Lupus is an autoimmune disease that may affect the joints, skin, nervous system and the kidneys. In an autoimmune disease, the body produces antibodies to its own tissues (autoantibodies). These antibodies act to destroy the body’s normal tissues. It affects women (particularly of child-bearing age) at much higher rates than men and is common in people of African-American descent. It is thought to be a genetic condition that is triggered by certain environmental factors such as smoking, sunlight, stress, pregnancy, surgery or infections. It is characterised by periods known as flares, where the condition is severe and periods of remission where there are no symptoms.
General Signs and Symptoms
Skin Manifestations
Lupus affects the skin in many different ways including:
- Acute cutaneous lupus erythematosus: one of the classical presentations of SLE is the butterfly-shaped red rash across the nose and cheeks, called the ‘malar rash’. In some people, the face may become quite swollen. The rash can also affect the chin, forehead and the neck in some people. In generalised acute cutaneous lupus erythematousus, other parts of the body can be affected, such as the hands and arms. Notably, the knuckles on the hands are never affected by the rash. The rash tends to only persist for a short duration, generally 2-3 weeks at the most. The condition can be made worse with exposure to sunlight.
- Subacute cutaneous lupus erythematosus: this condition occurs on areas of the skin that are exposed to the sun, such as the upper back, the arms, chest and shoulders. The rash is dry, but typically is not itchy and rarely leads to scarring. The rash can be ring-shaped, scaly or produce bumps called nodules.
- Discoid lupus erythematosus: commonly affects the cheeks, nose and ears. If discoid lupus affects an area with hair follicles, alopecia (hair loss) can also occur. The lesions on the skin are often red and scaly and can leave whitish scarring. There is an increased risk of developing squamous cell carcinoma if the mouth and the lips are involved.
- Lupus tumidus: this also affects sun-exposed areas and produces a red, hot swollen rash which resembles hives. It is most prominent during summer and generally doesn’t result in long-term scarring.
- Chillblain lupus: is most common in people with lupus who smoke and live in cold areas.
- Ulcers: lupus can produce ulcers in the mucous membranes, such as those found in the mouth and the nose. Interestingly, these tend to be painless.
- Petechiae – these tend to be found on the legs and are small red spots. They are related to thrombocytopenia, a condition seen in lupus where there are a low number of platelets circulating in the blood.
- Palmar erythema – this is a redness on the palms of the hands that is the result of increased blood flow through the blood vessels in the hands as a result of lupus.
- Alopecia – some people who are affected by lupus may experience some degree of hair loss.
Lupus and other parts of the body
Systemic lupus erythematosus is an autoimmune disease that affects not only the skin, but many other body systems. Some of the effects this type of lupus has on the body include:
- Joint pain (arthritis/arthralgia), which affects both sides of the body and tends to affect joints such as the hands, wrists and knees
- Pleuritis- an inflammation of the tissue that encloses the lungs
- Pericarditis- inflammation of the tissue that encloses the heart (the pericardium)
- Abdominal pain, vomiting and diarrhoea
- Anaemia and thrombocytopenia
- Headaches, seizures and memory problems
- Vasculitis
- Nephritis – inflammation in the kidneys
If you have any questions or concerns about cutaneous lupu,s contact your local doctor, who will arrange for you to see a dermatologist. Contact us today.