What to know about cutaneous lupus

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Cutaneous lupus is an autoimmune condition that affects the skin. Autoimmune conditions occur when the body’s immune system mistakenly attacks healthy tissues, causing inflammation. Inflammation is a normal bodily response to germs or injuries, but it can become harmful when the body does not regulate this response as usual.

The Lupus Foundation of America estimates that around two-thirds of people with lupus will develop cutaneous lupus at some point.

Several types of cutaneous lupus cause lesions in different forms and locations around the body. These lesions may be painful and itchy, or they may cause no further symptoms at all. In all forms of cutaneous lupus, sun exposure makes symptoms worse.

There are four main types of cutaneous lupus:

1. Acute: This form of the condition can occur with systemic lupus erythematosus and causes a butterfly-shaped lesion across the nose and cheeks. The symptoms typically occur after sun exposure. The condition causes itchy, flat, red or otherwise discolored areas of skin.
2. Subacute: This subtype can occur on its own or with systemic lupus. It causes lesions that are not typically painful or itchy. Some lesions may appear similar to pimples, and others may look like flat circles that are pink with a red ring or otherwise discolored.
3. Intermittent: Also known as lupus tumidus, this type causes lesions that appear on sun-exposed areas of the body and typically resolves in winter.
4. Chronic: This condition causes lesions around the head, neck, and hands that are typically not painful or itchy. There are several types of chronic cutaneous lupus. Discoid lupus, which causes coin-shaped lesions, is the most common subtype.

Cutaneous lupus results from the immune system mistakenly attacking healthy tissues. However, the cause of this dysfunction is not clear.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases highlights three types of factors that can trigger lupus:

• genetic factors
• environmental factors such as sunlight and viruses
• immune and inflammatory influences, such as an inability of the body to remove damaged cells

Certain medications, including some chemotherapy drugs and proton pump inhibitors, can also result in cutaneous lupus. The Arthritis Foundation estimates that around 20% of cutaneous lupus cases could be due to medications.

The symptoms of cutaneous lupus result from inflammation. People with lupus usually experience rashes, sores, or other lesions on the skin. These symptoms typically occur in response to sunlight and appear in areas of skin exposed to the sun, such as the:

• face
• scalp
• ears
• lips
• arms
• hands
• thighs

Different types of cutaneous lupus will cause different symptoms. For example, acute cutaneous lupus causes painless, butterfly-shaped rashes across the nose and cheeks. They can be mild or severe and itchy.

Subacute cutaneous lupus may cause scaly, red or otherwise discolored patches that appear similar to pimples. Alternatively, it can cause sores that appear similar to psoriasis, which may be pink with a red ring or otherwise discolored. Some people with the condition may have both types of lesions.

Intermittent cutaneous lupus is an uncommon variant that features a red-pink, raised, itchy rash that occurs on sun-exposed areas of skin. The lesions resolve in winter without scarring.

People with chronic cutaneous lupus can experience different symptoms depending on the subtype they have. The lesions can cause permanent scarring or changes in skin color.

Doctors will diagnose cutaneous lupus after performing a physical examination and checking the person’s medical history. They will check the skin for lesions and note their type, spread, and location. They might also order blood and urine tests or take a skin sample.

There is currently no cure for cutaneous lupus, but treatments are available to manage symptoms. The Arthritis Foundation states that the two primary types of treatment are as follows:

Non-drug treatments

To reduce symptoms and improve the appearance of the skin, doctors may suggest lifestyle strategies such as:

• avoiding drugs that trigger symptoms
• stopping smoking
• reducing sun exposure and protecting the skin during sun exposure, such as by wearing sunscreen

Drug treatments

Several drug treatments are available for cutaneous lupus depending on its severity and spread. These include:

• steroid creams to reduce inflammation
• calcineurin inhibitors to reduce the side effects of steroids
• antimalarial drugs
• methotrexate or anti-inflammatory drugs such as dapsone

It could be easy to miss the symptoms of cutaneous lupus or mistake them for symptoms of another condition. For example, acute cutaneous lupus causes a rash across the face that may appear similar to rosacea or psoriasis. Anyone who experiences lupus symptoms should be careful not to overlook them and should contact a doctor.

Below are frequently asked questions relating to cutaneous lupus.

What triggers cutaneous lupus?

The root cause of cutaneous lupus is unclear. However, the following may trigger symptoms:

• sun exposure
• drug interactions
• genetic factors
• infections
• immune system dysfunction

Is cutaneous lupus serious?

Cutaneous lupus is not life threatening. Lifestyle changes and medical treatment can often help manage symptoms.

However, it is still advisable for anyone with symptoms of cutaneous lupus to contact a doctor. Prompt diagnosis and treatment can help manage symptom frequency and reduce severity.

Cutaneous lupus is an autoimmune condition that affects the skin. It results from inflammation, which can lead to rashes and lesions around the body. Four main types of cutaneous lupus cause different types of lesions.

There is currently no cure for cutaneous lupus. However, treatments are available to manage the symptoms. People with any form of cutaneous lupus should avoid sun exposure and protect their skin when in sunlight. The sun can trigger symptoms of cutaneous lupus.