Healthy Living

Lupus Rash: The Top 10 Questions

1 Why does lupus give you a butterfly (malar) rash?

Lupus is a chronic disorder of the immune system. The immune cells attack the body's own healthy tissues, which lead to inflammation and tissue damage. Symptoms may be limited to the skin, but more often, lupus also causes internal problems.

Lupus is known to attack the body’s own tissue and organs which would include heart, kidney, lungs, brain, joints or skin. It is known to affect mostly every organ of the body without any predictions causing infection and inflammation on any part of the body. The butterfly rash or malar which is known as acute cutaneous lupus is one of the four types of lupus which is mostly related to the skin.

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Malar is derived from the Latin word “mala” which would mean cheekbone. Malar rash, also known as butterfly rash, is a medical indication consisting of a characteristic type of facial rash. A butterfly-shaped rash across the cheeks is the most visible sign of lupus. It could develop suddenly or it could appear after sunlight exposure. About 50 percent of people with lupus have a butterfly rash. The rashes which appear on the cheeks are mostly red or purple in color, which can appear as a blotchy pattern or it can completely appear red covering over the affected area. This area can be flat or slightly raised in nature.

The butterfly rash of lupus is typically painless and does not itch. However, at times this rash can cause itchiness if it appears more like a rash rather than a blush, there have been some instances wherein patients have complained of “hot” feeling wherein the malar rash gets more severe. Along with inflammation in other organs, the butterfly rash of lupus can be triggered by photosensitivity, a condition worsened by exposure to sunlight.

This rash is so-named because it resembles a butterfly, which spans the width of the face, covering both cheeks and the bridge of the nose. The butterfly rash may appear on its own, but some people observe that the appearance of the butterfly rash is a sign of an oncoming disease flare. Whatever the case, it is important to pay attention to the body’s signals and notify the doctor of anything unusual. Studies have revealed that malar rash is mostly seen in people who are suffering from a type of lupus known as systemic lupus erythematosus.

2 Can lupus cause itching without a rash?

It can be hard to tell if lupus can really cause itching without a rash. The reason is that a common characteristic of lupus is the presence of a rash. The rashes could either be itchy or not, but they are expected to be present on the skin of a person with lupus. In addition, it is difficult to rule out the cause of an itchy skin without the presence of rashes because there are several reasons that could lead to this symptom, which includes dermatitis, urticaria, hives, allergic reaction, etc.

On the other hand, lupus is an autoimmune disease, making it still one of the top reasons for an itchy skin without rash. In some cases, lupus patients experience itching without a rash during the early course of the disease and develop rashes later on. However, there is no sufficient evidence that lupus really causes itching without a rash. Thus, a thorough examination and assessment are necessary for individuals suffering from an itchy skin without a rash to have a definite and exact diagnosis.

3 What does a lupus rash look like?

A lupus rash looks red or purplish and is mildly scaly. Notably, the rash spares the nasolabial folds of the face, which adds to its characteristic appearance. It is usually not itchy and has a macular rash with sharp edges. The rash can be transient or progressive, which can involve other parts of the facial skin.

Discoid lupus produces a red, coin-shaped, scaly rash on the cheeks, nose, and ears. The rashes do not itch or hurt, but it may leave the skin discolored once they fade. A lupus rash is also sensitive to sunlight.

In lupus there are various types of skin manifestations which can vary from person to person. Lupus can give rise to any kind of rash. This would range from mild rashes spreading wildly across and seem to be very similar to those which are seen in other medical conditions such as German measles. At times there can small patches of rash which would appear on the elbows and some parts of knees which would seem similar to psoriasis. Lupus rashes can sometimes cause painful itching and at times there won’t be any itching.

The rash produced by lupus specifically causes pain, swelling, or stiffness of the joints because of its harmful effects on the connective tissues of the skin. A lupus rash may also be signaled by the inflammation of the glands and the infection of the urinary tract and kidneys. The pain that comes with the rash usually increases the body temperature.

Other common skin problems associated with lupus include sensitivity to the sun with flaky, red spots or a scaly and purple rash on different parts of the body including the face, neck, and arms. Some people also develop mouth sores.

4 What is discoid lupus erythematosus?

Chronic cutaneous lupus, also called as discoid lupus, appears as disk-shaped, round lesions. The sores typically appear on the scalp and face, but sometimes, they also occur on other parts of the body.

Discoid lupus lesions are often red, scaly, and thick, but do not usually hurt or itch. As the disease progresses, the lesions can produce scarring and skin discoloration. Discoid lesions that occur on the scalp may cause the hair to fall out. Hair loss may be permanent if the lesions form scars when they heal.

Chronic discoid lupus is found in only about 20 percent of patients with systemic lupus erythematosus. It can also be found in people who have no trace of systemic lupus. In discoid lupus patients, lupus is confined only to the skin and the lesions are rarely found below the chin. The lesions occur most often on the scalp, outer ear, and almost none on the legs. The lesions are usually slightly elevated pink or red areas that form flakes or a crust on the surface of the skin. The center area becomes depressed and scars over time as the lesions mature. They get larger and may be itchy, spreading outward, and then leaving a central scar.

