Cutaneous Lupus (Skin Lupus)

What is cutaneous lupus erythematosus (skin lupus)?

Systemic lupus is a type of autoimmune disease where your immune system attacks your body, including your internal organs. In cutaneous (skin) lupus, your immune system attacks your skin. About 10% of all lupus cases are cutaneous and 65% of people with systemic lupus will develop skin lupus.

Women are much more likely to have lupus. Around 90% of people with lupus are women between ages 15 to 44. However, people of all genders and ages can get it. Lupus in children usually develops around age 12. Your risk of developing lupus is higher if you have a relative with lupus or another autoimmune disorder.

Women of color are about two to three times more likely to have lupus. It’s much more common among women who are Black, Hispanic or of Asian descent.

Are there different types of cutaneous lupus?

There are three types of cutaneous (skin) lupus. Each type has similar symptoms, including a red, scaly rash that often results from exposure to the sun.

The three kinds of cutaneous lupus are:

Discoid cutaneous lupus

In this type of cutaneous lupus, the skin lesions are round (disk-shaped), thick, scaly and red. You may experience symptoms including pain, itching and burning. In some cases, you may not experience any symptoms. Most often, symptoms will develop on your face, ears or scalp. However, you can develop symptoms on other parts of your body too. This condition can sometimes cause scarring and discolorations on your skin (skin can turn darker or lighter). If you develop this condition on your scalp, it might lead to hair loss which may be permanent.

Discoid lesions that have been on your skin for years can potentially develop into skin cancer. These lesions should be monitored carefully and any changes should be reported to your healthcare provider. If you have discoid lupus, your provider will schedule regular checkups to monitor your health.

Subacute cutaneous lupus

When you have subacute cutaneous lupus, red borders develop around the edges of these lesions. They can look like a ring with a darker red circle on the ring's outer edge. The skin is red and scaly. These lesions can result from a reaction to certain medications.

They appear most often on the neck, chest, upper back, shoulders and arms. They typically develop on areas that have been in the sun. They don’t usually hurt, itch or scar. Your skin can develop discolored areas.

Acute cutaneous lupus

This red rash often develops along the cheeks and the bridge of the nose, usually after sun exposure. Providers call this a malar rash or “butterfly rash” because of its shape. A malar rash looks like a sunburn and can also develop on other parts of your body, including the arms and legs. These rashes don’t usually scar, but skin discoloration can occur.

This characteristic “butterfly rash” is a sign of systemic lupus. People who develop this type of rash could have lupus symptoms in other areas of their body as well.

What are the symptoms of cutaneous lupus?

Symptoms of SLE and skin lupus can range from mild to severe and may come and go. They may “flare up” at certain times throughout your life. Physical and emotional stress, illness, injury and some medications can trigger a flare in people who have lupus.

Signs of skin lupus are similar among all types of the disease, but the rash usually looks a little different with each type. The rashes may be painful and they may itch but not always. They can get better or go away after a few days or weeks. These rashes may be permanent.

Symptoms of skin lupus include:

• Red, scaly areas of skin. They can be round, like a coin or a disk. Darker red rings or borders may outline the scaly patches. They can appear anywhere on your body, but they more commonly develop on areas that have had sun exposure.
• Rash that extends across the cheeks and over the bridge of the nose (butterfly rash). About 50% of people with lupus develop this type of rash.

What causes cutaneous lupus?

Skin lupus is not contagious (you can’t get it from or give it to another person). Healthcare providers aren’t sure what causes lupus. They believe it results from a combination of genes, hormones and environmental factors. Lupus runs in families, and scientists have found more than 50 genes that people with lupus commonly have.

Women are much more likely to get lupus, so providers think the female hormone estrogen plays a role in who develops the disease and when symptoms appear. Symptoms can flare up around a woman’s menstrual cycle or during pregnancy when estrogen levels are higher.

