How is Skin Lupus Treated?
According to the Lupus Foundation of America, 1.5 million Americans are estimated to suffer from systemic lupus erythematosus. The Lupus Resource Center estimates that two-thirds of people diagnosed with lupus experience skin issues with the disorder, called cutaneously, or skin, lupus.
What is Lupus?
An autoimmune disorder like lupus occurs when the immune system of the body attacks normal, healthy tissues by mistake. The immune system normally fights off foreign substances like bacteria and viruses.
In lupus, the immune system can not recognize the difference between healthy tissues and foreign substances and attacks both indeterminately.
This video by Dr. Howard R. Smith of the Cleveland Clinic discusses different types of skin rashes associated with lupus and how to treat and avoid flare-ups.
When the immune system attacks healthy tissues, it causes inflammation and pain, often resulting in damage to different body parts.
Lupus can attack any part of the body, including the skin. When the skin is targeted, it can result in rashes, lesions, and sores.
Systemic lupus is chronic with phases of mild symptoms followed by phases of more severe symptoms. Most people are able to live a normal life with proper treatment of the disease.
What are the Symptoms of Lupus?
The symptoms of systemic lupus can vary from person to person and even change over time.
Typical symptoms of lupus include fatigue, pain and swelling in the joints, headaches, hair loss, anemia, and problems with blood clotting.
Raynaud’s phenomenon is a typical symptom of lupus. This occurs when the fingers turn white and blue with tingling when exposed to cold.
What is the Treatment for Systemic Lupus?
Unfortunately, there is no cure for systemic lupus. Treatment is focused on minimizing symptoms of the disease.
Typical treatments for lupus include anti-inflammatory medications for pain, steroid creams for the skin, corticosteroids to suppress the immune system, antimalarial drugs for skin and joint issues, and more intense immune suppressants for severe symptoms.
Diet and lifestyle can affect the severity of lupus symptoms. Patients may be able to lessen symptoms by eating or avoiding certain foods.
Certain infections can trigger lupus flare-ups, so if a vaccine is available, doctors may recommend a patient receives it.
Lupus can attack injure many different parts of the body, including vital organs. Over time, the damage from the disease can cause complications.
Some of these complications include blood vessel damage, inflammation of the heart muscle, heart attacks, strokes, memory issues, behavioral changes, seizures, inflammation of the lungs, inflammation of the kidneys, and kidney failure.
Pregnancy can cause severe flare-ups of lupus, possibly due to increased estrogen levels. This can result in complications during pregnancy and miscarriage.
Not everyone who is diagnosed with a form of skin lupus will go on to be diagnosed with systemic lupus. Most people with systemic lupus will develop skin lesions of some type, however.
What Causes Lupus?
While the exact cause of lupus is unknown, there are factors that are correlated with the disease.
Genetics, environment, and hormones all seem to play a role in being diagnosed with lupus.
While lupus is not linked to any specific gene, it does seem to run in families with lupus and other autoimmune disorders.
The environment can play a role in lupus. Certain things seem to trigger the disease.
Sunlight and ultraviolet rays, some types of medications, viruses, stress, and trauma can all contribute to a diagnosis of lupus.
According to the Centers for Disease Control, females tend to be diagnosed more often with lupus than males.
Women can also experience severe flare-ups during pregnancy and during their menstrual period.
Research is ongoing, but because of the higher rate of diagnosis and symptoms in women and during surges of the hormone estrogen, it is thought that this hormone may play a role in lupus.
How are People Diagnosed with Lupus?
A diagnosis of lupus is obtained through observation of any symptoms and a combination of blood tests, urinalysis, and chest x rays.
There is no one diagnostic test for lupus, but a physician will look for common signs and symptoms like rashes, mouth ulcers, arthritis, hair thinning and hair loss, and cardiac issues like murmurs and irregular heartbeats.
What is Skin Lupus?
There are three different forms of cutaneous, or skin, lupus. These include chronic discoid lupus, subacute cutaneous lupus, and acute cutaneous lupus.
