Rheumatoid arthritis rashes: What do they look like, and how do you treat them?

Statistics indicate that about 1.3 million people in the United States have RA, and it affects about 1% of the world’s population. However, only a few who get RA will develop skin disease.

RA can cause a skin disease in a variety of ways. Some are relatively common, while others are rare. Not all skin manifestations are rashes.

Most commonly, skin manifestation will present as rheumatoid nodules. This is not a rash but hard lumps that form directly under the skin. They range from about the size of a pea to that of a golf ball.

These may develop over bony or fleshy areas of a person’s body, such as elbows, hands, or fingers. About 40% of people with RA will have rheumatoid nodules.

Read on to learn more about RA-related skin rashes.

Learn how RA affects the skin here.

Typically, a rash from psoriatic arthritis appears red and scaly on light to fair skin tones. However, thickening and raised skin due to inflammation can often replace any discoloration.

On medium to dark skin tones, the scaly skin can present with silvering or whitening to the superficial layer of skin that peels from the inflammation. The rash appears as a thickening of the skin, and areas of acute inflammation also become raised.

However, different types of rashes can occur due to psoriatic arthritis, and these can appear slightly differently depending on the type. Examples include rashes due to vasculitis or ulcers. These are painful, but most RA rashes are painless.

RA rashes include:

Vasculitis

RA rashes can also happen due to inflammation of the arteries that deliver blood to the various body organs, including the skin and nerves. This is known as rheumatoid vasculitis.

Rheumatoid vasculitis can cause spots or patches to develop on the skin. It typically occurs in people who have had RA for a long time or have elevated blood markers for RA.

A blood test can identify these markers, which include cyclic citrullinated peptide (CCP) and RF-rheumatoid factor antibodies. An X-ray can also identify any visible erosions.

This rash can be painful and itchy. Patches can appear red or burgundy and have a red-violet hue on darker skin tones. They may appear as multiple pinpoint dots. RA-related vasculitis of the skin commonly appears on the fingers and toes.

Sometimes, rheumatoid vasculitis rashes develop into painful ulcers. If the ulcers become infected, they can lead to further complications. Deep ulcers can appear on the legs or digits.

Learn more about skin ulcers here.

Hives

Some people with RA experience chronic or recurring hives.

Hives are similar to a medication rash, but they may form independently of a medication. Allergists and researchers have increasingly noted hives as a presentation of RA.

Hives can appear as pink or red-colored patches on light and fair skin tones.

However, on medium to dark skin tones, while the skin still looks irritated and inflamed, skin reddening, or erythema, is not always as visible.

Skin welts from hives are often similar in color to skin tone, sometimes appearing slightly lighter or darker.

Learn how hives present on darker skin tones.

Rarer types of rheumatoid arthritis rash

RA can also excessively raise the number of neutrophils in the skin, which causes papules or plaques to form on the skin. Examples include rheumatoid neutrophilic dermatitis and palisaded neutrophilic granulomatous dermatitis, or neutrophilic dermatoses.

Other less common causes of RA-related rash include:

• acute febrile neutrophilic dermatosis, also called Sweet syndrome.
• pyoderma gangrenosum (PG)

In some cases, a person with RA can develop a rash for reasons other than the condition itself. These include:

Medication rash

RA medications may cause a skin rash. Doctors think these rashes develop due to an allergic reaction to the medications. Classes of medications that can cause a rash include disease-modifying anti-rheumatic drugs (DMARDs) and

Medications that may cause a rash as a side effect include:

• celecoxib (Celebrex)
• sulfasalazine (Azulfidine)
• hydroxychloroquine (Plaquenil)
• naproxen (Aleve)
• ibuprofen (Motrin, Advil)
• leflunomide (Arava)
• methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
• minocycline (Dynacin, Minocin, Minocin Kit, Solodyn, Ximino)
• diclofenac (Voltaren)

A person should tell their doctor if they develop a rash as a side effect of a medication they are taking. Depending on the severity of the reaction, the doctor may change the dose or the medication.

