Lupus and the Skin

What are the forms of lupus that can affect the skin?

There are three forms of lupus that affect the skin:

Acute Cutaneous Lupus Erythematosus (ACLE)

ACLE generally causes redness over the cheeks and nose. The redness is often called a “butterfly rash.” It fades over a few weeks and does not leave scarring.
The rash is usually seen in people with systemic lupus who are having a flare. It can be brought on or worsened by exposure to sunlight. People with lupus must protect themselves from the sun.

Subacute Cutaneous Lupus Erythematosus (SCLE)

SCLE is a rash that normally appears as red circles or scaly areas. These areas are very sensitive to the sun.
The rash does not normally cause scarring, though can cause considerable darkening or lightening of parts of the skin. These skin changes can be avoided or made less severe by using sun protection.
Some patients with SCLE also will get the rash seen with discoid lupus erythematosus (DLE). DLE rashes may cause scarring.
This rash can occur in patients with or without Systemic Lupus Erythematosus (SLE).

Discoid Lupus Erythematosus (DLE)

DLE is a rash that often appears as “coin-shaped” skin lesions. It also may make the skin appear scaly. DLE rashes are often a different color than the patient’s normal skin. They can cause skin thinning and scarring over time.
Skin exposed to the sun is more likely to have this rash.
Rashes on the scalp can cause hair loss. These rashes can be challenging to treat and manage.
This rash can occur in patients with or without SLE.

Most patients with lupus are very sensitive to the sun.
Skin disease is made worse by even minimal amounts of sunlight. In patients with SLE, sunlight can cause flare-ups of disease in other organs.
Unprotected sun exposure can cause you to get the rash. Sometimes the rash can occur a few days after being in the sun.
It is essential to protect yourself from the sun!

Avoid the sun during peak hours. These hours are between 10 a.m. and 3 p.m.
Wear a sunblock that protects your skin from both UVA and UVB rays. This should be worn every day. It also should be applied every 3-4 hours.
- Sunblock should be used all year long and everyday regardless of your activity.
- House and car windows protect against UVB. They do not protect you from UVA. If you spend a lot of time near windows you might get a UV-blocking shield.
- Apply sunblock to all exposed skin. This might include the ears, neck, “v” of the chest, hands, arms, legs, and face.
Wear a wide-brimmed hat. This will cover your ears and scalp. It also will keep your entire face shaded.
Wear sun protective clothing like long sleeves and pants.
- There is a sun protection product that can be added to laundry. You add it to your laundry to give cotton clothing an SPF. It should be added every 20 washes.
Avoid artificial light sources like tanning beds.
Wear sunglasses that offer UV protection.

Sunlight helps provide our bodies with vitamin D. This vitamin is important for maintaining strong bones and preventing osteoporosis (brittle bones).
Add vitamin D to your diet. This can make up for the vitamin D you would get from sun exposure.
- 1200-2000 IUs of vitamin D should be taken per day for people protecting themselves from the sun.

Most rashes in lupus are caused by inflammation. Medicines can be used to combat the inflammation. There are several types of drugs that can be given by doctors. They include:
Topical steroids (cream or ointment)
Plaquenil (hydroxychloroquine) or other antimalarials.

Please note:

Anti-malarials can rarely cause eye damage. If you take them, they require a yearly eye check by an eye doctor.

Smoking can cause a flare of skin lupus.
Smoking can lower the ability of Plaquenil to work. Plaquenil is a medicine used to treat skin lupus.
Talk to your doctor about ways to help you to quit smoking.

Special makeup can cover the redness from skin lupus. Makeup with green hues are very good. The green cancels out the red from the rash.

Please note: This information is intended to complement, not replace, the advice and care you receive from medical and health professionals.