Lupus Rash
Lupus is an autoimmune disease that can cause different symptoms, but one of the most common is a skin rash. These rashes affect many people with lupus, often showing up on the face, arms, or other areas exposed to sunlight. The immune system attacks healthy skin in lupus, causing redness, swelling, and sometimes scaly patches.
Some rashes, like the butterfly-shaped malar rash, are unique to lupus and may appear after sun exposure or during a flare-up. Light sensitivity is common, so even a small amount of sun can make the rash worse.
Definition Of Symptom
A lupus rash is a visible skin change often linked to the body’s immune system attacking its own tissues. This is a sign of skin involvement in lupus, especially in people with cutaneous lupus.
There are several types of lupus rash. These include the malar rash (often called a “butterfly rash”), which spreads across the nose and cheeks, and the discoid lupus rash, which causes round, scaly patches that may leave scars. Other types include the chilblain lupus rash, seen as red or purple bumps, and livedo reticularis, which looks like a lacy or mesh-like pattern on the skin.
Key Examples Of Lupus Rashes
| Rash Type | Description | Common Location |
|---|---|---|
| Malar (Butterfly) Rash | Redness across cheeks and nose | Face |
| Discoid Rash | Round, scaly patches; may scar | Face, scalp, ears |
| Chilblain Rash | Red or purple bumps, sensitive to cold | Fingers, toes, nose, ears |
| Livedo Reticularis | Lacy, purplish skin pattern | Arms, legs |
Lupus skin rashes can flare up and then disappear, or they can last for weeks or longer. Sunlight often triggers these rashes, a condition known as photosensitivity. Skin rashes in lupus are not only uncomfortable but also signal that lupus may be affecting other organs. These skin conditions show the need for further care.
Possible Causes/Disease Condition
Problems with the immune system most often cause lupus rash. The body mistakes its own skin for something harmful and attacks it. Systemic Lupus Erythematosus (SLE) is the main type behind these rashes. SLE can cause rashes and problems inside organs. Other related types include chronic cutaneous lupus and acute cutaneous lupus erythematosus (ACLE).
Discoid Lupus Erythematosus (DLE) usually causes disk-shaped, thick, and scaly patches. These patches are most common on the face and scalp but can show up anywhere on the body. Subacute Cutaneous Lupus Erythematosus (SCLE) forms ring-shaped or scaly spots, mostly on sun-exposed skin. These rashes tend to be very sensitive to sunlight.
| Disease Condition | Rash Features |
|---|---|
| Systemic Lupus Erythematosus (SLE) | Red, flat, or raised rash, often on cheeks, may affect body organs. |
| Chronic Cutaneous Lupus (DLE) | Thick, round, scaly patches; can leave scars. |
| Subacute Cutaneous Lupus (SCLE) | Ring-shaped, scaly, sun-sensitive patches. |
| Acute Cutaneous Lupus (ACLE) | Butterfly-shaped rash over nose/cheeks. |
Lupus can also cause cutaneous vasculitis, where blood vessels in the skin swell and lead to red or purple spots. This can make the rash worse or cause new spots. Other triggers of lupus rash include sunlight (UV exposure), stress, infection, and some medicines. A person’s genes and immune system may also play a role in who gets these rashes. Most rashes tend to come and go, flaring up suddenly, especially with sun exposure.
Other Non-Disease Causes
Some lupus rashes are triggered or made worse by things that are not diseases themselves. Sun exposure is a common cause. People with lupus often have photosensitivity, which means their skin reacts quickly to sunlight. Even a small amount of time in the sun can lead to a red or irritated rash.
Stress can also play a role. High stress levels may not directly cause a rash, but they can make lupus symptoms worse, including skin problems. Certain soaps, fragrances, and skincare products can irritate the skin. In people with lupus, these irritants can trigger rashes or make them worse. It’s important to use gentle products to help lower this risk.
Clothing that does not protect the skin from the sun may also increase rashes. Sun protection is key. People with lupus should use sunscreen and wear protective clothing, such as hats and long sleeves, when outdoors. Below is a quick list of non-disease triggers:
- Direct sunlight or ultraviolet light
- Emotional stress
- Harsh skincare products
- Lack of sun-protective clothing
How It Causes The Symptom
The immune system attacks healthy skin by mistake in lupus, causing inflammation and skin changes. When the body’s immune response starts, special cells release chemicals that cause swelling and redness. In lupus, sunlight and infections can make this reaction worse. Common lupus rash symptoms include:
- Red or scaly patches
- Swelling and itching
- Discoid lesions (round, thick, scarring sores found mostly on the face and scalp)
Discoid lesions are a type of rash that is firm and may leave scars, especially if not treated. These lesions often last longer than other types of rashes linked to lupus.
| Rash Type | What It Looks Like | Common Areas |
|---|---|---|
| Butterfly Rash | Redness across cheeks/nose | Face |
| Discoid Lesions | Thick, round, scarring sores | Face, scalp |
| Scaly Patches | Flaky, raised, red spots | Anywhere on skin |
Skin changes from lupus can also include color changes or sensitive spots. Some people may lose hair where discoid lesions appear on the scalp, due to the damage and inflammation in hair roots.
Possible Complications
Lupus rashes can lead to several complications that affect daily life. One common problem is increased photosensitivity, meaning skin may burn or flare up easily in sunlight. Fatigue often comes with lupus, even if there is no visible rash. Many people feel tired even after rest. Some may develop alopecia, or hair loss, because of lupus inflammation. This can be temporary or, in rare cases, permanent.
| Complication | Description |
|---|---|
| Hair loss | Thinning or patches of missing hair. |
| Canker sores | Painful ulcers inside the mouth. |
| Urticaria | Raised, itchy hives on the skin. |
Rashes may cause open sores, especially if scratched or exposed to sun. This increases the risk of infection and slow healing. Other lupus symptoms include joint pain, fever, and swelling. For some, rashes and skin irritation come with joint problems or body aches.
Canker sores are small ulcers that can appear inside the mouth during flares. They can make eating and drinking uncomfortable. Some people with lupus develop urticaria, or hives, which are raised, itchy patches. These may appear suddenly and can worsen with heat, stress, or certain foods.
When To Seek Medical Attention
Contact a healthcare provider if you notice a new rash that does not go away, especially if it appears on the cheeks, nose, or other parts of the body. Other warning signs to watch for include:
- Rash with swelling, warmth, or pus (these could signal infection)
- Rash that becomes painful or starts to blister
- Signs of skin lesions or scarring
- Rash that appears with other lupus symptoms like joint pain, mouth sores, fever, or severe fatigue
Get medical care right away if the rash comes with breathing problems, chest pain, or confusion, as these could be signs of serious complications. If you already have lupus, report any changes in the rash or new symptoms. Sunlight, infection, or a change in medication can make a lupus rash worse. Common treatments for lupus rashes include:
| Medication | Purpose |
|---|---|
| Corticosteroids | Reduce inflammation |
| Plaquenil | Control immune system activity |
| Nifedipine | Improve circulation (less common) |
- Corticosteroids come as creams or pills to help calm the rash.
- Plaquenil is often used long-term to manage lupus skin symptoms.
- Nifedipine may help if circulation is poor, but it is used less often.
If the rash shows signs of infection or does not improve with medication, contact your provider.
