he Skin and Lupus
By A. G. Moore 5/23/2013
V-sign Rash: Photosensitive Reaction
Photo by:Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider
Public Domain on Wikimedia Commons
The skin is the largest organ, so it’s not surprising that the skin is one place where lupus symptoms often appear. According to the Lupus Foundation, two thirds of people who have lupus will have some type of skin involvement. The Lupus Center at Johns Hopkins Hospital in Baltimore likewise describes the frequent incidence of skin problems in lupus patients.
Dr. Simon Meggitt, of the Royal Victory Infirmary in the UK, recommends that lupus patients with skin issues receive early and effective treatment. The doctor believes that skin issues are often dismissed. However, this attitude underestimates “the far-reaching impact that a skin problem can have…”.
While both the Lupus Foundation and Johns Hopkins suggest a dermatologist might be best qualified to deal with this manifestation of lupus, Dr. Meggitt is more of the mind that one physician–a rheumatologist–oversee the care and if necessary a dermatologist be on hand for consultation.
Just about everyone agrees that disruption in the skin in people with systemic disease may be a sign that lupus is acting up. This has been my experience; most of my skin issues have been with hives and rashes. Sometimes, when these appear to be of the type that I am used to, I wait to see if they’ll clear up on their own or with the application of a very mild topical steroid. However, I never dismiss a rash as unimportant; I take it as a sign that trouble may be brewing. I pay attention to my body and my environment and try to figure out what might have caused the rash. Because whatever made the rash appear could bring on a more generalized flare.
Some of the ways in which lupus can affect the skin are:
- Discoid lupus (chronic cutaneous lupus): This form of lupus needs accurate diagnosis and prompt, effective treatment. Usually a doctor can diagnose discoid lupus without a biopsy; sometimes a doctor will call for a biopsy in order to be certain that what appears to be discoid lupus isn’t in fact something elseWith discoid lupus, the best treatment begins with prevention. Stay away from UV, whether the source be natural (the sun) or artificial (ex., fluorescent lights). After this preventative measure is taken, topical steroids and anti-malarials are the first medicines a doctor will generally prescribe. If these interventions don’t work, doctors may move on to other, more powerful drugs.
Sometimes discoid lupus and systemic lupus occur together (about 20% of people who have SLE also have discoid lupus). In about 5% of people who have discoid lupus but not systemic disease, systemic symptoms may later appear.
- Cutaneous vasculitis: this symptom occurs when blood vessels under the skin become inflamed. Lesions develop that can be serious. Cutaneous vasculitis requires the attention of a physician and careful monitoring.
- Raynaud’s phenomenon: this symptoms occurs when blood vessels under the skin constrict. What is usually noticed is a change in the color of some extremity (perhaps a hand, a nose, an ear, for example). Raynaud’s used to be one of the diagnostic criteria for systemic lupus, but since this syndrome is so widespread in the general population, the ACR no longer includes this in its list of eleven lupus symptoms.
- Alopecia: not only may hair loss occur as a result of having discoid lesions, but there is often a general thinning of the hair in people who have systemic lupus. “Lupus hair”, as the characteristic appearance is sometimes called, looks thin and kind of ragged. Doctors who treat lupus may readily recognize this in a patient with active disease.
- Ulcerations in the nose and mouth: these are quite common in lupus. As with other skin disruptions, these may signal that lupus is active.
There are other dermatological manifestations of lupus. The skin is not only our largest organ it is also our most conspicuous. It can tell us a lot about what is going on elsewhere in the body. It’s probably a good idea to pay attention to the message our skin is giving us.