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Lupus and your skin: Diagnosis and treatment


When lupus affects your skin, a dermatologist may be part of your care team. This doctor specializes in diagnosing and treating conditions that affect the skin, hair, and nails.

How do dermatologists diagnose lupus on the skin?

When lupus affects the skin, a dermatologist will examine your skin. The doctor will look closely at the rash, patch, or other skin (or hair) problem. Your dermatologist may also ask if you have sores inside your mouth or nose. If you have these, be sure to tell your dermatologist.

Different types of lupus affect the skin. To learn which type affects your skin, your dermatologist may remove a bit of the diseased skin so that it can be examined under a microscope.

Removing the skin is a simple procedure, which your dermatologist can perform during an office visit. Called a skin biopsy, this procedure is often enough to determine whether the rash or other skin problem is cutaneous (medical term for skin) lupus.

Your dermatologist may also ask you about the medicines that you take. Some medicines can cause a type of lupus called drug-induced lupus. Be sure your dermatologist has a list of all the medicines you take.

How do dermatologists treat lupus on the skin?

To treat the lupus on your skin, your dermatologist will:

  • Tell you how to protect your skin from the sun

  • Prescribe medicine, if necessary

  • Recommend other lifestyle changes

Medicines that dermatologists prescribe to treat lupus on the skin include:

  • Corticosteroid that you apply to your skin or take as a pill: This helps to reduce the inflammation and clear the skin.

  • Corticosteroid that your dermatologist injects: This can help clear a thick patch on the skin or area of hair loss.

  • Antimalarial medicine: Developed to treat and prevent malaria, this medicine can also effectively treat lupus on the skin.

  • Steroid-sparing medicine that you apply to your skin: This works like a corticosteroid to reduce the inflammation and clear the skin.

  • Medicine that works on the immune system: These medicines include methotrexate, cyclosporine, and mycophenolate mofetil. They help calm the immune system.

Your treatment plan may include more than one medicine. This can increase how well the treatment plan works.

The goal is to clear the skin.

Preventing hair loss due to discoid lupus

If you have discoid lupus, clearing your skin can reduce your risk of scars, permanent hair loss, and discolored skin.

When discoid lupus forms on the scalp, you want to treat it early. Early treatment can prevent permanent hair loss.

To treat discoid lupus, your dermatologist may inject a thick patch with a corticosteroid to help it clear. An antimalarial medicine or a corticosteroid that you apply to your skin can help clear thinner patches.

If the patch turns into a scar, hair cannot regrow.

Drug-induced lupus requires different treatment

If your dermatologist thinks that a medicine you take is causing the lupus, you may need to stop taking the drug. You should work with your dermatologist or another doctor to find out.

Stopping some drugs like heart medicines can have serious consequences. You may need to start another drug or therapy immediately.

If you have drug-induced lupus, though, stopping the drug is the only way to find out. Testing cannot find out which drug is causing the lupus. If the lupus starts to clear a few months after you stop taking the drug, then the drug is likely the cause.

Drugs that most frequently cause drug-induced lupus are medicines used to treat high blood pressure like hydralazine and medicines used to treat heart disease like procainamide and quinidine.

Once the drug that causes the lupus is stopped and the symptoms clear, drug-induced lupus is considered cured.

When lupus on your skin clears

You may see unwanted side effects after a rash or other skin problem clears. Some people have dark or light spots on their skin. You may see a scar. If this happens, talk with your dermatologist. Your dermatologist may be able to treat these unwanted side effects.

Outcome: What can someone with cutaneous lupus expect?

Most people who have cutaneous lupus can lead active and productive lives. Treatment helps because it can clear the skin and reduce the effects that lupus has on your life. There is currently no cure for cutaneous lupus.


References
Costner MI, Sontheimer RD. “Lupus erythematosus” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008:1515-35.

Kuhn A, Gensch K, et. al. “Efficacy of tacrolimus 0.1% ointment in cutaneous lupus erythematosus: A multicenter, randomized, double-blind, vehicle-controlled trial.” J Am Acad Dermatol. 2011 Jul;65(1):54-64.

Kuhn A, Rutland V, et al. “Cutaneous lupus erythematosus: Update of therapeutic options: Part 1.” J Am Acad Dermatol 2011 Dec;65:(6)179-93.

Okon LG, Werth VP, “Cutaneous lupus erythematosus: Diagnosis and treatment.” Best Pract Res Clin Rheumatol. 2013 Jun;27(3): 391-404.

Vedove CD, Simon JC, et al. “Drug-induced lupus erythematosus with emphasis on skin manifestations and the role of anti-TNFα agents.” J Dtsch Dermatol Ges. 2012 Dec; 10(12): 889–97.

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