Cutaneous Lupus (Discoid)
SLE is not the only type of lupus. While most people with SLE will experience lupus skin rashes, lupus can also be limited to the skin. There are three different types of lupus-specific skin disease:
Chronic Cutaneous Lupus Erythematosus (CCLE)
Also known as discoid lupus erythematosus (DLE), CCLE causes skin lesions that are thick and scaly. They can plug the hair follicles and are likely to leave scars.
The lesions usually do not itch and appear on the surface of exposed skin more often than unexposed skin. Those with discoid lupus should absolutely avoid the sun!
Studies indicate that approximately five percent of those who suffer from DLE will develop SLE later in life. Treatment options include steroids — in both ointment and pill form, anti-malarial medication, and other immunosuppressive drugs.
Subacute Cutaneous Lupus Erythematosus (SCLE)
Unlike DLE, the skin lesions displayed on those with SCLE are not thick and scaly, and do not generally leave scars. They do not itch, but can be tricky to treat because they seem to resist steroid creams and antimalarial medications.
Sun exposure can trigger more lesions, so those who suffer from SCLE should avoid the sun as much as possible and wear sunscreen and protective clothing when necessary. Research indicates that about 10 percent of patients with lupus have SCLE and half of those with SCLE will meet the conditions for SLE.
Acute Cutaneous Lupus Erythematosus (ACLE)
About 50 percent of those with SLE will experience ACLE at some point during the course of their disease. ACLE lesions are those that appear on exposed skin when skin inflammation is active and are generally triggered by sun exposure.
As with the other skin-specific lupus conditions, sunscreen and protective clothing is recommended when going outdoors.
Characteristics of Lupus-Related Skin Problems
- Mylar rash: The “butterfly” rash that covers the cheeks and the nose after sun exposure is fairly common in lupus sufferers. It can appear spontaneously and is often indicative of a coming flare.
- Photosensitivity: Often a direct cause of lupus skin problems, many with lupus struggle with this complication. Reactions similar to sunburn may occur — even when exposed to artificial UV lighting, so sunscreen should be worn at all times. Photosensitivity may indicate a flare is on the horizon.
- Livedo reticularis: This is a lacy “web” type rash that appears under the skin of lupus sufferers. It is usually purple or red in color and may be more prominent when exposed to cold.
- Raynaud’s phenomenon: This condition causes fingers and toes to change colors (white, blue, red) and results from exposure to cold environments. See my article about Raynaud’s to learn more.