Great Info About Cutaneous Lupus From the Lfa

Lupus of the skin

10. What are the symptoms of cutaneous lupus?
The symptoms of cutaneous lupus may include a variety of different looking skin rashes, photosensitivity (where exposure to ultra-violet light triggers a rash), and sometimes ulcers on the inside of the nose or mouth.
Reference: see brochure, skin disease and lupus

what do the rashes look like?
There are a variety of ways that cutaneous lupus rashes can appear. The distinctive rash is called the "butterfly rash," which is a rash that extends across the cheeks of the face and the bridge of the nose. It can be flat or raised; it can be bright red or it can be just a mild blushing, light pink coloration to the skin. It appears on the face in a pattern that looks like a butterfly; the wings are beneath both eyes and the body of the butterfly covers the bridge of the nose. Here is one example of what a butterfly rash may look like. (photo source: dept. Of dermatology, university of iowa)


another classic rash found in cutaneous lupus is the discoid rash. This rash is coin-shaped or oval in shape, like a disk and it is seen on areas of the skin that are exposed to sunlight. Discoid lesions (sores) tend to be red and raised and become scaly. When they heal they can leave behind a scar. These rashes can also result in a change in coloring of the skin, making the area around the lesion either lighter or darker in color. These discoid lesions may appear on the scalp; on the face in a butterfly distribution; or, as mentioned earlier, in areas where the skin receives sun exposure, especially, for example, the v of the neck. Discoid lupus erythematosus (le) lesions are usually painless and typically do not itch. Here is one example of what a discoid rash may look like. (photo source: dermatology information system, dermis.Net)


chronic cutaneous lupus may also appear in different forms including:

verrucous (wart-like) discoid le
lupus tumidus - elevated areas of red skin with no scale or scarring
lupus profundus - discoid skin lesions in conjunction with panniculitis
palmar-plantar erosive discoid le - discoid lesions on the hands and feet
another type of lupus skin rash is classified as the subacute cutaneous lesions. These are lesions characterized by redness. They are also coin-shaped, very photosensitive and they get worse when exposed to ultra-violet light. These are lesions that do not leave behind scars, and can appear over large areas of the body. People who have subacute cutaneous lupus erythematosus (scle-a subset of cutaneous lupus) may experience systemic symptoms such as:
muscle and joint pain,
fever and
general discomfort.
Serious kidney or nervous system problems are rare.
These are just a few examples of what cutaneous lupus rashes may look like. Because the appearance of skin rashes in lupus can be quite variable, it can be difficult to diagnose just by looking at the lesion, and therefore other tests may be necessary.
Reference: "the skin in lupus," by richard d. Sontheimer, m.D. & thomas t. Provost, m.D. Lupus news, volume 18, number 2, spring 1998.

How is cutaneous lupus diagnosed?
Cutaneous lupus, because of the great deal of variability in the way that the skin rashes may appear, can be quite difficult to diagnose. However, a skin biopsy may be performed and this may be diagnostic.

What kind of doctor specializes in cutaneous lupus?
A dermatologist specializes in diseases of the skin, hair and nails. Cutaneous lupus is one of hundreds of diseases that involve these areas.

How is cutaneous lupus treated?
Treatment of cutaneous lupus may include corticosteroid creams or ointments applied to the rash or lesions. If the lesion does not respond to cream or ointment, the doctor may prescribe injections of corticosteroids directly into the lesion. If a person has particularly widespread lesions, oral corticosteroid medications may be prescribed or the doctor may prescribe anti-malarial medications such as plaquenil (hydroxychloroquine).

In addition to these medications, sunscreens are an important part of the prevention of photosensitivity (where skin exposed to ultra-violet light reacts by developing a rash) reactions that may occur with cutaneous lupus lesions.
Reference: see brochure: skin disease in lupus.

11. How is cutaneous lupus different from systemic lupus?
Cutaneous lupus is confined to the skin, whereas systemic lupus may involve not only the skin but any of the other organ systems in the body.

Can cutaneous lupus turn into systemic lupus?
In approximately 10% of the cases of cutaneous lupus, it evolves and develops into systemic lupus. However, this can't be predicted or prevented from happening.
References: see brochures, skin disease in lupus, and what is lupus?


12. I have hair loss due to several scars on my scalp. All are about the size of silver dollars. Is there anything to help this kind of hair loss?
If biopsy results indicate advanced scarring on the scalp, then there is little chance of bringing back significant amounts of hair. If, on the other hand, scarring is not prevalent, then treatment with corticosteroid and/or antimalarial drugs may be successful in getting the hair to return. When the disease is inactive, and scarring is not present hair usually grows back.

Reference: see brochure: skin disease in lupus

will the drugs used to treat baldness help the hair loss due to lupus?
Suppressing the disease with medication helps hair to re-grow.

13. Is there anything that can be done to cover the lesions (sores) that show-up on my face?
Yes. There are make-up products available commercially which may be helpful in this situation. Fallene's total block� spf 60 foundation can be used as a make-up as well as a sun block.

14. Can lupus cause either hives or a sensation of burning in the skin?
Lupus may cause hives. Itching can also occur but this is not a common finding. The sensation of itching is due to irritation of nerve fibers in the skin. If the irritation is more intense, it may cause a burning sensation.

15. What is photosensitivity and what are photosensitivity reactions?
Photosensitivity is sensitivity to the uv (ultra-violet) rays from the sunlight and other uv light sources. Photosensitivity reactions typically include a rash, but may also trigger fever, fatigue, joint pain and other symptoms of sle. In some cases, sun exposure has resulted in the onset of kidney disease. Reference: see brochure: skin disease in lupus