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The skin is involved in more than 90% of people with lupus. Skin symptoms are more common in whites than in African Americans. While the classic lupus rash is a redness on the cheeks (malar blush) often brought on by sun exposure, many different types of rashes can be seen in SLE. Discoid lupus with the red skin patches on the skin and scaly is a special characteristic rash that can lead to scarring. It usually occurs on the face and scalp and can lead to loss of scalp hair (alopecia). It is more common in African Americans with lupus. Occasionally, discoid lupus can occur as an isolated skin condition without systemic disease. Hair loss can occur with flares of SLE even without skin rashes in the scalp. In this situation, the hair regrows after the flare is treated. Hair loss can also occur with immunosuppressive medications.
 
 

Lupus Rash - Acute Cutaneous Lupus Erythematosus

Acute Cutaneous Lupus Erythematosus usually presents as an erythematous rash in a butterfly distribution on the face. This blush is slightly edematous and is located in both cheeks and across the bridge of the nose. The lesion usually appears after sun exposure but persists a few days to weeks before healing without scarring. It may be accompanied by erythematous lesions in other areas of the body. Usually more than 90% of the cases have positive ANA, as well as immunoglobulin deposits along the dermoepidermal junction by immunioflourescence studies of the involved skin.

Lupus Rash - Subacute Cutaneous Lupus Erythematosus

Subacute Cutaneous Lupus Erythematosus lesions may be localized or generalized. The maculopapular rash usually occur after sun exposure, the lesions are usually pruritic. It may involve any place on the body, and because the erythematosus lesions may involve palms and soles they resemble a drug reaction. The great majority of these lesions heal without scarring, however, persistent lesions that become crusty may heal with only slight atrophy of the skin. This type of rash is associated with a high prevalence (70%) of Ro(SS-A) antibodies; however, only 50% of cases have positive immunoglobulin deposition in lesional skin by immunofluorescence.

Lupus Rash - Chronic Cutaneous Lupus Erythematosus

Chronic Cutaneous Lupus Erythematosus, referred as Discoid Lupus Erythematosus, usually involves the fact, scalp and ears, but it may occur anywhere. The rash may be pruritic. The lesions at the beginning are erythematous, slightly elevated papules or plaques, that in time become raised, bright red, edematous, later on the center becomes depressed, the color fades and becomes atrophic, while the edematous red periphery slowly enlarges and becomes irregular with some telangiectasias. In older lesions follicular plugging characterized by small round areas of hyperkeratosis are noted. Later on the lesions heal with scar leaving a white area with or without focal hyperpigmentation. These lesions usually heal with scarring and hyperpigmentation or hypopigmentation. In the lesion involving the scalp where the lesions are erythematous and scaly, the hair usually grows back, but if the lesion heals with scarring the alopecia in that area is permanent. The names of the different variants reflect the predominant component of the lesion; the tuidus for example refers to raised lesions that are peculiarly soft to the touch, as the feeling to the touch obtained compressing a cotton hall. Only 5-10% of cases have a positive ANA, and immunoglobulin deposits at the dermoepidermal junction are present in 80% of involved skin by immunofluorescence studies, but usually immunofluorescence studies are negative in lesions less than three months old.

Lupus Rash - Lupus Panniculitis

Lupus Panniculitis, appears as deep nodules. The lesion is situated below the skin in the subcutaneous tissue, and heals with a deep atrophy of the involved area.

Lupus Rash - Bullous Lupus Erythematosus

Bullous Lupus Erythematosus is characterized by the presence of blisters which contain a clear seurous fluid, and may range from 3 to 40mm in diameter. The rash usually appears in sun exposed areas, and only rarely is associated with burning sensation, mild pruritus or redness. Some papules may accompany the blisters. The lesion may resolve spontaneously usually without a scar after a week, but they reappear episodically.

Lupus Rash - Neonatal Lupus

Neonatal Lupus is seen in newborn babies and the rash is similar to the annularpolycyclic rash seen in Subacute Cutaneous Lupus Erythematosus. Mothers with Ro(SS-A) positively with or without lupus may have babies with Neonatal Lupus. These mothers also share increased frequency of HLA-B8, HLA-DR3, HLA-DQ23 and Drw52 phenotypes.

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Arthritis can develop as a result of an infection. For example, bacteria that cause gonorrhea or Lyme disease can cause arthritis. Infectious arthritis can cause serious damage, but usually clears up completely with antibiotics. Scleroderma is a systemic disease that involves the skin, but may include problems with blood vessels, joints, and internal organs. Fibromyalgia syndrome is soft-tissue rheumatism that doesn't lead to joint deformity, but affects an estimated 5 million Americans, mostly women. The approximate number of cases in the United States of some common forms of arthritis.

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