Lupus and your skin: Overview

Butterfly rash of lupus

If you have a butterfly rash, lupus may be affecting more than your skin. A board-certified dermatologist can tell you.

How does lupus affect the skin?

Lupus can affect the skin in many ways. Some ways that it appears on the skin include:

• A widespread rash on your back

• A butterfly-shaped rash on your face

• Thick, scaly patches on your face

• Sores inside your mouth or nose

• A flare-up on your skin that looks like a sunburn

Sometimes, the rashes, sores, and other lesions burn or itch.

What types of lupus can affect the skin?

When people say "lupus," they’re usually referring to the most common — and serious — type of lupus, which is systemic lupus erythematosus (SLE). This type of lupus is an autoimmune disease, a disease that develops when your immune system attacks part of your own body.

If you have SLE, your immune system can attack your joints and different organs throughout your body.

One organ that your immune system may attack is the skin. When the immune system attacks healthy skin cells, people with SLE are diagnosed with cutaneous lupus.

You can also have cutaneous lupus without having SLE.

For many people, cutaneous lupus affects only their skin. Some types of cutaneous lupus are more likely to affect only or mostly the skin. These types of cutaneous lupus are:

Discoid lupus erythematosus: This is the most common type of cutaneous lupus. It causes a rash of disc-shaped patches that are raised, thick, and scaly. As the patches fade, dark spots and permanent scars may appear. People who have darker skin tones tend to develop more scarring and discoloration than people with lighter skin tones.

Lupus erythematosus tumidus: Firm, raised patches called plaques and bumps develop on the skin. The bumps and plaques clear without scarring or leaving other traces.

Lupus panniculitis or lupus profundus: This type affects the deepest layer of the skin, where deep-seated lumps form. As the lumps clear, they leave permanent hollows in the skin.

Chilblain lupus: Chilblains is a condition that causes itchy, tender, or painful bumps and patches on skin that’s exposed to damp cold. Chilblain lupus is also brought on by cold, especially a moist cold.

This type of lupus causes bumps and raised patches on the toes, fingers, and sometimes the nose, elbows, knees, and lower legs. These bumps and patches can be red to dusky purple in color.

Other types of cutaneous lupus tend to affect more than the skin. These are:

Subacute cutaneous lupus: Without strong sun protection, this type of lupus can quickly cause a rash. Some people develop a rash of ring-shaped patches with raised pink, red, or purplish crusted borders. Others get a scaly rash that can cover large areas of their skin and look like psoriasis or eczema.

Acute cutaneous lupus: This type often causes a butterfly-shaped rash across the nose and cheeks. The rash usually appears after being out in the sun and clears without scarring. After the rash clears, some people see patches of darker skin.

If you develop a butterfly rash, it can be a sign that lupus affects more than your skin. The butterfly rash can be the first noticeable sign of SLE, so it’s important to see your doctor if you develop this rash.

Instead of developing a butterfly rash, some people who have acute cutaneous lupus develop a widespread rash of small, raised, red or reddish-brown bumps on their chest, back, arms, or legs. This can also be a sign of SLE.

There are two other types of lupus. While both can affect the skin, they’re not considered types of cutaneous lupus because they don’t always affect the skin.

One of these is neonatal lupus erythematosus, a rare condition that develops in newborns. When this type of lupus affects the skin, you may see a rash. This rash usually consists of raised, slightly scaly, ring-shaped patches, which usually appear on the face, neck, or scalp.

You may see this rash when your baby is born or a few weeks after birth. The rash doesn’t need treatment. It disappears on its own, usually within 4 to 6 months of birth.

While the skin doesn’t require treatment, your baby will be watched closely. Neonatal lupus can cause problems with your baby’s blood, liver, or heart.

Drug-induced lupus erythematosus (DILE) is a lupus-like disease that occurs when certain medications are taken for months or years. DILE usually goes away when you stop taking the drug causing it.

This condition can affect different organs. Sometimes, the medication mostly affects the skin and is called drug-induced cutaneous lupus erythematosus (DICLE). What you see on your skin varies with the type of drug causing DICLE.

Is there a cure for cutaneous lupus?

There is no cure for any type of lupus, including the types that affect your skin.

Two types of lupus — drug-induced and neonatal lupus — tend to go away. When lupus is caused by a drug you took, the lupus-like effects usually go away when you stop taking the drug causing it.

If your child has neonatal lupus, it usually goes away on its own when the child is 4 to 6 months old. However, some children born with neonatal lupus have a type of heart disease called a congenital heart block. This causes a slow heartbeat that does not go away and requires treatment.

For the other types of cutaneous lupus, treatment can control, but not cure, the disease. Treatment includes medication and self-care like sun protection.

Getting treatment is important. Left untreated, some types of cutaneous lupus can damage your skin. For example, discoid lupus can cause scarring. When scarring occurs on the scalp, this can eventually lead to permanent hair loss. Treatment can prevent discoid lupus from worsening and new lesions from developing.

Seeing a board-certified dermatologist is important for another reason. If you have untreated discoid lupus on your skin for a long time, this may increase your risk of developing skin cancer.

Can you have lupus without having a rash?

Yes, you can. Only people who have some type of cutaneous lupus always develop a rash, sores, or other marks on their skin.

Some people who develop SLE, drug-induced lupus, or neonatal lupus never have signs of lupus on their skin.

Someone who has drug-induced lupus may have muscle and joint pain, flu-like symptoms, or discomfort caused by inflammation around their lungs or heart.

Signs of neonatal lupus in a newborn include liver disease, heart disease, and a low blood count.

How long does a lupus rash last?

This varies with the type of lupus that you have. Some rashes like the butterfly rash usually clear in a few days to weeks. After the rash clears, some people see discolored skin.

If you have discoid lupus, the raised, thick, and scaly patches can remain on your skin for months or years.

To see what the different types of cutaneous lupus look like, go to: Lupus and your skin: Signs and symptoms.

Images
Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References
Femia AN, Vleugels RA, et al. “Neonatal and pediatric lupus erythematosus.” Medscape. Last updated 5/17/2021. Last accessed 7/13/2022.

Gryka-Marton M, Szukiewicz D, et al. “An overview of neonatal lupus with anti-Ro characteristics.” Int J Mol Sci. 2021 Aug 27;22(17):9281.

He Y, Sawalha AH. “Drug-induced lupus erythematosus: An update on drugs and mechanisms.” Curr Opin Rheumatol. 2018 Sep;30(5):490-7. 

Lee LA, Werth VP. “Lupus erythematosus.” In: Bolognia JL, et al. Dermatology. (4th edition). Elsevier, China, 2018: 662-80.

Nozile W, Adgerson CN, et al. “Cutaneous lupus erythematosus in skin of color.” J Drugs Dermatol. 2015 Apr;14(4):343-9. 

Vleugels RA, Desai S, et al. “Discoid lupus erythematosus.” Medscape. Last updated 6/11/2020. Last accessed 7/13/2022.

Written by:
Paula Ludmann, MS

Reviewed by:
Brendan Camp, MD, FAAD
Mario J. Sequeira, MD, FAAD

Last updated: 9/23/22