Lupus is a group of autoimmune diseases where the body’s own immune system attacks healthy tissue leading to inflammation and damage in the affected organs. Lupus can affect the skin, joints, kidneys, brain, heart, lungs, and blood cells.
Types of lupus include:
- Systemic Lupus Erythematosus (SLE)
This is the most common and also the most serious form of lupus, affecting not only the skin, but also other organ systems in the body. The signs, symptoms, and severity can vary depending on what organ systems are involved. Symptoms can also come and go with flare-ups and periods of remission. Affected individuals can present with a butterfly-shaped rash on the nose and cheeks of the face, swollen or painful joints, fever, and fatigue. More serious complications can include damage to the kidneys, seizures, stroke, or heart attack. Lupus is seen most commonly in young and middle-aged women. Blacks, Asians, Latinos, and Native Americans are more at risk of developing lupus. Treatment options include various systemic medications such as prednisone, antimalarial medications, immune suppressing drugs, and possibly biologics.
- Cutaneous Lupus Erythematosus
Cutaneous lupus erythematosus is a subset of lupus that affects the skin, manifesting as rashes. It can be further subclassified into:
- Acute Cutaneous Lupus
Acute cutaneous lupus is the skin rash associated with flare ups of systemic lupus erythematosus (see above). The classic presentation is the pink, butterfly-shaped rash on the nose and cheeks of the face. A rash can also appear on the arms, legs, or body.
- Subacute Cutaneous Lupus (SCLE)
In subacute cutaneous lupus, red, scaly, round, ring-shaped lesions can appear in a sun-exposed distribution such as on the neck, shoulders, and arm. The rash typically resolves without any scarring.
- Chronic Cutaneous Lupus (Discoid Lupus)
In discoid lupus, affected individuals develop red to purple, scaly, round lesions, most commonly on the scalp, face, and ears. These lesions heal with residual skin discoloration and scarring. In the scalp, it may cause permanent hair loss.
Individuals with cutaneous lupus erythematosus should be routinely screened and monitored for systemic involvement (lupus involving other organs other than the skin). The skin rashes of lupus are photosensitive - meaning sun exposure and sunlight can exacerbate the condition and cause a flare. Treatment involves diligent and strict sun avoidance and sun protection. Topical medications and antimalarial medications are common therapies used to treat cutaneous lupus.
- Drug-Induced Lupus
Drug-induced lupus is lupus-like symptoms caused by certain medications. Affected individuals can present with similar symptoms as SLE including fever, fatigue, and joint pain. Some forms of drug-induced lupus cause only skin rashes similar to subacute cutaneous lupus erythematosus and more rarely chronic cutaneous lupus erythematosus. The most important treatment measure is to discontinue the medication, though symptoms can take many months to resolve even after stopping the medication.
- Neonatal Lupus Erythematosus
Neonatal lupus erythematosus occurs in infants born to mothers with certain autoantibodies; autoantibodies are immune proteins that mistakenly target and react with a person’s own tissue or organs. During pregnancy, the autoantibodies in the mother are passed to her unborn baby. Affected newborns can present with a skin rash, liver problems, or low blood counts. These symptoms are typically transient, resolving within months of delivery without long-term issues. Serious complications with long-term consequences can occur when neonatal lupus erythematosus affects the baby’s heart, causing congenital heart block (disruption of normal heart rate and rhythm). Congenital heart block does not resolve, and affected babies may eventually need a pacemaker.
- Acute Cutaneous Lupus