If you have lupus, you're likely to have skin issues at some point, but treatment can bring relief.
Your doctor will likely prescribe a topical medication, such as a steroid cream or gel, to clear up the problems. Sometimes, steroid shots are used.
You can help prevent skin reactions, too. The best way is to use sunscreen to protect yourself from the sun's ultraviolet (UV) rays, and cover up.
How Does Lupus Affect the Skin?
You can have skin lupus with or without having full-blown systemic lupus erythematosus (SLE), the most common kind of lupus. Be on the lookout for some of these rashes that lupus skin disorders can cause:
Butterfly rash
Called a "malar" rash, this may spread over your nose and cheeks in the shape of a butterfly. The butterfly rash can be just a faint blush or a very severe, scaly rash. The sun's UV rays can trigger it and make it worse.
Lupus and skin rashes
It's possible to have lupus skin rashes all over your body. Or you may get red, scaly patches or a red, ring-shaped rash, especially where your skin gets sun or other UV light.
Lupus skin rash from sun exposure
These rashes form from exposure to the sun's UV rays. Doctors call them subacute cutaneous lesions. They're red and scaly or ring-shaped. You'll likely see them in places where your skin is exposed to the sun, like your arms, shoulders, or neck. These rashes don't cause scarring, but they can darken or lighten the skin where they appear.
Lupus sores
People with discoid lupus can have coin-shaped sores inside their mouth, nose, or vagina. Doctors call these sores mucosal ulcers.
The sores may be painful and get worse without treatment. They usually don't itch or hurt, but they can cause scarring or change your skin color. If this happens on your scalp, you may have patches of permanent baldness.
Lupus Skin Problems
Lupus may also cause skin problems in areas such as your mouth, scalp, lower legs, and fingers. Here are some skin changes to watch out for:
Mucous membrane lesions. These are sores in the mouth or nose.
Hair loss. In some cases, your immune system may destroy hair follicles and make hair fall out for a time. New hair may sometimes grow in.
A severe lupus flare can also make your hair fragile and brittle. This is most likely around the edge of your scalp.
Purplish spots on lower legs. These happen when the blood vessels in your skin become inflamed and damaged. They may show up as small spots or larger knots. They may also show up as lines or spots of red or purple bumps in the folds of your fingernails or on your fingertips.
These spots are called cutaneous vasculitis lesions. They can cause severe damage to skin tissue and gangrene. If you have small black spots on your fingers or toes, let your doctor know right away.
Color changes in fingers and toes. Blood vessels in your fingers and toes can tighten and slow the flow of blood there. The tips of your fingers or toes may turn red, white, or blue in cold weather or a cold room. They may also tingle, hurt, or go numb.
This problem is known as Raynaud's phenomenon. It helps to keep your toes and fingers warm by wearing mittens and thick socks.
A bluish, lacy pattern under the skin. This is known as livedo reticularis. It's likely to appear on your legs, where it can give a "fishnet" look. Like Raynaud's, it tends to be worse in cold weather.
How to Treat a Lupus Skin Rash
To manage a lupus skin rash, you'll see a dermatologist – a doctor who diagnoses and treats skin problems. The goals of treatment are to clear your skin, relieve the itch, and prevent scars. Your doctor can prescribe medicines that you take as a pill or rub on your skin.
Over-the-counter rash treatment
You can buy some mild corticosteroid creams, like hydrocortisone, over the counter. These medicines work by lowering inflammation in your skin.
Nonsteroidal anti-inflammatory drugs (NSAIDs) bring down inflammation all over your body.
You can get some NSAIDs over the counter, including ibuprofen, naproxen, and aspirin.
Corticosteroids
These medicines bring down the inflammation that causes lupus skin problems. Corticosteroids can improve skin swelling, redness, and itching.
For small rashes, your dermatologist may recommend that you rub a corticosteroid cream or gel onto your skin every day. For a larger rash, the doctor might give you a steroid shot to deliver the medicine deeper into your skin. Injected steroids work faster than topical ones.
