Dermatologic Manifestations

Approximately 80 percent of people with SLE have skin manifestations and often suffer from itching, pain, and disfigurement. The classic sign of SLE is the “butterfly” rash extending over the cheeks (molar area) and bridge of the nose. This rash ranges from a faint blush to a severe eruption with scaling. It is photosensitive, and it may be transitory or fixed. Between 55 and 85 percent of people develop this rash at some time in the course of the disease.

Other rashes may occur elsewhere on the face and ears, upper arms, shoulders, chest, and hands. Discoid Lupus Erythematosus (DLE) is seen in 15-30 percent of people with SLE. Subacute cutaneous LE, seen in about 10 percent of SLE people, produces highly photosensitive papules that itch and burn. Skin changes, especially the butterfly rash and subacute cutaneous LE, can be precipitated by sunlight.

Some patients may develop mouth, vaginal, or nasal ulcers. Hair loss (alopecia) occurs in about one-half of SLE people. Most hair loss is diffuse, but it may be patchy. It can be scarring or nonscarring. Alopecia may also be caused by corticosteroids, infection, or immunosuppressive drugs.

Raynaud’s phenomenon (paroxysmal vasopasm of the fingers and toes) frequently occurs in patients with SLE. For most people, Raynaud’s phenomenon is mild. However, some SLE people with severe Raynaud’s phenomenon may develop painful skin ulcers or gangrene on the fingers or toes.

Varying levels of pain and discomfort due to skin alterations may occur. Pruritus accompanies many types of skin lesions. Attacks of Raynaud’s phenomenon can cause a deep tingling feeling in the hands and feet that can be very uncomfortable. Both pain and itching may affect a person’s ability to carry out activities of daily living (ADL).

Skin alterations in the Lupus person, particularly those of DLE, can be disfiguring. As a result, people may experience fear of rejection by others, negative feelings about their body, and depression. Changes in lifestyle and social involvement may occur.