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How is cutaneous lupus diagnosed?
Can a dermatologist test for lupus?
Is lupus affecting your skin?
Your dermatologist may also perform a skin biopsy, which involves removing a small amount of skin. The removed skin will be sent to a lab where it will be looked at under a microscope. This close-up view gives your dermatologist more clues about what is happening with your skin.
- Overview
- Symptoms and Causes
- Diagnosis and Tests
- Management and Treatment
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Cutaneous lupus is a type of lupus. It causes a red, scaly rash on the skin. Lupus is an autoimmune disease that causes your body to attack healthy tissues. Three types of cutaneous lupus cause different rashes to appear. The rashes often result from sun exposure. There’s no cure for skin lupus. Providers treat it with drugs and lifestyle changes.
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What are the symptoms of cutaneous lupus?
Symptoms of SLE and skin lupus can range from mild to severe and may come and go. They may “flare up” at certain times throughout your life. Physical and emotional stress, illness, injury and some medications can trigger a flare in people who have lupus. Signs of skin lupus are similar among all types of the disease, but the rash usually looks a little different with each type. The rashes may be painful and they may itch but not always. They can get better or go away after a few days or weeks. These rashes may be permanent. Symptoms of skin lupus include: Red, scaly areas of skin. They can be round, like a coin or a disk. Darker red rings or borders may outline the scaly patches. They can appear anywhere on your body, but they more commonly develop on areas that have had sun exposure. Rash that extends across the cheeks and over the bridge of the nose (butterfly rash). About 50% of people with lupus develop this type of rash. Advertisement
What causes cutaneous lupus?
Skin lupus is not contagious (you can’t get it from or give it to another person). Healthcare providers aren’t sure what causes lupus. They believe it results from a combination of genes, hormones and environmental factors. Lupus runs in families, and scientists have found more than 50 genes that people with lupus commonly have. Women are much more likely to get lupus, so providers think the female hormone estrogen plays a role in who develops the disease and when symptoms appear. Symptoms can flare up around a woman’s menstrual cycle or during pregnancy when estrogen levels are higher. If you have cutaneous lupus, you can develop a rash when your immune cells cause inflammation in your skin. Symptoms of cutaneous lupus can flare up following exposure to ultraviolet (UV) rays. These rays are in both the sun and fluorescent lights. Lupus skin lesions are very sensitive to light. Some medications (including over-the-counter drugs for acid reflux) can also cause a flare of skin lupus.
How do healthcare providers diagnose cutaneous lupus?
If you know you have lupus, your healthcare provider can diagnose cutaneous lupus by examining your skin and evaluating the rash. Your provider may take a sample of your skin (skin biopsy) and send it to a lab for testing. If you notice a rash but haven’t received a lupus diagnosis, your provider will do a thorough exam. They will ask about other symptoms and your family history of autoimmune disease. Advertisement
What tests might I have to confirm a diagnosis of cutaneous lupus?
Symptoms of lupus can be similar to signs of other health conditions. There isn’t a single test for lupus. A diagnosis may require several tests over many months. These may include blood tests, urine tests and a skin or kidney biopsy.
How do healthcare providers treat cutaneous lupus?
Healthcare providers help people manage cutaneous lupus with lifestyle changes and medications. Your provider may recommend: Avoiding the sun and fluorescent light: Lupus skin lesions are extremely sensitive to natural and artificial light, so you should limit your exposure. Stay inside when the sun is strongest during the day, and wear a wide-brimmed hat, sun-protective clothing and sunscreen when you can’t avoid the sun. Injections: Your provider may use a needle to inject a corticosteroid medication directly into the rash. Steroid injections reduce inflammation. You may need these injections every few weeks. Oral medications: Healthcare providers have used a drug called hydroxychloroquine to treat systemic lupus for many years. It controls your body’s immune response. You may also need other drugs that suppress the immune system, such as methotrexate. Topical medications: Creams, lotions and ointments can reduce inflammation on the skin. You may need to apply these to your skin once or twice a day. Types of topical medications include corticosteroid creams and tacrolimus ointment (Protopic®). You should see your provider regularly so they can monitor your health and adjust treatment. Since you will need to avoid the sun, your vitamin D levels might drop below normal levels. Your provider may prescribe vitamin D supplements. Care at Cleveland Clinic Lupus Treatment Find a Doctor and Specialists Make an Appointment
Can I prevent cutaneous lupus lesions?