It is important not to discontinue or reduce medication without speaking with a doctor.

A doctor may also prescribe an antihistamine to combat or reduce the reaction or steroids for severe reactions.

Learn more about allergic reactions and rashes here.

Livedo reticularis

Livedo reticularis is a condition that develops due to compromised blood flow in the blood vessels.

This produces a net-like pattern of red–blue or purplish weblike lines. However, it may appear brown, dark brown, or purple on medium to dark skin tones. The rash occurs or can become more evident during colder weather.

Livedo reticularis can cause other complications, including:

• ulcers
• painful nodules
• discoloration

Livideo reticularis can also occur in other autoimmune conditions such as vasculitis. It can also be a symptom of other serious underlying conditions, such as clotting disorders, vasospasm, infections, drug reactions, cardiovascular disease, and cancer.

Learn more about drug reactions and interactions here.

Palmar erythema

RA can also occur with palmar erythema, which presents as a non-itchy and painless rash. It typically affects both hands. They may feel warm, appear darker, or have a reddish hue.

Rheumatoid papules

A person with RA may also experience interstitial granulomatous dermatitis or rheumatoid papules. These present as asymptomatic plaques. It tends to affect the trunk and skin folds.

When the blood vessels become inflamed and impact the skin, a rash can present as:

• small to large red, brown, or purple dots or patches
• pain
• swelling of the skin
• itchiness

As RA becomes more severe, an RA rash may form ulcers or lesions. If these become infected, it can cause gangrene.

The following are examples of how an RA rash may present on the skin:

Treatment for RA rashes focuses on the underlying condition. Reducing the severity of RA symptoms will usually help clear up the rash.

In more severe cases of RA rash, a doctor may treat the rash directly. In these instances, a doctor may prescribe topical antibiotics or steroids to help treat or prevent any secondary infections.

Some people use skin creams and ointments to treat an RA rash. These can help reduce pain or itchiness. Topical steroids may also reduce swelling.

In cases where a reaction to RA medication directly causes a skin rash, a doctor can advise a person on how to reduce or replace their current medication.

Medications used to treat RA can also make a person more susceptible to other skin problems. For example, some drugs cause a person to bruise more easily or be more sensitive to sunlight.

Learn all about corticosteroids here.

RA is a chronic condition that can disrupt a person’s day-to-day life. There is no specific way to prevent RA, though research in this area is ongoing.

However, some treatments can help relieve a rash related to RA. In some cases, a doctor may prescribe topical ointments or steroid therapies. However, treatment may vary according to the specific type of rash and whether there are additional underlying causes.

A person with RA experiencing skin symptoms should talk with a doctor for advice on suitable treatment.

Here are some answers to frequently asked questions about RA rashes.

Can you get a rheumatoid arthritis rash on the face?

A rash from RA can occur on the face and any other part of the body. Additional causes for a rash on the face due to RA include interstitial granulomatous dermatitis, also known as rheumatoid papules. In addition, a rash on the face can occur if a person has a secondary illness along with RA, such as lupus.

Learn how RA affects different parts of the body here.

What is a juvenile rheumatoid arthritis rash?

Juvenile rheumatoid arthritis is part of a wider systemic condition known as juvenile idiopathic arthritis (JIA). This general term of arthritic conditions affects children before the age of 16 with symptoms that last for 6 weeks or longer.

One of the key symptoms can be a rash that may look pink or purple. It typically affects the trunk, arms, and legs, but not the face. It usually occurs alongside a fever.

Learn more about a juvenile rheumatoid arthritis rash here.

How does a rheumatoid arthritis rash on the leg present?

When RA causes a rash, the inflamed arteries can cause a particularly large area on the legs to develop into a rash. The rash may be smaller on other body parts, such as on or around the fingertips.

Read this article in Spanish.