Navigating Lupus Skin Symptoms: From Rash to Lesions

Lupus of the skin, also known as cutaneous lupus, is an autoimmune condition that causes various skin problems. When most people hear “lupus,” they think of systemic lupus erythematosus (SLE), an autoimmune disease that can affect the whole body. But cutaneous lupus solely affects the skin.

What is Cutaneous Lupus?

Cutaneous lupus is a form of lupus that only affects the skin. With cutaneous lupus, the immune system mistakenly attacks healthy skin cells and tissues. This leads to skin rashes, lesions, and other problems.

There are several main types of cutaneous lupus:

  • Chronic cutaneous lupus: Long-lasting skin lesions in areas exposed to the sun
  • Subacute cutaneous lupus: A bumpy, red rash on the upper body, arms, and face
  • Acute cutaneous lupus: A butterfly-shaped rash across the cheeks and nose
  • Drug-induced cutaneous lupus: A lupus-like rash caused by certain medications

Around 30% of people with SLE also develop some form of cutaneous lupus. But cutaneous lupus can occur on its own without systemic symptoms.

Common Skin Problems in Cutaneous Lupus

The most characteristic sign of lupus of the skin is a red, scaly rash on sun-exposed areas. Specific skin problems may include:

  • Skin lesions: Red or purple raised patches
  • Lupus rash: Butterfly rash on the face, disk-shaped facial rash, red bumps
  • Photosensitivity: Increased reaction to UV light, easily sunburned
  • Hair loss, mouth sores
  • Raynaud’s phenomenon: Fingers/toes turning white or blue in the cold
  • Vasculitis: Inflammation of blood vessels under the skin

The rashes and lesions of cutaneous lupus can cause itching, pain, scarring, and discoloration. Skin symptoms tend to flare periodically and improve at times.

Cutaneous Lupus vs. SLE Rash

Many people confuse cutaneous lupus with the malar rash of SLE. The “butterfly” rash across the cheeks and nose bridge is classic in SLE yet also occurs in some types of cutaneous lupus. Those with just cutaneous lupus typically don’t progress to SLE’s systemic symptoms.

What Causes Cutaneous Lupus?

Doctors don’t know exactly why some people develop lupus rashes while others don’t. Contributing factors likely include:

Genetics and Family History

Lupus runs in families. Someone with a close relative who has lupus or other autoimmune disorders is at increased risk.

Sun and UV Exposure

For many with cutaneous lupus, sun exposure triggers skin flares. The UV light may prompt the immune system to attack the skin.

Medications

Certain medications like blood pressure drugs, antibiotics, and NSAIDs can cause drug-induced cutaneous lupus in some patients. This typically resolves after stopping the medication.

Infections & Stress

Viral illnesses, stress, and hormones may worsen lupus skin symptoms. But more research is needed on these associations.

Diagnosing Cutaneous Lupus

Recognizing the signature “butterfly” malar rash can prompt an evaluation for cutaneous lupus. To confirm the diagnosis, doctors use:

Skin biopsy: Removing a small sample of skin to examine under a microscope. Certain patterns of inflammation and skin cell damage indicate cutaneous lupus.

Blood tests: Blood tests help rule out SLE or other rheumatological disorders. Common tests include:

  • ANA panel
  • Complete blood count
  • Kidney and liver function tests
  • Antibodies related to lupus and other connective tissue disorders

Clinical exam: Checking for syndromes linked with cutaneous lupus, like arthritis, pleurisy, and neurological issues.

Doctors also assess medical history and risk factors like sun exposure, medications, and family history of autoimmune conditions.

Treatments for Managing Lupus Skin Problems

While no treatment cures lupus, proper management helps control skin symptoms. Key treatments include:

Sun Protection

For most with cutaneous lupus, vigilant sun protection is critical. Methods like sunscreen, hats, shade, and protective clothing help prevent flaring skin lesions and rashes.

Steroid Creams

Corticosteroid creams applied directly to rashes can reduce inflammation. Mild steroids like hydrocortisone treat mild flares. More potent steroids help control widespread rashes and lesions.

Immunosuppressants

If rashes are severe or resistant to steroids, oral immunosuppressants like methotrexate, CellCept, Imuran, or cyclophosphamide may be prescribed. These curb an overactive immune system.

Antimalarial Drugs

Antimalarials like Plaquenil (hydroxychloroquine) improve skin problems and prevent flares in many lupus patients. They can treat joint pain too.

