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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.