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. A sensitivity
to and too much exposure to the ultraviolet (UV) rays of sun and
some types of artificial light are responsible for aggravating some
rashes and lesions. Many types of skin conditions are common in
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 gets 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, coin-shaped 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 lupus patients. Nose and vaginal ulcers may also occur.
These lesions are usually painless
Hair loss: In addition to losing hair because of discoid
lesions, some lupus patients 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, skinulcers 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
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 (vasoconstrict).
This decreases the blood supply going through the vessel. As a result,
the fingers and toes become cold and can become 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 a sunscreen on exposed areas of skin. It should
have a sun protection factor (SPF) of 15 or higher. Be sure that
the sunscreen protects against both UVB and UVA rays.
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 (glass does not filter out UV rays).
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.
Be aware of fluorescent light and halogen lamps. They
can be found in many places and include floor lamps, overhead lights,
photo-copiers, and slide projectors. Sunscreen and protective clothing
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 hair dyes, skin creams,
certain drugs that can make you more sensitive to the sun (for example,
tetracyclines or diuretics), and things you are allergic to.
It’s okay to wear makeup, but try hypoallergenic
brands. A brand that also includes UV protection would be good to
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
From LUPUS: A Patient Care Guide for Nurses and
Other Health Professionals, National Institute of Arthritis and
Musculoskeletal and Skin Diseases/National Institutes of Health