Skin Problems Associated With Lupus
What to Watch for, When to Worry, and How to Relieve Your Skin Symptoms
Lupus may be rooted in your immune system, but the effects can surface quickly and dramatically. For the majority of lupus sufferers, the range of common skin symptoms that come with the disease are not only unsightly, they can also be worrying and uncomfortable.
Since lupus tends to target organs, and your skin is your largest organ, it’s no wonder that rashes, bumps, bruises, and other markers of inflammation pop up from time to time. It’s important to know what to expect, what might be the sign of a deeper issue, and how to tame the damage and discomfort in your skin.
Understanding Cutaneous Lupus
The type of lupus that specifically targets the skin — cutaneous lupus — can be further divided into three categories: chronic, acute and subacute. Most of the time, this type of lupus affects women between the ages of 20 and 50.
It’s possible to have both a cutaneous form of lupus and a systemic form at the same time. Although systemic lupus (the most common form, which can attack a variety of organs) often brings some skin symptoms, cutaneous lupus is generally limited to the skin, and shows up in specific patterns.
Chronic Cutaneous Lupus (CCLE)
The most common form of chronic cutaneous lupus is discoid lupus (DLE), which brings disc-shaped lesions of thickened skin to areas on the face, neck, upper back, and hands. Though they’re not painful, the lesions tend to leave behind a discolored scar when after they heal.
Depending on the specific form of DLE, the lesions could also be wart-like, or affect the fat beneath the skin with firm nodules that leave indented scare when they clear.
Subacute Cutaneous Lupus (SCLE)
The symptoms of this type of lupus takes two forms: red scaly patches (papulosquamous) and rings with a scaly edge (annular). Since the skin lesions can bear so much resemblance to psoriasis plaques, and it’s not uncommon to also have joint inflammation with SCLE, it’s important to get a thorough examination to determine which disease is causing the skin trouble.
Acute Cutaneous Lupus (ACLE)
This subtype of cutaneous lupus often comes along with systemic lupus, so in addition to “butterfly rash” that typically appears over the nose and cheeks, you will also suffer from some of the more widespread symptoms (joint pain, fever, swelling, fatigue, and headaches). Aside from the facial rash, you may notice flat red patches over your arms, legs, and torso that can leave dark or light pigment changes in the skin.
Many cases of cutaneous lupus are triggered or exacerbated by the sun — photosensitivity is one of the most common symptoms of the disease. If your skin symptoms get worse rather than better when you’re out in the sun, chances are that it’s lupus, not psoriasis or dermatitis.
It’s important to know what to expect, what might be the sign of a deeper issue, and how to tame the damage and discomfort in your skin.
Cutaneous Lupus Skin Problems
Chronic Cutaneous Lupus
Subacute Cutaneous Lupus
Acute Cutaneous Lupus
Red scaly patches and rings with scaly edges
Butterfly rash, red patches on arms, legs, and torso
Face, neck, upper back, and hands
Similar to psoriasis plaques
Can leave dark or light pigment changes
Not painful, but can leave a scar
Could occur with joint inflammation
How to Cover a Butterfly Rash
Skin Symptoms With Systemic Lupus
About 70 percent of lupus patients suffer from systemic lupus erythematosus (SLE), but two-thirds of lupus patients will also suffer from some sort of skin disease. There is a link between cutaneous and systemic lupus: those with particular forms of cutaneous lupus are at risk of eventually developing the systemic type.
However, even if you’re diagnosed only with SLE, you can expect to encounter some skin problems.
It’s difficult to predict how SLE will affect you, and how often symptoms will flare. However, some of the most common skin symptoms include:
- Malar rash (the red, butterfly-shaped rash that spreads across the face)
- Patchy red rash of lesions that can cause scarring
- Photosensitivity (vulnerable to sunburn and skin irritation in the sun or in artificial UV light)
Other distinct skin conditions can occur at the same time as lupus, too. In some cases, they are triggered by lupus inflammation, tissue damage, or even medication used to treat lupus.