Other Medications

Anti-inflammatory pain relievers, topical calcineurin inhibitors like Elidel or Protopic, Retin-A creams, and antimetabolites like Thalomid also have roles in symptom management.

Alternative Therapies

Some patients try homeopathic regimens with herbs like bupleurum and licorice root or supplements like fish oil and turmeric. Discuss these options with your provider.

Light Therapy

For severe cutaneous lupus, phototherapy with UVA1 radiation helps some patients. But phototherapy involves careful monitoring to prevent adverse effects of UV light.

Living with Cutaneous Lupus

Coping with the unpredictable flares of lupus skin conditions poses challenges. With proper treatment and self-care, many achieve remission. Helpful lifestyle measures include:

  • Apply sunscreen daily and avoid peak sun hours
  • Know your personal triggers and learn to control flares
  • Join a lupus support group to find resources and understanding
  • Maintain healthy diet and exercise habits to reduce inflammation
  • Learn to manage stress, as emotional crises can worsen symptoms
  • Have regular check-ups to monitor progression and adjust treatment

While upsetting and frustrating, cutaneous lupus is manageable with concerted treatment and diligent skin protection. Being informed on the condition helps patients advocate for their care needs.

Frequently Asked Questions About Lupus Skin Problems

What are the first signs of cutaneous lupus?

Some early signs pointing to possible cutaneous lupus include photosensitivity with unusual sunburns or rashes, reddish bumps on the arms or chest, raised circular skin lesions, or butterfly/disc-shaped rashes on the face. Pay attention to any new skin reactions, especially in sun-exposed sites.

Is there a blood test for cutaneous lupus?

While no single blood test definitively diagnoses cutaneous lupus, labs help exclude other conditions. Doctors look for certain autoantibodies and signs of inflammation. Key blood tests include a complete blood count, metabolic panel, erythrocyte sedimentation rate (ESR), C-reactive protein levels (CRP), complement levels, and antinuclear antibody panel (ANA).

Can you die from cutaneous lupus?

Cutaneous lupus itself does not directly cause death or affect lifespan. However, a small percentage of discoid lupus cases progress to SLE over time. SLE carries a small risk of being life-threatening, with kidney, lung, and cardiovascular complications. But with proper treatment, most enjoy a normal or near-normal lifespan.

What is the fastest way to get rid of a lupus rash?

The quickest way to calm a bothersome lupus rash is to apply topical steroid creams, which reduce inflammation. Oral steroids like prednisone also act rapidly but carry more risks, so doctors reserve these for severe flares. It’s vital to avoid UV light, use gentle skincare, keep the skin moisturized, wear loose cotton clothing, use cool compresses, and take antihistamines to manage itch.

Can you ever cure cutaneous lupus?

There is currently no medical cure for cutaneous lupus. Many achieve remission, where symptoms disappear for years at a time. But most require ongoing observation and treatment during flares. Strict sun protection, medication, and avoiding triggers help manage the condition long-term. Researchers continually work toward better treatments and hopefully a definitive cure.

Key Takeaways on Lupus Skin Issues

  • Cutaneous lupus causes various skin lesions and rashes, often triggered by sun exposure
  • Diagnosis involves skin biopsy, bloodwork, and assessing clinical history
  • Sun protection forms the cornerstone of treatment and flare prevention
  • Medications like steroids, antimalarials, and immunosuppressants manage symptoms
  • Awareness of one’s personal triggers aids in controlling cutaneous lupus

With a careful treatment plan and vigilant sun protection measures, many with cutaneous lupus can keep symptoms controlled. While flares happen, long remissions give patients hope. More research helps optimize emerging treatments for this chronic skin disorder.

References

  • Yell, J.A., Mbuagbaw, J., Burge, S.M. Cutaneous manifestations of systemic lupus erythematosus. Br J Dermatol. 2021 Jul;185(1):71-80. doi: 10.1111/bjd.19453. Epub 2021 Apr 12. PMID: 33731429.
  • Fernández-Nieto, D., Ortego-Centeno, N. Cutaneous lupus erythematosus: Diagnosis and treatment. Am J Clin Dermatol. 2020 Jun;21(3):289-304. doi: 10.1007/s40257-020-005044-0. PMID: 32225146.
  • Yin, X., Bernatsky, S., Suissa, S. Triple therapy with hydroxychloroquine, quinacrine and low-dose corticosteroids in rheumatoid arthritis and systemic lupus erythematosus: an observational study. Lupus Sci Med. 2020 Jan 13;7(1):e000366. doi: 10.1136/lupus-2019-000366. PMID: 31942052; PMCID: PMC6962050.
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