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Dealing with your skin

The development of some sort of rash is one of the most common features of lupus and is often the first sign of the condition. Approximately two thirds of those with lupus will develop a type of skin disease, called cutaneous lupus erythematous (CLE). Skin disease in lupus can cause rashes or sores, most of which will appear in sun-exposed areas such as the face, ears, neck, arms and legs. For this reason, too much exposure to ultraviolet rays from the sun or artificial light can worsen symptoms.

Types of skin lupus

Chronic cutaneous lupus (CCLE)

CCLE, also known as discoid lupus presents as disc-shaped, round lesions which can be red, scaly and thick, but they do not usually hurt or itch. The sores normally appear on the scalp and face but occasionally appear on other body sites including the arms, legs and torso. Over time, these lesions can produce scarring and skin discolouration and if they occur on the scalp, they may cause the hair to fall out and may be permanently lost due to scarring.

Approximately 5-10% of people with CCLE will develop lupus in other organ systems. However, these people may have already had systemic lupus erythematosus (SLE) with the skin rash as the first symptom.

Subacute cutaneous lupus (SCLE)

SCLE lesions may appear as areas of red scaly skin with distinct edges or as red, ring-shaped lesions. Like CCLE, the lesions most commonly occur in sun-exposed areas of the skin and they do not usually itch or scar, but they can cause skin discolouration. As SCLE lesions are also photosensitive, preventive measures should be taken if outdoors or under fluorescent lights.

Acute cutaneous lupus (ACLE)

ACLE lesions occur in about one third of people with lupus. These lesions are associated with systemic lupus and reflect disease activity. The most common form of ACLE is a butterfly rash, also called a malar rash, which appears on both cheeks and across the bridge of the nose in the shape of a butterfly. However, this type of rash can also appear on the arms, legs and body. These lesions are also very photosensitive, but they do not typically produce any scarring, although changes in skin colour may occur.

A butterfly rash is not always due to lupus and certain skin conditions such as rosacea or eczema can mimic lupus. Allergies, illnesses and body temperature shifts are also reasons why you might develop a rash similar to a butterfly rash. For this reason, it is important to take account of any other unusual symptoms such as profound fatigue, painful and swollen or stiff joints, fever and weight changes and discuss these with your Doctor.

Prevention tips

As CCLE, SCLE and ACLE lesions can be very photosensitive it is important to take the following preventative measures:

· Avoid being outside in direct sunlight

· Use plenty of sunscreen (factor 50+) when you are outdoors

· Wear sun-protective clothing and wide-brimmed hats

· Limit the amount of time spent under indoor fluorescent lights

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

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