It isn’t possible to prevent cutaneous (skin) lupus. You may be able to prevent rashes from flaring up by avoiding the sun and limiting your indoor exposure to fluorescent light. To lower your risk of developing lupus skin rashes, you should: Avoid being outdoors in the sun when it’s strongest (between about 10 a.m. and 4 p.m.). Protect your skin with sunscreen that has both UVB and UVA protection (broad spectrum protection). Choose clothing that offers complete coverage. Wear a hat with a wide brim. Certain medications can make you even more sensitive to light. Tell your provider about any medications you take so you can ensure that you’re protected from the sun. If you smoke, talk to your provider about a plan to help you quit.
What is the outlook for people with cutaneous lupus?
With the right treatments, lifestyle changes and regular monitoring, providers help many people manage cutaneous lupus. Early diagnosis and treatment can improve the prognosis by preventing scarring, hair loss and other long-term skin problems. For the best possible outlook, you should avoid exposure to the sun, schedule frequent checkups and follow your healthcare provider’s directions carefully. Sticking to a treatment plan and making smart choices can lower your risk of lupus skin flare up.
When should I see my healthcare provider about cutaneous lupus?
If you have a rash that doesn’t go away in a day or two, call your healthcare provider. It’s important to see your provider whether you’ve received a lupus diagnosis or not. They will examine you and determine what’s causing the rash. Early diagnosis and treatment for lupus skin disease can improve your prognosis. A note from Cleveland Clinic Cutaneous lupus (skin lupus) can cause irritating and unsightly rashes. Untreated, these rashes can cause long-term damage, such as permanent hair loss, scarring and skin discoloration. Some types of cutaneous lupus can develop into skin cancer. It’s essential to see your provider regularly and follow their directions carefully. Avoid sun and light exposure by wearing a hat, protective clothing and sunscreen. These lifestyle changes may not be easy to adopt, but they can help you prevent a skin lupus flare-up. Medically Reviewed Last reviewed by a Cleveland Clinic medical professional on 06/07/2021. Learn more about our editorial process.
He or she may perform a skin biopsy by removing a small piece of affected skin and sending it to a laboratory for testing. There are two common ways your doctor may perform a biopsy. One technique involves shaving off a small piece of skin with a scalpel, called a shave biopsy.
A skin biopsy is used to diagnose this condition, and the lesions have a characteristic pattern known to clinicians: they are thick and scaly, plug the hair follicles, appear usually on surfaces of the skin exposed to sun (but can occur in non-exposed areas), tend to scar, and usually do not itch.
Skin lesions of cutaneous lupus erythematosus can be subdivided into: Lupus-specific changes. Clinical signs diagnostic of, or unique to, LE. Histology is diagnostic for LE; vacuolar interface dermatitis. Lupus-nonspecific changes. Clinical signs found not only in LE, but also in other connective tissue diseases.
Biopsy is critical in these cases, as lesions have frequently been shown to closely resemble subcutaneous lymphoma . Biopsy specimens should be reviewed by a dermatopathologist, as diagnosis can be difficult, occasionally requiring the use of cell markers and gene rearrangements.
Jul 11, 2022 · A skin biopsy is often required to confirm a diagnosis of cutaneous lupus. Local anesthesia is administered, and the physician then performs either a shave biopsy, which involves scraping the skin, or more commonly in lupus, a punch biopsy.
