chronic autoimmune disorder that can affect your skin, joints and other internal organs in the body.

Autoimmune disorders occur when the body’s immune system is dysregulated and attacks normal healthy tissue instead. Did you know that there is a systemic form of lupus that affects multiple organs in the body, and that there are also skin-limited forms of lupus?

At times skin signs of lupus can act as clues that it may be systemic, which means further investigation is needed to properly evaluate the extent of lupus.

Systemic lupus erythematosus (SLE) is a common disease which commonly affects women in early adulthood. Another risk factor is ethnicity, where SLE is most commonly observed in darker skin types.

Skin signs in lupus

Skin signs showing up in lupus can be classified into four groups:

  1. Acute cutaneous lupus erythematosus

Acute cutaneous lupus erythematosus usually occurs during a SLE flare. The rash most commonly seen here is known as the “butterfly” rash over both the cheeks.

  1. Chronic cutaneous lupus erythematosus e.g. discoid lupus erythematosus (DLE)

Discoid lupus erythematosus (DLE) is one of the most common skin changes in lupus. The plaques are most commonly found on sun-exposed areas such as the face, scalp and ears. These lesions usually result in scarring. Only a small proportion of DLE patients (10 – 20%) progress to develop systemic lupus erythematosus (SLE).

  1. Subacute cutaneous lupus erythematosus (SCLE)

Subacute cutaneous lupus erythematosus lesions most commonly affect sun-exposed areas and patients report photosensitivity (sensitivity to sun exposure). These lesions may be eczema-like or have raised, red borders. Medications may also induce its eruption, so it is important to give a complete medication history to your treating doctor. About a third of these patients have SLE. A lupus patient may have one form or different forms of cutaneous lupus, e.g. DLE and SCLE lesions occurring at the same time. 

  1. Other non-specific skin lesions and hair problems

Skin lesions due to photosensitivity may also occur. Often hair loss may also be tell tale sign of the condition. Hair loss in lupus is often characterised by dry, brittle hair that breaks easily. Hair loss is more common around the top of the forehead.

Treatment of cutaneous lupus erythematosus

During the treatment of cutaneous lupus, avoiding the sun is very important. Sun exposure may trigger or worsens skin lesions.

We advise wearing a good daily sunscreen with an SPF of 50 and above.

Topical corticosteroids reduce the inflammation of lesions and are helpful in treating cutaneous lupus. Your doctor may prescribe a medication called chloroquine to treat your lupus. This medication is an anti-malarial with anti-inflammatory effects and is useful in some cases of cutaneous lupus.

You will undergo blood tests to screen for internal organ involvement e.g. kidney disease or anaemia. If you do have any signs of internal organ involvement (e.g. painful joints), you will be referred to a rheumatologist who often co-manage SLE patients together with dermatologists to get the optimal treatment outcome for patients. Dr. Johann de Wet is a top skin specialist in Stellenbosch where he also specializes in lupus treatment.

Reference:

  1. Bolognia, Jean L., et al. Dermatology. Elsevier Health Sciences, 4th edition, 2018.
  2. Lupus foundation of America website: https://www.lupus.org/resources/what-is-lupus#