Understanding elusive lupus; how to minimize scars

Q: I have two friends who have lupus, and it seems like they have two different diseases. One is having a lot of aches and pain, and the other seems to just be losing it — tired all the time, confused, moody. Have they been diagnosed correctly? — Sonia J., Ocala, Florida

A: SLE (systemic lupus erythematosus) is the most common form of lupus, which is an autoimmune disease. As you have discovered with your two friends’ experiences, SLE can present with a diverse array of symptoms; they can vary from mild to severe and can mimic other conditions. That’s why lupus is sometimes hard to diagnose.

Diagnosis: For reliable diagnosis and treatment, it’s important to go to a rheumatologist who specializes in SLE. He or she uses blood tests that look for immunological involvement (certain antibodies) and the presence of clinical symptoms, such as fatigue, cognitive changes and psychological disruption, as well as skin eruptions and kidney, eye, muscle, joint, gastro, cardiac, endocrine or hematological problems.

SLE affects up to 12 women for every man. Women ages 15 to 44 are at greatest risk.

Treatment: After examination and diagnosis by a rheumatologist, it’s time to determine the best course of treatment.

Lifestyle choices can go a long way in helping reduce the impact of lupus on muscle, bones and organ systems. The first step is to maintain a healthy weight; eat up to nine servings daily of produce; ditch red and processed meat, highly processed foods and added sugars and syrups. Regular physical exercise, however possible, is essential. The rheumatologist will help determine the best routine.

As for medical treatments, mild symptoms may be managed with over-the-counter pain relievers and anti-inflammatories.

Hydroxychloroquine, an antimalarial drug, often is used initially to treat lupus-related mouth sores and skin lesions. When internal organs are affected, options include immunosuppressive drugs, such as methotrexate; steroids; and the monoclonal antibody belimumab. Approved in 2011, it’s the first new medication for lupus in more than 50 years.

Q: I was in a car accident two years ago, and my collarbone was broken in two places. The emergency room surgeons had to do major repair work, and I ended up with a big, ugly scar. Is there any way to get rid of it? — Rachel Q., Los Angeles

A: Scars can be disconcerting — even psychologically damaging — and physically uncomfortable, but they are a sign that the body was on the job, helping heal a wound. Depending on the type of trauma, there are ways to prevent or minimize scarring, or after the fact — as in your case, Rachel — reduce it. It’s rare to be able to remove a scar completely.

What is a scar? A scar is fibrous tissue created when collagen and skin cells scramble to fix and replace injured skin. There are several kinds: keloid (raised), contracture (where the skin is pulled), hypertrophic (slightly raised) and atrophic (recessed or sunken). A hypertrophic scar is common after surgery and might be what you have.

Minimizing scars: Your first step is to find a plastic surgeon you can work with to explore your options.

1. For dark-colored scars, you can ask your doctor to recommend over-the-counter creams containing vitamin E, silicon, bleaching and brightening agents. To avoid discoloration, keep your scar out of the sun.

2. A steroid injection into the scar could make it softer and flatter in one to two weeks. Dermabrasion also can smooth out a scar.

3. For raised scars, laser treatments that break down excess collagen are an option. A lack of collagen, on the other hand, causes a pitted (atrophic) scar; you can use dermal fillers or laser treatments to build up collagen in the area.

4. Scar revision is the surgical option. Any surgery can create new scar tissue, so discuss the benefits and risks. Usually a skin graft or skin flap is used to cover the area. Recovery can take a couple of weeks.