Skin Care and Lupus

Skin problems are very common in people with lupus. Some skin rashes and sores (also called lesions or ulcers) are very specific to lupus, while others can occur in other diseases as well. A sensitivity to and too much exposure to the ultraviolet (UV) rays of sun and some types of artificial light are responsible for aggravating some rashes and lesions. Many types of skin conditions are common in lupus.

Butterfly rash: This rash over the nose and cheeks can range from a faint blush to a rash that is very severe, with scaling. It is very sensitive to light and appears to gets worse when skin is exposed to sun or certain types of artificial light. The rash may be permanent or may come and go.

Discoid lesions: These scarring, coin-shaped lesions are seen on areas of the skin that have been exposed to UV light. They may also occur on the scalp and produce a scarring, localized baldness that is permanent.

Subacute cutaneous lesions: These nonscarring, red, coin-shaped lesions are very sensitive to UV light. They can appear scaly and can mimic the lesions seen in psoriasis. They may occur only on the face or cover large areas of the body.

Mucous membrane lesions: Mouth ulcers are sometimes seen in lupus patients. Nose and vaginal ulcers may also occur. These lesions are usually painless.

Hair loss: In addition to losing hair because of discoid lesions, some lupus patients may develop a temporary, generalized hair loss followed by the growth of new hair. Hair loss may also be caused by infection or by use of corticosteroids or other lupus medications. A severe lupus flare could result in defective hair growth, causing the hair to be fragile and break easily.

Vasculitis: This is a condition in which the blood vessels become inflamed. Very small blood vessels can break and cause bleeding into the tissues, resulting in tiny, reddish-purple spots on the skin known as petechiae (pe-teke-ee-ah). Larger spots are called purpura and may look like a bruise. Vasculitis can also cause blood clots to form, skinulcers to develop, and small black areas to appear around fingers and toenails. These black areas are a sign of serious tissue damage. If they begin to develop, see your doctor immediately.

Raynaud’s phenomenon: This is a condition in which the blood vessels of the fingers and toes react in an extreme way to cold or stress. They suddenly get very narrow (vasoconstrict). This decreases the blood supply going through the vessel. As a result, the fingers and toes become cold and can become pale or bluish. Pain or tingling can occur when the hands and feet warm up and circulation returns to normal.

Drug-induced skin changes: Some drugs used to treat lupus, such as corticosteroids, immunosuppressives, and antineoplastics, can affect the skin. Your doctor or nurse will review these side effects with you if one of these drugs has been prescribed.

Caring For Yourself

• Reduce your exposure to the sun and to some sources of artificial light (especially fluorescent and halogen bulbs). The skin of people with lupus is very sensitive to the UV light that comes from these sources.
• Limit outdoor activity between the hours of 10 a.m. and 4 p.m. This may mean a big change in your lifestyle if you work or play outdoors a lot.
• Wear a sunscreen on exposed areas of skin. It should have a sun protection factor (SPF) of 15 or higher. Be sure that the sunscreen protects against both UVB and UVA rays.
• Wear sunscreen all year round and on cloudy days as well as on sunny days. Also wear it indoors if you spend a lot of time in a room with many windows (glass does not filter out UV rays).
• Wear protective clothing, such as hats with wide brims and clothing made of tightly woven material. Thin, loosely woven material allows UV light to penetrate to the skin.
• Be aware of fluorescent light and halogen lamps. They can be found in many places and include floor lamps, overhead lights, photo-copiers, and slide projectors. Sunscreen and protective clothing can help.
• Tell your doctor immediately if any rash or sore appears or gets worse.
• If your doctor prescribes a medication for your skin condition, be sure to take it as directed.
• Try rinsing your mouth with salt water and eating soft foods if you have mouth ulcers. A number of other treatments and preparations are available to treat mouth ulcers as well as those in the nose and vagina.
• Avoid preparations or medications you know will make your skin condition worse. These might include hair dyes, skin creams, certain drugs that can make you more sensitive to the sun (for example, tetracyclines or diuretics), and things you are allergic to.
• It’s okay to wear makeup, but try hypoallergenic brands. A brand that also includes UV protection would be good to use.
• If you have Raynaud’s phenomenon, dress warmly in cold weather. Pay particular attention to keeping your hands and feet warm. Keeping your home warm will also help prevent an attack. Avoid smoking, caffeine, and stress — all of these can contribute to Raynaud’s phenomenon.
• If you have trouble maintaining a positive attitude about your appearance or your lupus, call your doctor or nurse to discuss your feelings and concerns.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, January 1999