Lupus erythematosus—commonly called lupus—is a chameleon that can attack many parts of the body. One of the most commonly affected areas is the skin. Roughly two-thirds of people with lupus will experience some kind of lupus-related skin condition, according to the Lupus Foundation of America.
University of Minnesota Health Dermatologist David Pearson, MD, is an expert in the treatment of lupus-related skin conditions. We asked him answer a few questions about lupus, its effects on the skin and the treatment options available for patients.
Lupus is a chronic autoimmune disorder. This means that the body’s immune system—which is responsible for fighting off bacteria, viruses and other invaders—is not working properly. Rather than attacking the outside invaders that make us sick, autoimmune disorders cause the immune system to attack the body’s own cells. Lupus can affect any part of the body, including the internal organs, joints and skin.
Studies have shown that approximately 50 percent of people with lupus have cutaneous—or skin-only—lupus. The skin is the body’s largest organ, and the immune system is very active in the skin, so there are many opportunities for lupus to wreak havoc.
Cutaneous lupus can be caused by a combination of factors, including the immune system, genetics and the environment. Some people have a genetic susceptibility that makes them more likely to develop lupus, but an environmental trigger can set off the disease as well. Environmental triggers may include sunlight (ultraviolet light), infections, medications and tobacco use.
Cutaneous lupus is classified into three main types: acute cutaneous lupus, subacute cutaneous lupus and chronic cutaneous lupus.
Acute cutaneous lupus often appears as a butterfly-shaped rash across the nose and cheeks. This butterfly rash can be an important clue for diagnosis: 95 percent of people with acute cutaneous lupus have or will eventually develop systemic lupus with internal organ involvement. This rash can also be a sign that the disease is flaring up in other areas of the body, such as the internal organs.
Subacute cutaneous lupus typically appears as a series of ring-shaped scaly patches, most often on the trunk of the body. Subacute cutaneous lupus is frequently triggered by medications and affects adults over 40 years of age.
The most common form of chronic cutaneous lupus is discoid lupus, which causes scarring plaques on the head and neck. The condition can be itchy, painful and even result in disfiguring scars or hair loss.
Each type of lupus is associated with a different set of skin symptoms, and doctors treat each one differently. Lupus can also cause other skin conditions, including mouth sores, hair loss, inflammation of the blood vessels and blistering.
Sometimes, patients referred to one of our University of Minnesota Health dermatology clinics with a red facial rash ask us: “Is this lupus?”
Not every red facial rash is lupus. Similar rashes can be caused by other conditions, including eczema or rosacea. There are a few clues we can use to distinguish lupus from these other conditions. People with acute cutaneous lupus (who have a butterfly rash on the face) generally have other symptoms, such as fatigue or joint pain, which we can use to help narrow the diagnosis. In contrast, people with rosacea—but not lupus—will often have pustules associated with the rash. Next, we carefully assess the distribution of the rash. Where is it positioned on the face? Lupus characteristically spares a specific area on each side of the nose and the upper lip.
Finally, for a definitive answer, we can biopsy the skin. Biopsies of lupus, rosacea, and eczema look very different under the microscope.
Lupus treatment typically involves the use of medications—call immunosuppressants—that suppress the immune system’s activity. To address lupus-related skin conditions, we may use a topical cream to reduce inflammation in mild cases. For more severe cases, we employ stronger immunosuppressants, including an anti-malarial medication that is helpful in lupus treatment, or other pills or injectable medications. Patients with severe forms of the disease endure frequent hospitalizations and may have to spend time in a hospital-based burn unit.
University of Minnesota Health specialists like me have a close, multidisciplinary partnership with experts from other medical specialties. I work jointly with my colleagues in rheumatology, nephrology, neurology, and other specialties on challenging lupus cases. This collaboration is particularly important for lupus treatment, because the disease affects so many different areas of the body.
As an academic medical system, University of Minnesota Health can connect patients with a greater number of resources in order to give patients comprehensive, supportive care. As researchers and physicians, we also help develop innovative new treatments for this and other diseases.