How to Identify & Treat a Lupus Rash on the Legs

Lupus is a group of autoimmune diseases that can affect multiple systems in the body, including the skin. Several rashes are linked to lupus, including some that itch and may appear on the legs.

This article discusses the types and causes of itchy lupus rashes on the legs, treatment options, and when to see a healthcare provider.

Types of Lupus Rash

Lupus can cause several types of rashes, including some specific to certain disease forms. Three common types of lupus are defined by cutaneous (skin) involvement. The four main lupus types are:

• Systemic lupus erythematosus (SLE): May lead to symptoms in one or more of your bodily systems, including the skin
• Acute cutaneous lupus (ACL): Usually appears alongside SLE
• Chronic cutaneous lupus (CCL): Persistent skin involvement and can appear alongside SLE
• Subacute cutaneous lupus (SCL): Can appear alongside SLE

If you have SLE, you may be prone to lupus-associated skin problems.

Acute Cutaneous Lupus

One of the most common skin symptoms of lupus is a malar rash. It’s referred to as a butterfly rash when it’s across the cheeks and nose. 

Malar rash is a type of ACL that is commonly seen in SLE. About 50% of people with lupus will develop a malar rash. While most commonly associated with lupus, a malar rash can be seen in other disorders, such as cellulitis, rosacea, and erysipelas.

Chronic Cutaneous Lupus

CCL involves long-term skin inflammation. The most common type is called discoid lupus. In some people, CCL may be an early sign of SLE. Otherwise, symptoms are purely skin-based.

Subacute Cutaneous Lupus

SCL involves two types of sores (lesions): papulosquamous lesions and annular lesions. You can have one or both of them at different times or concurrently.

Other Symptoms of Lupus

Other symptoms of systemic lupus vary somewhat by type. General lupus symptoms include:

• Fatigue despite adequate sleep
• Joint, muscle, and tendon pain and inflammation
• Puffiness in the hands and feet and around the eyes
• Recurring low-grade fever
• Hair loss
• Anemia
• Dry eyes and mouth
• Digestive problems
• Raynaud's disease (causes fingers and toes to be cold and numb)

Many other symptoms are possible, depending on what organs or systems the disease targets.

Lupus Rash Treatment

Lupus rash treatments generally involve topical treatment (applied to the skin), oral medication (taken by mouth), and avoiding ultraviolet (UV) light.

Topical Treatment

Topical treatment includes corticosteroid creams. These are powerful anti-inflammatory medications. The strength that’s usually needed is only available with a prescription and should be used under the supervision of a healthcare provider.

Other topical anti-inflammatory medications may be used to avoid the possible side effects of corticosteroids.

Oral Medication

The medications for lupus-related skin problems may also be prescribed for the full range of lupus symptoms. They include:

• Antimalarial drugs: Plaquenil (hydroxychloroquine), chloroquine
• Immunosuppressants: Trexall (methotrexate), Gengraf (cyclosporine), CellCept or Myfortic (mycophenolate mofetil)
• Oral corticosteroids: For when topical steroids aren’t effective enough

Avoiding UV Light

Many lupus-related skin problems are exacerbated by sunlight. Avoiding UV light may involve staying out of direct sunlight, wearing strong sunscreen, such as with a sun protection factor of 50 (SPF 50), when outside, and wearing protective clothing. Take special care to keep out of the sun when you have an active rash.

When to See a Healthcare Provider

Anytime you have an unexplained rash, you should see a healthcare provider. Get immediate help if it is:

• Especially itchy or painful
• Covering much of your body
• Spreading quickly
• Blistering
• Shows any signs of infection (swelling, crusting, pain, heat, red streaks, yellow or green pus)

If you’re diagnosed with lupus and notice any possible new skin involvement, let your rheumatologist or dermatologist know right away.

Summary

Lupus can cause a variety of rashes, some of which can affect the legs and be itchy. A malar rash is typical of SLE and acute cutaneous lupus. Chronic cutaneous lupus often causes a discoid rash. Subacute cutaneous lupus can cause two types of rash, one of which can be mistaken for psoriasis. Treating lupus rashes involves topical creams, medications, and avoiding sunlight. Contact your healthcare provider if you have a new, undiagnosed, or worsening rash.

A Word From Verywell

An itchy lupus rash, especially on large areas of your body, such as the legs, can be uncomfortable and can significantly impact your quality of life. Fortunately, there are treatment options that can make lupus-related skin problems manageable.