If you have cutaneous lupus, you can develop a rash when your immune cells cause inflammation in your skin. Symptoms of cutaneous lupus can flare up following exposure to ultraviolet (UV) rays. These rays are in both the sun and fluorescent lights. Lupus skin lesions are very sensitive to light. Some medications (including over-the-counter drugs for acid reflux) can also cause a flare of skin lupus.

How do healthcare providers diagnose cutaneous lupus?

If you know you have lupus, your healthcare provider can diagnose cutaneous lupus by examining your skin and evaluating the rash. Your provider may take a sample of your skin (skin biopsy) and send it to a lab for testing.

If you notice a rash but haven’t received a lupus diagnosis, your provider will do a thorough exam. They will ask about other symptoms and your family history of autoimmune disease.

What tests might I have to confirm a diagnosis of cutaneous lupus?

Symptoms of lupus can be similar to signs of other health conditions. There isn’t a single test for lupus. A diagnosis may require several tests over many months. These may include blood tests, urine tests and a skin or kidney biopsy.

How do healthcare providers treat cutaneous lupus?

Healthcare providers help people manage cutaneous lupus with lifestyle changes and medications. Your provider may recommend:

• Avoiding the sun and fluorescent light: Lupus skin lesions are extremely sensitive to natural and artificial light, so you should limit your exposure. Stay inside when the sun is strongest during the day, and wear a wide-brimmed hat, sun-protective clothing and sunscreen when you can’t avoid the sun.
• Injections: Your provider may use a needle to inject a corticosteroid medication directly into the rash. Steroid injections reduce inflammation. You may need these injections every few weeks.
• Oral medications: Healthcare providers have used a drug called hydroxychloroquine to treat systemic lupus for many years. It controls your body’s immune response. You may also need other drugs that suppress the immune system, such as methotrexate.
• Topical medications: Creams, lotions and ointments can reduce inflammation on the skin. You may need to apply these to your skin once or twice a day. Types of topical medications include corticosteroid creams and tacrolimus ointment (Protopic®).

You should see your provider regularly so they can monitor your health and adjust treatment. Since you will need to avoid the sun, your vitamin D levels might drop below normal levels. Your provider may prescribe vitamin D supplements.

Can I prevent cutaneous lupus lesions?

It isn’t possible to prevent cutaneous (skin) lupus. You may be able to prevent rashes from flaring up by avoiding the sun and limiting your indoor exposure to fluorescent light. To lower your risk of developing lupus skin rashes, you should:

• Avoid being outdoors in the sun when it’s strongest (between about 10 a.m. and 4 p.m.).
• Protect your skin with sunscreen that has both UVB and UVA protection (broad spectrum protection). Choose clothing that offers complete coverage.
• Wear a hat with a wide brim.

Certain medications can make you even more sensitive to light. Tell your provider about any medications you take so you can ensure that you’re protected from the sun. If you smoke, talk to your provider about a plan to help you quit.

What is the outlook for people with cutaneous lupus?

With the right treatments, lifestyle changes and regular monitoring, providers help many people manage cutaneous lupus. Early diagnosis and treatment can improve the prognosis by preventing scarring, hair loss and other long-term skin problems.

For the best possible outlook, you should avoid exposure to the sun, schedule frequent checkups and follow your healthcare provider’s directions carefully. Sticking to a treatment plan and making smart choices can lower your risk of lupus skin flare up.

When should I see my healthcare provider about cutaneous lupus?

If you have a rash that doesn’t go away in a day or two, call your healthcare provider. It’s important to see your provider whether you’ve received a lupus diagnosis or not. They will examine you and determine what’s causing the rash. Early diagnosis and treatment for lupus skin disease can improve your prognosis.

A note from Cleveland Clinic

Cutaneous lupus (skin lupus) can cause irritating and unsightly rashes. Untreated, these rashes can cause long-term damage, such as permanent hair loss, scarring and skin discoloration. Some types of cutaneous lupus can develop into skin cancer. It’s essential to see your provider regularly and follow their directions carefully. Avoid sun and light exposure by wearing a hat, protective clothing and sunscreen. These lifestyle changes may not be easy to adopt, but they can help you prevent a skin lupus flare-up.