While most people who are diagnosed with systemic lupus will go on to have effects on their skin, only one out of ten people who experience skin lupus will develop systemic lupus.
Chronic discoid lupus is named after the disk-shaped sores that appear on the skin.
These lesions typically show up on the scalp and face but can occur anywhere on the body. This rash is often one of the first signs of systemic lupus.
The lesions that occur with chronic discoid lupus are red, thick, and scaly. They can be unsightly, but usually, do not create itchiness or pain. The lesions can cause scarring and discoloration of the skin over time.
When the discoid lesions occur on the scalp, they can result in hair loss which can become permanent if scarring occurs.
Discoid lesions can also occur as ulcers in the mucous membranes of the mouth and nose.
Lesions that have occurred on the skin and inside the mouth are susceptible to cancers occurring later in life. Patients with long-standing lesions should be regularly screened for skin and oral cancers.
Like other types of skin lupus, the lesions can very sensitive to light, like sunlight.
Avoiding the strong sunlight, using sunscreen, wearing protective clothing, and even limiting exposure to indoor fluorescent lighting can help alleviate the lesions.
Subacute cutaneous lupus lesions are red and scaly ring-shaped areas. These lesions have distinct borders.
The lesions typically occur on areas of the skin exposed to the sun most often, like arms, shoulders, neck, and the trunk.
Itching and scarring do not typically occur with these lesions, but they can become discolored over time.
These lesions are also sensitive to light, so precautions to limit exposure to both sunlight and fluorescent light should be observed.
Acute cutaneous lupus skin lesions happen during a systemic flare-up of lupus. Most often, the rash occurs on the face. Because it is flat and very red, it can appear like a sunburn.
Most commonly, the bright red rash occurs across the bridge of the nose and the cheeks, resembling a butterfly.
Like other types of skin lupus lesions, this type of rash is very sensitive to light, so precautions should be taken to minimize exposure to sunlight and fluorescent light.
The lesions do not usually cause scarring, but discoloration of the skin can occur over time.
How is Skin Lupus Treated?
Treatment for chronic discoid lupus is aimed at preventing new lesions, limiting scars from forming, and making the skin look and feel healthier overall. Treatments usually involve creams, ointments, steroid injections, and antimalarial drugs.
Topical treatments, like creams and ointments, help to reduce the inflammation and redness that occurs with a discoid rash.
Steroid injections can be injected into or around lesions to reduce inflammation and improve the skin’s appearance.
Antimalarial drugs, like hydroxychloroquine, are taken orally. They are usually prescribed when other treatments and medications fail to improve the skin’s appearance.
These drugs can lessen the effects of the skin lesions over time, reduce the frequency of lesions, and help the skin to delay the absorption of ultraviolet light.
Oral steroids can be used to treat severe cases of skin lupus. Steroids can reduce inflammation and also can suppress the immune system.
Oral steroids should be avoided for nonsevere cases because of the side effects they can cause.
Immunosuppressive medications can be used to treat skin lupus. These medications include drugs like methotrexate.
They lower the body’s immune response so that it stops attacking the skin and other body tissues.
These medications are typically used in severe cases due to the risk of unwanted side effects.
The expression, an ounce of prevention is worth a pound of cure, is very true with skin lupus. Preventing disease flare-ups is the first line of defense with this disorder.
Some things that can be done to lower flare up frequency include avoiding the sun, using sunscreen at all times, and wearing protective clothing like hats and long sleeves when outside.
Patients should be aware that certain types of medications like antibiotics and diuretics can make them sensitive to sunlight.
Smoking can cause flare-ups of skin lupus and patients who smoke should quit right away.
When skin discoloration has occurred, particularly on the face, many patients want to put makeup on the areas that are affected.
Some ingredients in makeup may cause additional flare-ups, so a physician should be consulted when choosing makeup to cover up the associated lesions.
For those patients left with scarring or discoloration due to long-term lesions, treatments are available to lessen the appearance of these issues.
Therapies with lasers and injectable fillers can improve the appearance of the skin, in particular on areas of the face.