Lupus Rash: Symptoms, Causes, Treatment

Lupus is an autoimmune disease that occurs when the body mistakenly attacks healthy tissue. There are four different types of lupus, one of which affects the skin only. This is referred to as cutaneous lupus.

People with lupus may experience skin problems when they are having a flare, or flare-up (when symptoms worsen), such as during times of stress or illness. Certain skin conditions are also specific to lupus.

Learn more about lupus skin conditions, their causes, and how to treat them.

Symptoms

Approximately two-thirds of people with lupus will develop some sort of skin disease. Skin rash can often be the first symptom of lupus and can appear differently depending on what type of skin condition you are experiencing. There are three different types:

• Chronic cutaneous (discoid) lupus: This rash produces disklike, round, scaly, red, and thick lesions that mostly occur on the scalp and face but can also appear throughout the body. It can cause scarring and typically causes either hypopigmentation (lack of pigmentation) or hyperpigmentation (excess pigmentation) of the skin.
• Subcutaneous lupus: These lesions that commonly appear on sun-exposed areas of the body, such as the arms, neck, and face usually don't itch or hurt but can become discolored. They appear as red, scaly skin with distinct edges or as red, ring-shaped lesions.
• Acute cutaneous lupus: A butterfly-shaped rash on the face that looks like a sunburn (referred to as a malar rash) develops. It can also occur on other parts of the body.      
  
• Other skin-related issues: These can be hard white lumps under the skin (calcinosis) and ulcers inside the mouth, vagina, and nose.

Causes

Lupus symptoms are different for everyone who has it, making it a complicated disease to treat. Although lupus is considered a disease of the whole body, oftentimes people will develop skin conditions that can come and go.

Immune dysfunction leads to inflammation, which can affect the skin. In addition, some skin conditions are caused by ultraviolet (UV) light, including sun exposure, or indoor lighting.

What Medications Can Cause a Lupus Rash?

There is a phenomenon referred to as drug-induced lupus that is associated with symptoms similar to systemic lupus erythematosus (SLE), which commonly presents as a skin rash. While many medications have been linked to drug-induced lupus, there are a few that have a higher risk, which include:

• Pronestyl (procainamide), used to treat irregular heart rhythms
• Apresoline (hydralazine), used to treat high blood pressure
• Quinaglute (quinidine), used to treat irregular heart rhythms
• Nydrazid (isoniazid), used to treat tuberculosis

How to Treat Lupus Rash

The treatment for a lupus rash will depend on its cause, the severity of the skin, as well as the location and type of rash. Treatment should take place under the supervision of a rheumatologist (a specialist in diagnosing and treating arthritis and other diseases of the joints, muscles, and bones) and dermatologist (specialist in diagnosing and treating conditions of the skin, hair, and nails), who will educate you on sun protection, and if necessary, prescribe medication based on your symptoms. The medications may include:

• Corticosteroids: These are topical creams applied directly to the skin. A pill or a corticosteroid injection may also be used to clear a thick patch of skin. Corticosteroids reduce inflammation but can also impair the immune system.
  
• Antimalarial medication: These medications are used to treat malaria but can also effectively treat a lupus rash. These include hydroxychloroquine and chloroquine.
• Steroid sparing medicine: When applied to the skin, it works in ways similar to a corticosteroid by reducing inflammation of the skin.
• Immune-modifying medications: Methotrexate, cyclosporine, and mycophenolate mofetil work to calm the immune system.

Are There Tests to Diagnose the Cause of a Lupus Rash?

Different types of lupus can cause a skin rash. In addition to visually examining your skin, your dermatologist may remove a small sample of the rash (skin biopsy) to be examined under a microscope in a lab. Your healthcare provider will also ask you what types of medications you are taking to rule out drug-induced lupus.

When to See a Healthcare Provider

Self-care is important in managing lupus rashes. Refraining from smoking, avoiding the sun, not scratching or picking at the skin, and using a colloidal oatmeal bath are all ways to soothe the skin and keep it protected.

If you have a new skin problem or an existing one that is changing, getting worse, or looking unfamiliar you should schedule an appointment with a dermatologist. In addition, if you have new moles that look suspicious in size, shape, or color, you should have your healthcare provider look at them. People with cutaneous lupus may be at increased risk of developing skin cancer.

Summary

Lupus is an autoimmune disease that can affect the skin, causing rashes that appear differently in people. Rashes can come and go depending on the cause. It’s important to avoid picking and scratching at the skin as this can cause the rash to spread or get worse. Additionally, avoiding the sun and seeing a dermatologist can help you to determine a treatment plan that works for you.

A Word From Verywell

If you have drug-induced lupus, finding a new medication may be part of your treatment plan. While there is no cure for lupus, its symptoms can be treated and most people who experience lupus rashes can live active lives.