Steroids also come as pills. Oral steroids may be helpful if you have bigger rashes on many parts of your body, but they have more side effects than topicals or injections.
Antimalarial medications
Hydroxychloroquine (Plaquenil) is a treatment for malaria, but it also improves lupus skin rashes by calming the immune system. You take it as a pill once a day. Because the medicine gets into your blood, it can clear skin all over your body.
If you can't take Plaquenil, your doctor may prescribe another antimalarial drug called chloroquine (Aralen). Antimalarial medicines can cause side effects like belly pain and diarrhea. Taking high doses of Plaquenil for a long time could damage your eyes. Ask your doctor how often you need to have eye exams while you take this medicine.
Tacrolimus ointment
Tacrolimus is a type of medicine called a calcineurin inhibitor. Tacrolimus ointment (Protopic) blocks a protein called calcineurin in your blood to reduce inflammation. It can treat small areas of sores or rashes. Pimecrolimus cream (Elidel) is another calcineurin inhibitor.
How to Prevent a Lupus Skin Rash
The first step in preventing lupus skin rashes is to get your disease under control. With your doctor's help, find a lupus treatment plan that works for you. Managing your disease will prevent the flares that cause rashes, sores, and other skin problems.
Also follow these tips to prevent lupus skin problems:
Shield your skin from ultraviolet (UV) rays
Exposure to UV rays triggers flares in up to 70% of people with lupus. To protect your skin from UV light:
- Stay indoors when the sun's rays are strongest, between 10 a.m. and 4 p.m.
- When you have to go outside, wear sun-protective clothing – long sleeves, long pants, a wide-brimmed hat, and sunglasses.
- Cover all exposed areas of skin with an SPF 30 or higher, broad-spectrum (UVA/UVB) sunscreen. Reapply sunscreen every four hours, or every two hours when you sweat or swim.
- Don't use tanning beds.
- Put UV-protective coverings over your windows at home, at work, and in your car.
- Remove fluorescent and halogen light bulbs, which give off UV light. Replace them with LED or incandescent bulbs.
Get more vitamin D
You may be short on this "sunshine" vitamin if you've been avoiding the sun. A blood test can show whether your vitamin D levels are low. If so, your doctor may recommend a supplement.
Avoid tobacco smoke
Don't start smoking. If you already smoke, ask your doctor about smoking cessation programs, nicotine replacement products, and medicines to help you quit. Research shows that smokers with lupus have a more active disease than nonsmokers. Plus, smoking can make drugs like Plaquenil less effective.
Don't pick at your skin
Try not to touch or pick at your skin rashes and sores. You could damage your skin even more and make new sores form.
Bundle up in the cold
Some people with lupus also have Raynaud's disease, which reduces the blood flow to your fingers and toes. A lack of blood could cause tissue damage. To protect your digits, wear gloves and shoes with warm socks in cold weather.
Takeaways
Lupus can cause skin disorders like rashes and sores. Corticosteroids, antimalarial medicines, and tacrolimus are some of the treatments for lupus skin problems. To prevent skin rashes, protect your skin from the sun, don't smoke, and work with your doctor to keep lupus symptoms under good control.
Lupus and Skin FAQs
What does skin affected by lupus look like?
The typical lupus rash is butterfly-shaped and goes across the nose and cheeks. Other signs of cutaneous lupus are red, scaly, patches that may be round or disc-shaped.
How does lupus change your face?
Along with the butterfly rash, lupus can cause swollen eyelids, scaly patches of skin, or a ring-like rash on your face. On dark skin, the rash may leave behind dark spots, light spots, or permanent scars.
Does lupus affect your physical appearance?
Lupus can change your appearance in many ways. It can cause rashes on your face and other parts of your body. You may have swollen eyelids. Some people with lupus have patches of hair loss or cracked and discolored nails.
Does lupus change your skin tone?
Lupus can change your skin tone. The subacute cutaneous lupus rash can make skin darker or lighter than it was before.
