Lupus and Your Skin

Lupus is an autoimmune disease, a condition in which your body’s immune system attacks healthy cells. Lupus can affect many organs in your body, including your skin. The skin is affected in approximately two-thirds of people who have lupus.

Discoid lupus erythematosus (DLE) flare

WHAT IS LUPUS?

There are many types of lupus, and each type affects different parts of the body in different ways.

Systemic lupus erythematosus (SLE)

is the most common form of lupus. It may be mild or severe, and it can affect many parts of the body. People with this type of lupus experience chronic inflammation, especially of the kidneys, joints and skin.

Cutaneous lupus erythematosus (CLE)

only affects the skin, although some people who have CLE also develop SLE. There are multiple forms of CLE that affect the skin differently:

• Discoid lupus erythematosus (DLE) causes dark red, scaly and sometimes thickened patches, most often on the face, scalp and in the ears. The patches may develop a rim of skin that is darker than your natural skin tone. These patches also may form inside the mouth or nose, or around the eyelids. Patches can remain on the skin for a long time. As the skin heals, scars can
• Subacute cutaneous lupus erythematosus (SCLE) causes red, ring-shaped patches that have scaly edges, which usually form on the arms, shoulders, neck and trunk. This type of lupus can be mistaken for
• Acute cutaneous lupus erythematosus (ACLE) causes areas of red skin that look like a sunburn or blushing, especially on the arms, legs and When the rash spreads across the nose and cheeks, it can take the shape of a butterfly and is thus known as a “butterfly rash.” If you have SLE, acute cutaneous lupus can develop when your lupus flares.

Drug-induced lupus erythematosus

is a lupus-like disease that is caused by certain prescription drugs. The symptoms are similar to those of SLE and usually improve a few months after stopping the medication that caused the condition. If you believe you are experiencing this condition, talk to your doctor; do not stop any medication without talking to your doctor first.

Neonatal lupus

is a rare disorder that affects the skin of newborns. Although it usually improves on its own, infants with this condition should be closely monitored by physicians, as they may develop a serious heart condition.

Acute cutaneous lupus erythematosus

(ACLE) flare

HOW ELSE CAN LUPUS AFFECT THE SKIN?

Sometimes lupus damages the blood vessels, and this damage is visible on the skin. A condition known as Raynaud’s phenomenon occurs in some people who have lupus. Raynaud’s phenomenon restricts blood flow, resulting in the tips of the fingers or toes turning white or blue in response to cold or stress. Some people also experience numbness, tingling or pain when they are cold or stressed.

Other signs that appear on the skin when lupus involves the blood vessels include:

• A blue or purplish lace-like pattern on the skin, usually on the
• Reddish-purple spots or bumps, especially on the lower
• Deep lumps and sores, especially on the lower

CAN LUPUS AFFECT MY HAIR?

SLE may be associated with hair thinning, which usually improves when the lupus is treated.

A severe lupus flare can also result in fragile hair that breaks easily. This broken hair is called “lupus hair.”

Some people who have discoid lupus, a form of CLE, can experience hair loss when the rash forms on the scalp. If the scalp scars as the rash clears, the hair loss can be permanent. Early treatment of the rash can prevent permanent hair loss.

HOW DOES A DERMATOLOGIST TREAT SKIN AFFECTED BY LUPUS?

When lupus affects the skin or scalp, you should see a board-certified dermatologist for treatment. Treating the skin can help prevent problems such as scars and permanent hair loss.

To diagnose lupus, your dermatologist may perform a skin biopsy. The dermatologist will remove a small piece of the 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.

Your dermatologist may also ask you about the medicines that you take, since some medicines can cause drug-induced lupus erythematosus. Make sure your dermatologist has a list of all the medicines you take.

Treatments for skin affected by lupus may include:

Corticosteroids

This type of medicine, which is applied topically, taken orally or injected in the skin, can reduce redness and swelling. Corticosteroids can also calm an overactive immune system, which causes lupus. While this type of medication is usually safe when used as directed, most patients only use a corticosteroid for a short time or occasionally to prevent the side effects associated with long-term use. If you have a patch of skin that is very thick, your dermatologist may inject a corticosteroid directly into the patch.

Subacute cutaneous lupus erythematosus (SCLE) lesions

Topical immunomodulators

This type of medicine, which is applied to the skin, can provide treatment without the side effects associated with corticosteroids. Medications in this category include tacrolimus ointment and pimecrolimus cream.

Systemic medicine

This type of medication, which works throughout the body, can help calm an overactive immune system, which causes lupus. Medicines in this category include mycophenolate mofetil, prednisone, thalidomide, methotrexate and azathioprine, as well as antimalarial drugs and retinoids.

When rashes and sores from lupus clear, they can leave dark or light spots on your skin, or even scars. If you experience this and it bothers you, talk with a board-certified dermatologist, who can provide appropriate treatment.

HOW CAN I REDUCE LUPUS FLARE-UPS?

What causes your lupus to flare depends on many factors, including the type of lupus you have. The following tips can help you avoid serious side effects from lupus and can reduce your need for treatment.

• If you smoke, quit. Smoking not only makes lupus worse, it can also reduce the effectiveness of lupus treatment. Additionally, in patients with SLE, smoking can increase the risk of developing squamous cell carcinoma, a type of nonmelanoma skin
• Protect your skin from ultraviolet light. In some cases, UV exposure can trigger systemic symptoms, such as joint pain, weakness, fatigue, headaches, fever or even organ

If you have lupus, you should stay out of indoor tanning beds and protect your skin from the sun by:

• seeking shade, especially between the hours of 10 a.m. and 2 p.m., when the sun’s rays are the
• wearing protective clothing such as a long-sleeved shirt, pants, sunglasses and a wide-brimmed
• applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher at least 15 minutes before going outside. Research shows that applying a sunscreen every day can reduce lupus flare-ups.

• Replace fluorescent, compact fluorescent and halogen light bulbs. These light bulbs emit some UV light. If you are light-sensitive, this UV light can cause a flare or itchy skin. Replacing these bulbs with incandescent bulbs can

If you cannot replace the bulbs, a UV light filter may help. Some people say this filter reduces the skin flares and itching that occurs when they spend hours under fluorescent lights — at work, for example.

If you cannot replace bulbs or get a UV filter, you may want to wear sunscreen and sun-protective clothing while indoors.

• Before taking a medicine, ask the doctor prescribing it whether it can cause sun sensitivity. Some medicines, such as the antibiotic tetracycline, make your skin more sensitive to If this is a risk for a medicine you’ve been prescribed, ask if there is another treatment option.
• If you see anything on your skin that is changing in size, shape or color, make an appointment to see a board-certified dermatologist. These can be signs of skin cancer. Some types of skin diseases associated with lupus increase your risk of developing skin cancer. When detected early, skin cancer is highly

• Before trying an herb, vitamin or other alternative treatment, talk with your dermatologist. Some of these may interact with medicine you use to treat lupus on your skin, causing unwanted side
• Connect with others who have lupus. You can find others who have lupus through local support groups or through social media sites, such as Facebook and

A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about lupus or to find a dermatologist in your area, visit aad. org/lupus, or call toll-free (888) 462-DERM (3376).

All content solely developed by the American Academy of Dermatology.Copyright © by the American Academy of Dermatology and the American Academy of Dermatology Association.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

American Academy of Dermatology

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