Butterfly rash: This rash appears on the nose and cheeks in the shape of a butterfly, skipping the skin under each side of the nose.
LUPUS AND YOUR SKIN: OVERVIEW
Lupus is a disease that can affect the skin in many ways. It may cause a:
- Widespread rash on the back
- Thick scaly patch on the face
- Sore(s) in the mouth or nose
- Flare-up that looks like sunburn
Lupus can show up on the skin in other ways, too.
When lupus affects the skin, it is called cutaneous (medical term for skin) lupus. There are different types of cutaneous (cue-tane-e-ous) lupus. For many people who have cutaneous lupus, the lupus affects only their skin.
Some types of cutaneous lupus are more common in people who have systemic lupus erythematosus (SLE). SLE is a type of lupus that can affect different parts of the body, including the skin, joints, and lungs.
How a dermatologist can help
A dermatologist can tell you whether you have lupus or another skin condition. What looks like a lupus rash on your face could be another skin condition like rosacea or an allergic skin reaction.
If you have cutaneous lupus, a dermatologist can:
- Develop a sun-protection plan that’s right for you
- Create a treatment plan for your skin
- Recommend skin care products that are less likely to irritate skin with lupus
- Teach you how to camouflage lupus on your skin with makeup
- Help determine whether lupus affects other parts of your body
- Check your skin for signs of skin cancer
Lupus and skin cancer
Lupus can increase a person’s risk of developing skin cancer. If you take a medicine that works on your immune system, you may have a higher risk of getting skin cancer.
People who have a type of lupus called discoid lupus may also have a greater risk. When discoid lupus develops on the lip or inside the mouth, it increases a person’s risk for a type of skin cancer called squamous cell carcinoma.
Discoid lupus: This often looks like a raised, thick, scaly patch. Most patches develop on the face, scalp, or ears. Treatment is important.
What’s the difference between cutaneous lupus and systemic lupus erythematous (SLE)?
Each is a different type of lupus. Cutaneous lupus affects the skin. SLE can affect the skin and other parts of your body, including the joints, lungs, and kidneys.
A person can have cutaneous lupus without having SLE. If you have lupus on your skin, however, it can be a sign that lupus is affecting other parts of your body. That’s why it’s so important to see a dermatologist for an accurate diagnosis.
Dermatologists have expertise in treating lupus on the skin.
Who gets lupus?
People of all ages and races get lupus. Women are more likely to get some types of lupus. The following explains who is most likely to get the different types of lupus.
Subacute cutaneous lupus: Some people develop a red, scaly rash that usually appears on the chest, upper back, or neck.
Systemic lupus erythematous (SLE): This type of lupus can affect many organs, including the skin, kidneys, and joints.
Women are much more likely to get SLE. It often begins between 15 and 45 years of age.
Smoking may increase the risk of developing SLE.
Cutaneous (affects the skin) lupus: Several types of lupus affect the skin. Most types are more common in women and often appear between 20 and 50 years of age.
Subacute cutaneous lupus: This type of cutaneous lupus can also cause a rash that has a ring-like pattern.
Drug-induced lupus: Caused by taking medicine, this type seems more common in men.
Neonatal lupus: With medical help from specialists, mothers who have lupus can give birth to healthy babies. Occasionally, a baby is born with neonatal lupus. This type of lupus usually disappears by the time the baby is 6 to 8 months old — and never returns.
A thorough checkup is important if a baby is born with neonatal lupus. Some babies with neonatal lupus have permanent heart disease and need a pacemaker.
What causes lupus?
All types of lupus are autoimmune diseases. This means that the immune system attacks the body. When a person has systemic lupus erythematous (SLE), the immune system may attack different parts of the body, including the skin, kidneys, and lungs.
What causes people to develop this type of autoimmune disease isn’t certain. It may be a combination of genes, environmental triggers, and hormones.
