Lupus and Itching
Lupus and skin problems tend to go hand in hand, especially for those with cutaneous lupus, which primarily affects the skin.
An ongoing poll on Lupus Corner revealed that 97% of respondents with lupus experienced skin manifestations and itchy skin. At the time of writing this article, there was a small response for those two questions, just over 30 people, but I was the only one who did not report itchy skin with lupus.
After asking my support group members, who all have systemic lupus, I found that most had skin involvement, including itching, and it was one of their most problematic lupus symptoms. So what causes lupus-related itching and how can you find relief?
What Causes Lupus Itching?
Any form of lupus can cause itching, but people with cutaneous lupus tend to have more frequent and intense itchiness than those with systemic lupus. Since lupus manifests in such a diverse manner among different people, the list of potential causes of lupus itching is very long. The leading causes, however, are rashes, dry skin, hives, organ involvement, and medications.
Rashes are common during lupus flares and can be itchy, hot, and irritating. The heat from a lupus rash can easily dry out skin, and dry skin usually leads to itchiness. Many lupus patients also have Sjögren’s Syndrome, which causes dryness throughout the body due to damage to the exocrine glands.
Hives that last more than 24 hours in lupus patients are typically caused by inflammation in the small blood vessels (this is called urticarial vasculitis) that restricts blood flow. It is estimated that 10% of people with lupus experience these hives, which may look like lesions and itch.
Itching can occur when lupus attacks organs, especially the liver or the kidney. Lupus nephritis can lead to kidney failure; waste products build up in the blood when the kidneys aren’t working correctly and they can cause severe itching. Other lupus-related issues, such as anemia or thyroid problems, can also cause itching.
Medications that people take because of lupus can also cause itching – it’s particularly known to happen with narcotic pain medications. Even medications that are supposed to relieve itching, such as prednisone, can end up causing it. Lupus warriors are often exposed to many different medications, and their bodies may not react as expected, or they may suddenly become sensitive to a particular medication.
The Relationship Between Lupus and Itching
As with most lupus symptoms, the itching will typically be provoked by a flare. Determining the unique relationship between one person and their itching will depend on the reason behind it, although the immune system is typically the culprit.
A 2016 study published in the Journal of the American Academy of Dermatology, looked at how immune system dysfunction is related to itching and found that high blood levels of IgE, an immunoglobulin connected to elevated inflammation levels, was found in people experiencing itchiness. They also found high levels of eosinophils in those people, which are known to occur with allergic inflammation.
Allergic reactions happen when the immune system begins to attack a substance in the body, so it could be that lupus is causing something akin to an allergic reaction when people with lupus experience itching.
There is not a singular relationship between lupus and itching. The itching can happen with or without rashes, it can be all over or just in one spot, it may be from the immune system or a side effect. Someone could be experiencing itching that has been blamed on lupus, but it’s coming from another condition; any long term itching should be discussed with your rheumatologist and a dermatologist as well.
How to Relieve Lupus Itching
Finding the cause of your lupus itching is the first step in relieving it. For some people, avoiding flare triggers, such as sunlight or stress, is all that’s necessary. For others, it may mean starting a new medication – especially if lupus is attacking the skin.
Treating Dry Skin
If dry skin is the source of the itchiness, which it often is, there are many ways to treat it.
You need to stay hydrated, increase humidity, avoid hot water when bathing, and moisturize regularly. Choosing the correct moisturizer is important because some have alcohols that dry out skin – look for moisturizers that include zinc oxide.
Itch Relief Medications
You may want first try simple itching remedies, such as aloe, coconut oil, calamine lotion, or body butters. However, if those don’t work or your itching becomes more serious, several medicinal options can help.
Corticosteroids and antihistamines are the main medications used for itchy skin. Corticosteroids can be applied topically to itchy patches, although they may be taken orally if you’re experiencing widespread itching. There are even steroid shampoos and foaming sprays to help with itchy scalps.
When lupus is attacking the skin as an organ, then traditional lupus medications such as hydroxychloroquine, immunosuppressants, and/or belimumab may be utilized. In extreme cases of itchiness, thalidomide may be used – but it’s a strong and dangerous drug that should be taken with caution.
Ultimately, it’s important to find the source of lupus-related itching and not to scratch the itchy area (as hard as that may be) and have recurring itching treated by a dermatologist who has experience with lupus.