- Raynaud’s phenomenon
- Livedo reticualris and palmar erythema
About 70 percent of lupus patients suffer from systemic lupus erythematosus (SLE), but two-thirds of lupus patients will also suffer from some sort of skin disease.
Poll: Lupus Skin Issues
What Lupus Skin Issues Do You Experience?
Why Lupus Patients Bruise Easily
If you notice bruises popping up around your legs, arms, and torso for no good reason, you’re not alone. Lupus can make you more vulnerable to bleeding — whether externally (like nosebleeds and heavier menstruation) or internally (bruising).
Although sudden, severe lupus bruising could point to a more serious disorder, certain aspects of lupus and its treatment can explain the brown or blue spots that appear:
Steroids, NSAIDs, and other immunosuppressant drugs are known to thin the blood and make you more susceptible to bruising and bleeding. If you’re taking an anticoagulant (aspirin or warfarin, for example) to treat blood vessels disorders or blood clots, adding even a simple non-prescription pain reliever can make things worse.
Low Level of Platelets
If you notice new bruises and haven’t had a blood test in a while, see your doctor about having a full blood count done. This test will reveal the number of platelets per unit of blood, an important marker of your blood’s ability to clot.
Your overactive immune system could be attacking your healthy platelets as well as unhealthy cells. When there are too few platelets, you are more likely to bruise easily, and you may experience nosebleeds, too.
Also known as ITP, this condition results from a chronically low level of platelets in the blood. It’s common consequence in lupus, and although severe bleeding rarely occurs, it can produce some unsightly marks on the skin.
Bruising is common, as are the small red dots called “petechiae” that tend to appear on the lower legs.
Managing Lupus Skin Issues
Redness and bruising that comes with lupus may not be painful or particularly dangerous, but it sure can make you self-conscious. People may back away from a rash that they associate with infectious disease, or pry a bit too much when your array of bruises suggests abuse.
Naturally, the less visible these signs, the more comfortable you’ll be, but good skin care will also play a role in your general lupus management.
Caring for Your Skin
Skincare is incredibly important for anyone with lupus, and the right regimen will help you on the inside and the outside. Since you’re more sensitive to the effects of the sun, you’ll have to take extra care to use plenty of sunscreen and wear protective clothing; too much UV exposure can trigger auto-antibody production, which will inflame your lupus more.
Aside from sun protection, topical anti-inflammatory creams can help with rashes, and moisturizers can keep dry skin protected and more flexible.
When lupus leaves you with lighter or darker scars on your skin, you might want to turn to a heavyweight concealer to cover-up the marks.
There are a few makeup lines that are geared to camouflaging skin issues rather than simply enhancing features, like Nicole Paxson Cosmetics. The company’s founder has lupus, and has created thick foundations to cover bruises and smooth out scars.
If you’re looking to cover redness and rashes, try a concealer with a green tint. Green is the complement to red, which means it can cancel it out. If you combine your light concealer with an antioxidant-rich moisturizer (look for one with vitamin C), you can minimize inflammation at the same time.
Lupus Skin Issues: In Summary
- Rashes, bruises, lesions, and other skin inflammation are common with lupus.
- Cutaneous lupus specifically targets the skin, and can also occur with systemic lupus simultaneously.
- Two-thirds of people with systemic lupus will suffer from some kind of skin disease as well.
- Lupus patients bruise very easily, due to medications, low platelets, ITP, or other issues.
Learning to live with the symptoms of lupus can be a long and difficult journey, but the first step is to ease up on yourself. Don’t expect to overcome all the discomforts overnight, and remember that you’re battling an aggressive disease — a few red marks and bruises are nothing compared to the blow you deal your enemy each day by getting up, living a happy life, and overcoming the obstacles in your path with grace and persistence.
Written by Angela Finlay