Lupus Rash

Skin rashes are a common sign of lupus. A lupus rash is a patch of inflamed, itchy, bumpy and discolored skin. These rashes can happen anywhere on your body. Some of the most common locations on your skin include:

• Arms
• Back
• Face
• Hands
• Neck

A common lupus rash is a butterfly-shaped facial rash, known as a malar rash. This rash reaches across your nose, from cheek to cheek. There are other kinds of lupus rashes that vary based on the type of lupus you have.

You can have lupus with or without the rash. But lupus rashes tend to come and go or flare up unexpectedly. Most lupus rashes develop on sun-exposed areas of your skin. Your skin may be sensitive to light or the sun’s ultraviolet (UV) rays, which may trigger the rash or make it worse.

A healthcare provider can help you manage this symptom and its underlying cause.

Lupus rash types

There are different types of rashes based on the type of lupus that causes them. Cutaneous lupus, or skin lupus, causes chronic inflammation in your skin. Different subtypes of cutaneous lupus cause different rash symptoms.

Discoid lupus rash

Discoid lupus erythematosus (DLE), or chronic cutaneous lupus, is the most common form of cutaneous lupus. A discoid lupus rash typically appears on your face and scalp, but it can also affect any part of your body. Discoid lesions on your scalp may cause temporary or permanent hair loss.

A discoid lupus rash typically:

• Doesn’t itch or cause pain
• Has circular, coin- or disk-shaped patches that are thick and scaly
• May scar or discolor skin (lighter or darker than your natural tone or red to purple) when it heals

Chronic discoid lupus rashes or sores may put you at risk for skin cancer. Discoid sores on your lips or inside of your mouth may develop a type of skin cancer called squamous cell carcinoma.

Subacute cutaneous lupus erythematosus rash

Subacute cutaneous lupus erythematosus (SCLE) rashes tend to develop on parts of your body that get a lot of sun, such as your arms, shoulders, chest and neck.

The features of an SCLE rash include:

• Comes on quickly and isn’t present all the time (subacute)
• Isn’t painful or itchy.
• Won’t scar when it heals but might cause permanent discoloration (lightening or darkening) of your skin
• Skin discoloration (redness or darker than your natural skin tone)
• Shapes that connect to form interlocking circles

Acute cutaneous lupus erythematosus rash

Acute cutaneous lupus erythematosus (ACLE) rashes happen when you have a flare-up of lupus symptoms. This means that the disease is active when you experience the rash. The rash usually occurs on your face, arms, legs or other parts of your body.

A butterfly rash (malar rash) may happen with ACLE. These rashes may cause a patch of skin with:

• Bumps
• Discoloration (pink to red or darker than your natural skin tone)
• Pain (burning sensation)
• Scales

Rarely, ACLE also causes:

• Canker sores (painful sores in your mouth)
• Hives (raised, painful bumps)
• Temporary hair loss

Other types of lupus rashes

Other types of cutaneous lupus rashes may include:

• Chilblain lupus rash. This type presents with patches of itchy, painful, tender, discolored bumps that are triggered in cold and wet temperatures.
• Lupus erythematosus tumidus rash. This is raised patches (plaques) with bumps and skin discoloration. This rash doesn’t leave permanent skin changes when it heals.
• Lupus panniculitis (lupus profundus) rash. This is a type of lupus that affects deep layers of your skin. It causes ulcers and permanent skin indentations when the ulcers heal.
• Neonatal lupus erythematosus rash. Affecting newborns, a skin rash may be discolored with circular shapes. It usually affects your child’s head, face and neck.

What causes a lupus rash to flare up?

There are many things within your environment that can cause a lupus rash to flare up (happen). One of the most common triggers is light exposure from the sun or artificial light sources. Lupus is an autoimmune condition, and your immune cells may react to light. These cells release chemicals to cause inflammation, which is what you see when a rash occurs on your skin.

Next to light exposure, other common lupus rash triggers include:

• An infection
• An injury
• Certain medications
• Smoke exposure
• Stress
• Temperature changes

Your healthcare provider can help you determine what causes this symptom to flare up, as triggers are different for everybody.

Lupus rash treatment

Your healthcare provider may offer different medications to treat rash symptoms and help them go away. There are different treatment options depending on the type of lupus rash you have, including:

• Antibiotics
• Antimalarial medication
• A retinoid
• A topical corticosteroid cream or a corticosteroid injection
• Biologics
• Immunosuppressants
• Topical tacrolimus ointment

Your provider will help you choose the best treatment option for your body’s needs.

How long do lupus rashes last?

Lupus rashes can last for days to weeks. Some types of rashes, like discoid lupus rashes, may last for months to years in some cases. Some rash complications may be permanent, like scarring, although they may fade over time or with treatments.

A healthcare provider can help you manage a lupus rash to help it go away sooner.

When should I call my healthcare provider?

You should call your provider if you experience lupus rashes that:

• Appear on your lips or inside of your mouth
• Appear suddenly, without a known cause
• Get worse after treatment
• Itch or cause pain
• Linger for weeks

You may want to ask your provider:

• What type of lupus rash do I have?
• What’s causing the lupus rash?
• How should I treat the rash?
• What steps can I take to prevent a future rash?

How can I prevent a lupus rash?

Learning about what causes and triggers lupus rashes on your skin and taking steps to avoid those triggers can help prevent some lupus rashes. But not all lupus rashes are preventable.

For example, if you have photosensitive skin (light sensitivity), you can take these steps to protect yourself from sun damage and light exposure:

• Apply a broad-spectrum sunscreen every day, even when indoors. Reapply sunscreen every two hours.
• Avoid going outside between 10 a.m. and 4 p.m., when the sun’s rays are strongest.
• Don’t use tanning beds.
• Wear clothing and accessories that cover your skin, like long sleeves and a wide-brimmed hat.
• Install lower-intensity lightbulbs and UV-protective window coverings at home.
• Relocate your workspace away from windows.