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