Approximately 80 percent of patients with systemic lupus erythematosus have skin manifestations and may suffer from disfigurement. Some skin rashes and sores (also called lesions or ulcers) are very specific to lupus, while others can occur in other diseases as well. Sensitivity or too much exposure to the ultraviolet (UV) rays of sun and to some types of artificial light are responsible for aggravating some rashes and lesions. Many types of skin conditions are common in lupus.
Butterfly rash: The classic sign of lupus is the “butterfly” rash extending over the cheeks and bridge of the nose. This rash over the nose and cheeks can range from a faint blush to a rash that is very severe, with scaling. It is very sensitive to light and appears to get worse when skin is exposed to sun or certain types of artificial light. The rash may be permanent or may come and go. Between 55 and 85 percent of patients develop this rash at some time in the course of the disease.
Discoid lesions: These scarring, coin-shaped lesions are seen on areas of the skin that have been exposed to UV light. They may also occur on the scalp and produce a scarring, localized baldness that is permanent.
Subacute cutaneous lesions: These nonscarring, red, coin-shaped lesions are very sensitive to UV light. They can appear scaly and can mimic the lesions seen in psoriasis. They may occur only on the face or cover large areas of the body.
Mucous membrane lesions: Mouth ulcers are sometimes seen in people with lupus. Nose and vaginal ulcers may also occur. These lesions are usually painless.
Hair loss: In addition to losing hair because of discoid lesions, some people with lupus may develop a temporary, generalized hair loss followed by the growth of new hair. Hair loss may also be caused by infection or by use of corticosteroids or other lupus medications. A severe lupus flare could result in defective hair growth, causing the hair to be fragile and break easily.
Vasculitis: This is a condition in which the blood vessels become inflamed. Very small blood vessels can break and cause bleeding into the tissues, resulting in tiny, reddish-purple spots on the skin known as petechiae (peteke-ee-ah). Larger spots are called purpura and may look like a bruise. Vasculitis can also cause blood clots to form, skin ulcers to develop, and small black areas to appear around fingers and toenails. These black areas are a sign of serious tissue damage. If they begin to develop, see your doctor immediately.
Raynaud’s phenomenon: This is a condition in which the blood vessels of the fingers and toes react in an extreme way to cold or stress. They suddenly get very narrow (they “vasoconstrict”). This decreases the blood supply going through the vessel. As a result, the fingers and toes become cold and can turn pale or bluish. Pain or tingling can occur when the hands and feet warm up and circulation returns to normal. For most patients, Raynaud’s phenomenon is mild. However, some SLE patients with severe Raynaud’s phenomenon may develop painful skin ulcers or gangrene on the fingers or toes. Attacks of Raynaud’s phenomenon can cause a deep tingling feeling in the hands and feet that can be very uncomfortable.
Drug-induced skin changes: Some drugs used to treat lupus, such as corticosteroids, immunosuppressives, and antineoplastics, can affect the skin. Your doctor or nurse will review these side effects with you if one of these drugs has been prescribed.
Summary of Potential Dermatologic Lupus Complications