Anything that triggers your immune system to attack itself can cause lupus to flare. When lupus affects the skin, common triggers for lupus are:
- Sunlight
- Ultraviolet (UV) light from tanning beds and fluorescent light bulbs
- An infection
- Some medicines
- Stress
- Surgery or a serious injury
If you believe that you could have lupus, early diagnosis and treatment are important.
When lupus affects your skin, a dermatologist may be part of your care team. This doctor specializes in diagnosing and treating conditions that affect the skin, hair, and nails.
How do dermatologists diagnose lupus on the skin?
When lupus affects the skin, a dermatologist will examine your skin. The doctor will look closely at the rash, patch, or other skin (or hair) problem. Your dermatologist may also ask if you have sores inside your mouth or nose. If you have these, be sure to tell your dermatologist.
Different types of lupus affect the skin. To learn which type affects your skin, your dermatologist may remove a bit of the diseased skin so that it can be examined under a microscope.
Removing the skin is a simple procedure, which your dermatologist can perform during an office visit. Called a skin biopsy, this procedure is often enough to determine whether the rash or other skin problem is cutaneous (medical term for skin) lupus.
Your dermatologist may also ask you about the medicines that you take. Some medicines can cause a type of lupus called drug-induced lupus. Be sure your dermatologist has a list of all the medicines you take.
How do dermatologists treat lupus on the skin?
To treat the lupus on your skin, your dermatologist will:
- Tell you how to protect your skin from the sun
- Prescribe medicine, if necessary
- Recommend other lifestyle changes
Medicines that dermatologists prescribe to treat lupus on the skin include:
- Corticosteroid that you apply to your skin or take as a pill: This helps to reduce the inflammation and clear the skin.
- Corticosteroid that your dermatologist injects: This can help clear a thick patch on the skin or area of hair loss.
- Antimalarial medicine: Developed to treat and prevent malaria, this medicine can also effectively treat lupus on the skin.
- Steroid–sparing medicine that you apply to your skin: This works like a corticosteroid to reduce the inflammation and clear the skin.
- Medicine that works on the immune system: These medicines include methotrexate, cyclosporine, and mycophenolate mofetil. They help calm the immune system.
Your treatment plan may include more than one medicine. This can increase how well the treatment plan works.
The goal is to clear the skin.
Preventing hair loss due to discoid lupus
If you have discoid lupus, clearing your skin can reduce your risk of scars, permanent hair loss, and discolored skin.
When discoid lupus forms on the scalp, you want to treat it early. Early treatment can prevent permanent hair loss.
To treat discoid lupus, your dermatologist may inject a thick patch with a corticosteroid to help it clear. An antimalarial medicine or a corticosteroid that you apply to your skin can help clear thinner patches.
If the patch turns into a scar, hair cannot regrow.
Drug-induced lupus requires different treatment
If your dermatologist thinks that a medicine you take is causing the lupus, you may need to stop taking the drug. You should work with your dermatologist or another doctor to find out.
Stopping some drugs like heart medicines can have serious consequences. You may need to start another drug or therapy immediately.
If you have drug-induced lupus, though, stopping the drug is the only way to find out. Testing cannot find out which drug is causing the lupus. If the lupus starts to clear a few months after you stop taking the drug, then the drug is likely the cause.
Drugs that most frequently cause drug-induced lupus are medicines used to treat high blood pressure like hydralazine and medicines used to treat heart disease like procainamide and quinidine.
Once the drug that causes the lupus is stopped and the symptoms clear, drug-induced lupus is considered cured.
When lupus on your skin clears
You may see unwanted side effects after a rash or other skin problem clears. Some people have dark or light spots on their skin. You may see a scar. If this happens, talk with your dermatologist. Your dermatologist may be able to treat these unwanted side effects.
Outcome: What can someone with cutaneous lupus expect?
Most people who have cutaneous lupus can lead active and productive lives. Treatment helps because it can clear the skin and reduce the effects that lupus has on your life. There is currently no cure for cutaneous lupus.