From the Guidelines
Lupus can cause several types of nonfacial rashes, including subacute cutaneous lupus erythematosus (SCLE), discoid lupus erythematosus (DLE), maculopapular rash, vasculitic rashes, livedo reticularis, bullous lupus, and lupus panniculitis, with treatment typically including sun protection, topical corticosteroids, and systemic medications like hydroxychloroquine, methotrexate, or mycophenolate mofetil. The most common nonfacial rashes in lupus patients are:
- Subacute cutaneous lupus erythematosus (SCLE), which appears as red, scaly patches in sun-exposed areas like the arms, shoulders, neck, and upper back 1
- Discoid lupus erythematosus (DLE), which causes thick, red, scaly patches that can scar if left untreated, typically on the scalp, ears, and chest 1
- Maculopapular rash, resembling a drug reaction, with flat and raised red spots
- Vasculitic rashes, which appear as small red or purple spots (petechiae) or larger bruise-like areas (purpura) due to blood vessel inflammation
- Livedo reticularis, a lace-like purple pattern on the skin, particularly on the legs
- Bullous lupus, which causes fluid-filled blisters
- Lupus panniculitis, which affects deeper skin layers, creating firm, painful nodules These rashes often worsen with sun exposure because ultraviolet light triggers inflammation in lupus patients 1. Treatment of nonfacial rashes in lupus patients may include:
- Sun protection
- Topical corticosteroids for mild cases
- Systemic medications like hydroxychloroquine, methotrexate, or mycophenolate mofetil for more severe or widespread rashes 1
- Belimumab, which has been shown to be effective in reducing skin disease activity in lupus patients 1 It is essential to note that the treatment of nonfacial rashes in lupus patients should be individualized and based on the severity and extent of the rash, as well as the patient's overall health status and medical history.
From the Research
Nonfacial Rashes in Lupus
- The studies 2, 3, 4 describe various forms of cutaneous lupus erythematosus (CLE), which can manifest as nonfacial rashes.
- Chronic cutaneous lupus (CCLE) includes sub-types such as discoid lupus erythematosus (DLE), LE profundus (LEP), chilblain cutaneous lupus, and lupus tumidus, which can cause nonfacial rashes 2.
- Subacute cutaneous lupus erythematosus (SCLE) is another form of CLE that can cause nonfacial rashes, characterized by photosensitive rash and anti-Ro association 3, 4.
- The histopathologic characteristics of SCLE and DLE can be used to differentiate between the two conditions, with SCLE showing more epidermal atrophy and DLE showing more hyperkeratosis and basement membrane thickening 4.
Specific Types of Nonfacial Rashes
- Discoid lupus erythematosus (DLE) can cause nonfacial rashes, characterized by discoid lesions on the skin 2, 4.
- LE profundus (LEP) is a subtype of CCLE that can cause nonfacial rashes, characterized by deep inflammation of the skin 2.
- Chilblain cutaneous lupus is a rare subtype of CCLE that can cause nonfacial rashes, characterized by inflammation of the skin in response to cold temperatures 2.
- Lupus tumidus is a subtype of CCLE that can cause nonfacial rashes, characterized by inflammation of the skin and underlying tissue 2.
Treatment and Management
- The treatment of nonfacial rashes in lupus typically involves a combination of topical and systemic agents, as well as patient education on proper sun protection 2, 3.
- Belimumab, a monoclonal antibody, has been shown to improve mucocutaneous and vasculitis manifestations in patients with systemic lupus erythematosus, including nonfacial rashes 5.