Recognising skin lupus
Dear Editor,
Lupus erythematosus is an autoimmune disease. In this disorder, the immune system, which normally protects the body against infection and disease, mounts an inflammatory reaction against the body.
When multiple organs or systems of the body, such as the joints, the blood vessels, heart, kidneys, lungs, and brain, are targeted, a serious disease known as systemic lupus erythematosus occurs. When the autoimmune process affects the skin, the condition is referred to as cutaneous lupus.
Cutaneous lupus occurs more commonly in women and in those of African descent but may affect men and other ethnic groups. Genetics; environmental factors, particularly sun exposure; and irregularities in the immune system play a role in the onset of lupus erythematosus.
Acute and chronic cutaneous lupus are the more common types of cutaneous lupus.
Round, red, scaly lesions, which heal with dyspigmentation (areas of skin that are both lighter and darker than normal skin) and scarring, are the typical presentation of chronic discoid lupus erythematosus. These lesions may affect sun-exposed areas only or may be more widespread. Characteristic sites are the cheeks, ears, and scalp. Lesions affecting the scalp result in alopecia or hair loss, which may become permanent.
Acute cutaneous lupus is often referred to as the butterfly rash. The rash spreads out from the nose onto the cheeks, like the wings of a butterfly. This red, scaly, and sometimes swollen rash lasts days to weeks, is sun-induced, and does not result in scarring.
Cutaneous lupus may occur with or without concomitant systemic lupus erythematosus (SLE). Acute cutaneous lupus has a strong association with SLE and one to 30 per cent of patients with chronic discoid lupus erythematosus will eventually develop SLE.
If you are diagnosed with cutaneous lupus, your doctor will examine you and request blood investigations to check whether any other organs is involved.
Strict sun protection is an important part of treatment. People with lupus should avoid the sun and use sunscreen before sun exposure. Your doctor may prescribe creams or ointments to be rubbed onto the affected areas (topical treatment) or tablets or injections (systemic treatment) or a combination of the two, depending on the extent and severity of skin involvement. The most commonly used medications are steroids and hydroxychloroquine.
Cutaneous lupus may be mistaken for other skin diseases like seborrhoeic dermatitis, Rosacea, and acne to name a few. If you notice a rash on your face, scalp, or ears that is worsened on exposure to sunlight, please visit your dermatologist for accurate diagnosis and treatment.