Skin problems are very common in people with lupus. Some skin rashes and sores (also called lesions or ulcers) are very specific to lupus, while others can occur in other diseases as well. Sensitivity or too much exposure to the ultraviolet (UV) rays of sun and to some types of artificial light are responsible for aggravating some rashes and lesions. Many types of skin conditions are common in lupus.

Butterfly rash: This rash over the nose and cheeks can range from a faint blush to a rash that is very severe, with scaling. It is very sensitive to light and appears to get worse when skin is exposed to sun or certain types of artificial light. The rash may be permanent or may come and go.

Discoid lesions: These scarring, coinshaped lesions are seen on areas of the skin that have been exposed to UV light. They may also occur on the scalp and produce a scarring, localized baldness that is permanent.

Subacute cutaneous lesions: These nonscarring, red, coin-shaped lesions are very sensitive to UV light. They can appear scaly and can mimic the lesions seen in psoriasis. They may occur only on the face or cover large areas of the body.

Mucous membrane lesions: Mouth ulcers are sometimes seen in people with lupus. Nose and vaginal ulcers may also occur. These lesions are usually painless.

Hair loss: In addition to losing hair because of discoid lesions, some people with lupus may develop a temporary, generalized hair loss followed by the growth of new hair. Hair loss may also be caused by infection or by use of corticosteroids or other lupus medications. A severe lupus flare could result in defective hair growth, causing the hair to be fragile and break easily.

Vasculitis: This is a condition in which the blood vessels become inflamed. Very small blood vessels can break and cause bleeding into the tissues, resulting in tiny, reddish-purple spots on the skin known as petechiae (pe teke-ee-ah). Larger spots are called purpura and may look like a bruise. Vasculitis can also cause blood clots to form, skin ulcers to develop, and small black areas to appear around fingers and toenails. These black areas are a sign of serious tissue damage. If they begin to develop, see your doctor immediately.

Raynaud's phenomenon: This is a condition in which the blood vessels of the fingers and toes react in an extreme way to cold or stress. They suddenly get very narrow (they "vasoconstrict"). This decreases the blood supply going through the vessel. As a result, the fingers and toes become cold and can turn pale or bluish. Pain or tingling can occur when the hands and feet warm up and circulation returns to normal.

Drug-induced skin changes: Some drugs used to treat lupus, such as corticosteroids, immunosuppressives, and antineoplastics, can affect the skin. Your doctor or nurse will review these side effects with you if one of these drugs has been prescribed.

Caring for Yourself Reduce your exposure to the sun and to some sources of artificial light (especially fluorescent and halogen bulbs). The skin of people with lupus is very sensitive to the UV light that comes from these sources. Limit outdoor activity between the hours of 10 a.m. and 4 p.m. This may mean a big change in your lifestyle if you work or play outdoors a lot. Wear sunscreen on exposed areas of skin. It should have a sun protection factor (SPF) of 15 or higher. To be sure that your sunscreen protects against both UVA and UVB rays, look for one labeled broad-spectrum protection, or look for ingredients such as micronized zinc oxide or titanium dioxide that block both UVA and UVB. Wear sunscreen all year round and on cloudy days as well as on sunny days. Also wear it indoors if you spend a lot of time in a room with many windows (UVA rays can penetrate glass). Wear protective clothing, such as hats with wide brims and clothing made of tightly woven material. Thin, loosely woven material allows UV light to penetrate to the skin. If you are very sensitive to the sun, you may want to try specially designed UV- protective clothing. Be aware of fluorescent light and halogen lamps. Found in many places, they include floor lamps, overhead lights, photocopiers, and slide projectors. Sunscreen and protective clothing can help. If you work in an office that has fluorescent lights, ask whether you can remove the bulbs directly over your work area, and use a desk lamp if necessary. Tell your doctor immediately if any rash or sore appears or gets worse. If your doctor prescribes a medication for your skin condition, be sure to take it as directed. Try rinsing your mouth with salt water and eating soft foods if you have mouth ulcers. A number of other treatments and preparations are available to treat mouth ulcers as well as those in the nose and vagina. Avoid preparations or medications you know will make your skin condition worse. These might include products such as hair dyes and skin creams. Also, some drugs can make you more sensitive to the sun. These include tetracycline antibiotics, diuretics and, ironically, some of the drugs (nonsteroidal anti inflammatory drugs, methotrexate, hydroxychloroquine) used in lupus treatment. Be particularly conscious of sun protection if you are taking any of these drugs. It's okay to wear makeup, but try hypoallergenic brands. A brand that also includes UV protection would be good to use. If you have Raynaud's phenomenon, dress warmly in cold weather. Pay particular attention to keeping your hands and feet warm. Keeping your home warm will also help prevent an attack. Avoid smoking, caffeine, and stress - all of these can contribute to Raynaud's phenomenon. If you have trouble maintaining a positive attitude about your appearance or your lupus, call your doctor or nurse to discuss your feelings and concerns.

Source: National Institutes of Health, U.S.Dept of Health and Human Services