Lupus Facial Rashes

Changes of the skin and facial rashes are very common with lupus patients. In most cases, abnormalities can be treated with medication, specifically corticosteroids (prednisone) or antimalarial drugs (hydroxychloroquine or chloroquine). In some extreme cases, a lupus patient may be unresponsive to the usual treatment. There are two many categories of lupus facial rashes: specific and non-specific.

Specific Lupus Rashes

Lupus Butterfly Rash on FaceThe Butterfly Facial Rash
The butterfly lupus facial rash gets its name because of the butterfly shape it makes on the face.  It is a red rash over the lower face, covering the cheeks and nose. This lupus facial rash can be slight or very prominent. Sometimes the facial rash is flat with the skin and sometimes raised or bumpy. The rash doesn’t always itch, but the more prominent ones usually do. This facial rash is typical with lupus but only occurs in 30% of all patients.

Subacute Cutaneous Lupus Lesions
The first type of this rash takes the form of small red pimples when it first appears. As the rash persists, the pimples become bigger and scales appear. This rash is usually very itchy and can appear on the face, chest or arms. It often occurs after exposure to the sun or if you already have the rash, may worsen after ultraviolet exposure.

The second type appears as a flat lesion and gets bigger by expanding outward like a growing puddle of water. As the rash grows, the center of each rash area may begin to clear up, causing what looks like rings on the skin. This rash can occur on the face, chest, arms and back . It is also sensitive to the sun and is very itchy. This type of rash usually heals without scars but can leave a non-depressed scar or area of depigmentation where the rash occurred.

Chronic Discoid Lupus Lesions
These types of rashes are found on only 20% of lupus patients. This lesions are always slightly elevated and appear as crusty/flaky pink or red areas. As the lesion persists, the area affected usually becomes depressed and forms a scar. These lesions are almost always found on the face and practically never on the legs.  The rash often occurs on the scalp and outside of the ear, starting at a center point and moving outward. These lesions can disfigure the patient and should be treated immediately and aggressively as possible to avoid permanent scarring and disfigurement.

Non-Specific Lupus Rashes

Non-specific rashes are rashes that are not specific or isolated to only lupus patients, but do occur often with lupus. These rashes will appear as blotchy red or pink marks on the skin and may be caused by other viruses and even medications. These types of rashes usually disappear quickly when treated with corticosteroids.

Vasculitic Rashes
These rashes can occur with lupus patients but are often found with those that also have rheumatoid arthritis. Symptoms of vasculitic rashes include bumps on the end of your fingers and/or toes, rashes that appear as splinters under your nails, ulcers that form around the ankle joints or legs, or tender red bumps on the shins.

Lupus Rash Treatment

The main treatment for lupus rashes is the use of hydroxychloroquine  (Plaquenil). Some patients are more responsive to chloroquine. Steroid creams can also be used, but with caution, on the face since they often dilate blood vessels. Some lesions can be injected with corticosteroids and occasionally it is necessary to use moderate doses of corticosteroids and other therapies orally.

There are some general precautions you can take to avoid lupus rashes:

  • Avoid too much sun exposure, especially during the hottest parts of the day.
  • Wear sunscreen regularly. Test different brands until you find the one that doesn’t irritate your skin and also provides you with good protection. SPF 30 or higher is recommended.
  • Wear a hat with a large rim all around. Protecting your entire face, neck and chest is recommended. A baseball cap cannot provide adequate protection.
  • Wear long sleeve shirts to avoid sun exposure on your arms.

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