Skin Conditions and Lupus
Reviewed by: HU Medical Review Board | Last reviewed: January 2020 | Last updated: January 2020
Skin problems remain one of the most common complications of lupus. An estimated 66 percent of people with lupus develop some sort of skin disease during their lifetime. Rashes and sores (lesions) often appear on any skin exposed to the sun, such as the face, neck, arms, and legs.1
Between 40 percent and 70 percent of people with lupus find that exposure to ultraviolet (UV) rays from sunlight or fluorescent lights makes their skin issues worse or triggers other symptoms such as joint pain, fatigue, and fever. This is called photosensitivity.1-3
Malar ("butterfly") rash
When lupus is active, about half of people with lupus develop a butterfly-shaped rash across both cheeks and the nose called a malar rash. These red, raised rashes often follow sun exposure or precede a flare.
Cutaneous vasculitis lesions
When inflammation damages the blood vessels it can cause red-purple spots and bumps on the lower legs. These are called cutaneous vasculitis lesions. Sometimes larger knots called nodules and ulcers develop. At other times, the sores will appear at the edges of the fingernails or tips of the fingers. If the skin dries, it can turn black and cause gangrene (dead tissue), which is a serious condition.
Raynaud’s disease, or phenomenon, is a condition in which the blood vessels in the fingers and toes constrict when exposed to cold, turning the fingers white, blue, and red. About 30 percent of people with lupus experience Raynaud’s.2
Sometimes lupus causes the mineral calcium to build up under the skin. These deposits may leak a white fluid and be painful. Calcinosis may be the result of steroid use or kidney damage.
Hives (urticaria) are itchy splotches on the skin that occur in about 10 percent of people with lupus. While hives caused by allergic reactions tend to last a short time, lupus hives often last longer than 24 hours.2
The skin disease cutaneous lupus is a very common symptom of systemic lupus. It is also a different type of lupus that only affects the skin. There are 3 types of cutaneous lupus:
Discoid lupus (also called chronic cutaneous lupus)
This type of skin disease creates thick, round, red, scaly lesions on the skin. The sores usually appear on the scalp and face but can appear anywhere on the body. Lesions on the scalp may cause permanent hair loss. Ten percent of people with this type of lupus go on to develop lupus in other organ systems. Most only experience skin lesions.
These lesions look like red, scaly areas of skin that are sometimes ring-shaped and sometimes not. The lesions appear most often on sun-exposed areas of the body.
Malar "butterfly" rash and red rashes
This skin condition can appear on the face or on other parts of the body.
Cutaneous lupus is also the name for a different type of lupus that primarily affects the skin and not the whole body the way systemic lupus does.
Other skin conditions
Additional skin conditions found in people with lupus include:
- Livedo, a lacy, reddish or violet-colored pattern under the skin that may be worse in cold temperatures.
- Purpura (petechiae), small red or purple discolorations just under the skin caused by broken blood vessels.
- Dry mouth (oral sicca) can occur in people with Sjogren syndrome, which also causes dry eyes.
Who treats skin diseases associated with lupus?
Your rheumatologist may treat any skin issues you have, or you may need to see a dermatologist, a doctor who specializes in treating skin conditions.
How are skin complications treated?
- A variety of treatments are available to treat the skin conditions common to lupus. You’re your doctor recommends will depend on the skin issue you have.
- Topical ointments, creams, or gels that you spread on affected areas of the skin are used to reduce inflammation and soothe itchiness and flaking.
- In more serious cases, liquid steroids may be injected directly into skin lesions.
- Avoiding sunlight and fluorescent lights are mainstays in controlling photosensitivity. This includes wearing sunscreen, staying indoors between 10 a.m. and 4 p.m. and wearing protective clothing.
- Thalidomide is sometimes used to improve cutaneous lupus that does not respond to other treatments.
- Prescription mouthwashes may help heal mouth ulcers.