This image displays the red, slightly scaly, elevated lesions on the cheeks and nose in systemic lupus erythematosus.
This image displays the red, slightly scaly, elevated lesions on the cheeks and nose in systemic lupus erythematosus.
This image displays redness and deep red-purple lesions on the cheeks and nose in a
This image displays redness and deep red-purple lesions on the cheeks and nose in a "butterfly" distribution typical of systemic lupus erythematosus.
This image displays bleeding from small capillaries under the nail in a person with systemic lupus.
This image displays bleeding from small capillaries under the nail in a person with systemic lupus.
This image displays deep red and purple skin lesions due to inflammation of blood vessels with systemic lupus erythematosus.
This image displays deep red and purple skin lesions due to inflammation of blood vessels with systemic lupus erythematosus.
This image displays how inflammation in systemic lupus can be intense, causing very red skin lesions.
This image displays how inflammation in systemic lupus can be intense, causing very red skin lesions.
This image displays the cheeks and nose of a patient affected by systemic lupus that has been aggravated by sun exposure.
This image displays the cheeks and nose of a patient affected by systemic lupus that has been aggravated by sun exposure.
The rash of systemic lupus often involves the hands, as displayed in this image.
The rash of systemic lupus often involves the hands, as displayed in this image.
This image displays a case of lupus on the backs of the hands, worsened by sun exposure.
This image displays a case of lupus on the backs of the hands, worsened by sun exposure.
The dull red patches of systemic lupus are prominent in sun-exposed areas. When these patches are seen on the cheeks, one can imagine why the term
The dull red patches of systemic lupus are prominent in sun-exposed areas. When these patches are seen on the cheeks, one can imagine why the term "butterfly rash" is used.

Images of Systemic Lupus Erythematosus (9)

This image displays the red, slightly scaly, elevated lesions on the cheeks and nose in systemic lupus erythematosus.
This image displays redness and deep red-purple lesions on the cheeks and nose in a
This image displays bleeding from small capillaries under the nail in a person with systemic lupus.
This image displays deep red and purple skin lesions due to inflammation of blood vessels with systemic lupus erythematosus.
This image displays how inflammation in systemic lupus can be intense, causing very red skin lesions.
This image displays the cheeks and nose of a patient affected by systemic lupus that has been aggravated by sun exposure.
The rash of systemic lupus often involves the hands, as displayed in this image.
This image displays a case of lupus on the backs of the hands, worsened by sun exposure.
The dull red patches of systemic lupus are prominent in sun-exposed areas. When these patches are seen on the cheeks, one can imagine why the term

Systemic Lupus Erythematosus

Systemic lupus erythematosus, often simply called lupus, is a chronic inflammatory disease that can affect almost any part of the body, especially the skin, joints, kidneys, heart, lungs, bones, blood, or brain. Systemic lupus erythematosus is considered an autoimmune disorder, meaning that a person’s own immune system attacks their healthy cells and tissues, causing inflammation and damage.

Because systemic lupus erythematosus can affect any organ system, no two people have identical forms of the disease. However, most people with systemic lupus erythematosus report periods of time in which their symptoms seem to be mild or absent (remission) and other periods of time when the inflammation is more severe (flare or relapse).

Who's At Risk?

Systemic lupus erythematosus can occur in people of any age, race / ethnicity, or sex. However, it is far more common in women, especially those aged 15-45 years, and especially Black women.

Although it is not directly inherited, lupus and other autoimmune diseases may run in families. Inheriting certain genes may make some people more susceptible to developing lupus.

In addition, certain environmental factors may trigger lupus in those who have a genetic tendency toward the disease, including:

  • Ultraviolet light, especially sunlight.
  • Certain medications, especially hydralazine and procainamide.
  • Infections.
  • Antibiotics, especially penicillins and sulfa-containing medicines.
  • Stress.
  • Hormonal changes, especially related to pregnancy and menstrual cycles.

Signs & Symptoms

More than 90% of people with systemic lupus erythematosus have skin symptoms. The most common locations for the skin lesions of systemic lupus erythematosus include the:

  • Face, especially the cheeks and nose.
  • Sun-exposed skin on the arms, backs of hands, upper chest, and upper back due to increased sensitivity to sunlight (photosensitivity).
  • Fingers and fingernails.
  • Inside the mouth or nose.
  • Scalp.

The classic skin finding in systemic lupus erythematosus is the malar blush, commonly called the “butterfly rash.” Redness across the cheeks and bridge of the nose can occur after sun exposure and may appear several weeks before other symptoms develop.

The rash appears as red, scaly patches (flat areas larger than a thumbnail). In darker skin colors, the redness may be subtle or may appear purple or brown.

The skin around the fingernails can be inflamed, and tiny, dilated blood vessels may be seen. In addition, people may develop Raynaud phenomenon, in which the fingers (and sometimes toes) turn pale, blue and reddish, and numb after exposure to cold temperatures.

Small, painless ulcers (wounds or sores that are missing skin) can develop in the nose or, more commonly, in the mouth, especially on the roof of the mouth.

When lupus affects the skin on the scalp, there may be hair loss in the area. It may be patchy, or there may be thinning across the scalp, especially at the temples.

In addition to the skin lesions of lupus, people may have:

  • Joint pain or swelling, especially in hands, wrists, and knees.
  • Blood problems, including anemia and clotting disorders.
  • Kidney disorders.
  • Lung problems, such as painful breathing.
  • Seizures or other brain disorders.
  • Swollen lymph glands.
  • Fever.
  • Fatigue.

Self-Care Guidelines

If you have systemic lupus erythematosus, several measures can help prevent flares:

  • Avoid intense sun exposure.
  • Apply sunscreen that blocks UVB and UVA rays (ie, broad spectrum) with SPF 30 or higher every day.
  • Maintain healthy habits such as resting well, eating a balanced diet, and exercising regularly.
  • Reduce stress.
  • Avoid smoking and limit alcohol use.

Treatments

In addition to a careful review of your medical history, your medical professional may perform blood tests, urinalysis, chest x-ray, or other imaging tests, depending on which organ systems are involved, before confirming the diagnosis of lupus. If you have a rash that is suspicious for lupus, you may need a skin biopsy.

Treatment depends greatly on which organs are affected and how severe your symptoms are. In general, however, the following oral medications are frequently used for lupus:

  • Antimalarial drugs such as hydroxychloroquine
  • Glucocorticoids
  • Anti-inflammatory medications such as aspirin, ibuprofen, naproxen, or indomethacin
  • Immune-suppressing medications including methotrexate, mycophenolate mofetil, azathioprine, cyclophosphamide, cyclosporine

Other medications that are sometimes used for lupus include belimumab, rituximab, and anifrolumab.

Visit Urgency

See your medical professional if you develop a rash with fever and fatigue.

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.

Last modified on June 18th, 2024 at 8:26 am

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