Lupus Panniculitis

Lupus panniculitis is a rare form of lupus that causes painful bumps under your skin. Healthcare providers also call it lupus erythematosus panniculitis, lupus profundus or the abbreviation LEP.

Lupus is an autoimmune disease that makes your immune system damage your body instead of protecting it. There are lots of types. LEP is a subtype of cutaneous lupus — lupus that affects your skin.

Panniculitis is the medical name for inflammation in the layer of fat just below your skin. If you have lupus panniculitis, your immune system damages that fat layer. The inflammation leads to lumps or bumps called nodules.

Visit a healthcare provider if you notice any new growths or lumps on your body. They’ll diagnose the cause and help you find the right treatments.

Symptoms of lupus erythematosus panniculitis

The painful bumps under your skin are the most noticeable LEP symptom. Your skin might look discolored in patches around them. The nodules can form anywhere on your body. But they’re most common on your:

• Face
• Neck
• Shoulders
• Arms
• Back
• Breasts
• Belly
• Thighs
• Butt

The nodules often feel:

• Sensitive to touch
• Hard, like a pencil eraser is trapped under your skin
• Itchy

Lupus panniculitis nodules usually appear quickly and last for days or weeks. Eventually, they’ll go away. But they almost always come back later on. These symptoms happen in periods called episodes or flares.

If the nodules come and go in the same spot, they might eventually cause scarring. Over time, they can damage the fat under your skin so much it breaks down. This can lead to that area looking deflated or not as firm as the skin around it. Your skin may look or feel indented. This is called pitting.

Lupus profundus causes

Experts aren’t sure what causes lupus erythematosus panniculitis. Lupus is an autoimmune disease. So, experts think LEP may be, too. It might happen when your immune system attacks the fat under your skin. But researchers are still studying it to understand how and why it happens.

Lupus erythematosus panniculitis usually starts causing symptoms when you’re around 30 years old. It seems more common in females. But it’s so rare, this might just be a coincidence and not a solid fact.

Some risk factors may include:

• Exposure to too much UV radiation, whether from the sun or artificial sources of UV light like tanning beds
• Smoking
• Taking tumor necrosis factor (TNF) inhibitors
• Having a condition that affects your T cells, like DiGeorge syndrome or HIV

How doctors diagnose this condition

A healthcare provider will diagnose lupus panniculitis by examining your skin and running some tests. Tell your provider when you first noticed the nodules or other changes. Let them know if any activities seem to trigger the nodules.

Your provider will ask about your medical history, including conditions you may currently have and how you’re treating or managing them.

You might need a few tests to help your provider diagnose LEP. They’ll usually rule out other, more common conditions first. You may need:

• A biopsy to look for signs of damage or inflammation
• Blood tests to see if your immune system is working well
• Urinalysis to check your pee for signs of issues
• An ANA test that will show specific antibodies

How is it treated?

Your provider will suggest treatments that manage the symptoms. Some common lupus panniculitis treatments include:

• Hydroxychloroquine: This medication usually treats malaria. But it can also relieve LEP symptoms and slow down how often you have them.
• Corticosteroids: These are prescription anti-inflammatory medications. Your provider will tell you which ones are best for you. Prednisone is a common option.
• Methotrexate: This medicine usually treats autoimmune conditions like rheumatoid arthritis. But it can help manage LEP symptoms, too. It’s another type of anti-inflammatory.
• Immunosuppressants: These medications slow down your immune system. This can help prevent tissue damage and inflammation.
• Avoiding UV exposure: Your provider will suggest ways to limit how much UV light hits your skin. Using sunscreen with an SPF of 30 or more, wearing special sun-protective clothing and limiting your time in the sun can all help.

Like all kinds of lupus, there isn’t a cure for LEP. But your provider will help you find treatments that protect your skin. You might experience fewer symptom flares after starting treatment. And the episodes may be milder.

When should I see my healthcare provider?

Visit a healthcare provider if you notice any new lumps or bumps on your skin. Especially if they hurt or are sensitive to touch.

Let your provider know if you’re having lupus panniculitis flares more often, or if the symptoms are more severe than before. They might be able to tweak your treatments.

Your provider will tell you how often you’ll need follow-up skin exams and tests. They’ll monitor any changes in your body.

What can I expect if I have this condition?

You should expect lupus erythematosus panniculitis symptoms to come and go for the rest of your life. The flares should be less severe once you find the right treatments. You might enter remission. This is a long period between episodes of symptoms. Remission can last months or years. But there’s always a chance the symptoms may come back. Your healthcare provider will help you understand what to expect.