Discoid lesions usually develop in sun-exposed areas but are plaque-like in character with follicular plugging and scarring. DLE is known to cause permanent scars if the treatment is not carried out on time. DLE is known to affect people under the age bracket of 20 and 40. It is seen that women are mostly affected with this illness rather than men and it is mostly affecting to people who smoke.

DLE affects those areas which are mostly exposed to the sun such as ears, neck, back of hands, cheeks and upper back. Rashes are very rarely seen on the palms or soles of the feet. DLE is also known to affect the inside of the mouth along with lips which would then result into scaling or ulcers. The lesions in DLE can be painful. If treatment is not initiated on time during the early phases of diagnosis of this disease then it could lead to scarring, loss of hair and pigmentary changes.

5 Is a lupus rash contagious?

Lupus rash and lupus itself is not contagious. Lupus cannot be transferred from one person to another by physical contact or by touching the skin lesions, not even through sexual contact. The exact cause of lupus is not known. However, many genetic predispositions (HLA types, regulatory genes) and gene-environment interactions (UV exposure, the immune system's response to microbes and/or drugs) have been identified that predispose individuals to develop this type of autoimmune disease.

An autoimmune disease is characterized by a malfunction of the immune system where the immune system is unable to distinguish between the body's own cells and tissues and that of foreign matter such as viruses and bacteria. Instead of simply producing antibodies to attack antigens (viruses, bacteria, and similar foreign matter), the immune system creates autoantibodies that hit the immune system itself.

Lupus may be triggered in people who are predisposed to the disease through genetic and environmental factors such as certain drugs and infections. Environmental factor would include smoking, exposure to sun light, constant stress, antibiotics and infections. There is yet no complete cure for lupus, however medications can control the symptoms if taken on a regular basis.

People with lupus cannot transmit the disease and people who interact with them will not catch the disease.

6 What can trigger lupus?

The exact cause of lupus is still not known. Lupus occurs when the immune system attacks the healthy tissues in the body. Researchers associate lupus to a genetic predisposition as well as external factors such as extreme stress, medications, exposure to ultraviolet light, infections, and smoking. It appears that people with an inherited predilection for lupus could develop the disease when they come into contact with something in the environment that can activate the condition.

No gene or group of genes has been confirmed to cause lupus. However, lupus appears in certain families and genes, which have been identified to contribute to the development of lupus. However, these associations alone are not enough to cause this disease.

Some of the potential triggers are:

  • Sunlight - exposure to the sun could bring on lupus skin lesions or activate an internal response in predisposed people.
  • Infections - having an infection can trigger lupus or could cause a relapse in some people.
  • Medications - lupus may be triggered by certain types of blood pressure medications, anti-seizure medications, and antibiotics. People with drug-induced lupus more often than not see their symptoms fade away when they stop taking the medication.

It is not yet clearly identified as to what exactly causes lupus. However, studies indicate that the development of lupus is a response to a varied number of factors which would involve both the inside and outside of the human body which would include genetics, hormones or the environmental factors.

  • Genetics: There is no specific gene or any group of genes which is known to be the cause for lupus. The prevalence of lupus is known to be in some families and certain genes which have been identified as a contributing factor for the development of this medical condition. Also there are chances of lupus being developed in an individual with no family history of this medical condition. Certain ethnic groups such as African, Native American, Asian or Hispanic are known to be at a greater risk of developing lupus.
  • Hormones: The chemical substances which are produced in the body are known as hormones. These hormones are known to regulate or control the activity of specific cells or organs. Lupus is mostly seen as a common occurrence in females than men. Studies say that women have lupus symptoms mostly increasing just before their menstrual periods or during pregnancy when the production of estrogen levels are high in the body.
  • Environment: Studies indicate that there are certain environmental agents such as virus or chemicals which would trigger the occurrence of lupus in an individual. Few of those triggers would be in the form of infection, cold, ultraviolet rays, exposure to silica, stress, exhaustion, injury or smoking.

7 Natural Remedies for Lupus

Although lupus is an autoimmune disease, there are natural remedies that can help improve the symptoms and can help prevent disease flares. Moreover, the natural remedies for lupus can help manage the symptoms as well as improve the overall immune function without the risk of having complications.

Below are some of the natural remedies that can help people with lupus:

Anti-inflammatory food

Having a healthy diet is important to people who are diagnosed with lupus. A healthy diet can help control inflammation that is caused by poor gut health. In addition, having a healthy diet can lower the risk of developing complications such as heart disease, lessens the side effects of medications, and helps build energy and strength. The recommended foods for people with lupus include organic and unprocessed foods, raw vegetables, fish, high antioxidant foods, and bone broth. Drinking plenty of fluids and taking coconut or olive oil are also beneficial.

Apart from these, there are certain foods which can provide relief from skin dryness and irritation which is very commonly found in lupus. These foods would help to moisturize the skin from inside out and those would include, raw milk, drinking plenty of fluids including water, avocado, melon, cucumbers, olive oil, coconut oil, nuts such as walnuts, almonds, chia and flaxseeds. An individual suffering from lupus should avoid certain foods else would worsen the illness, gluten enriched food, sugary products, caffeine drinks, alcohol, foods high in sodium, foods which have trans-fat and saturated fats.

Regular exercise

Doing regular physical activities can help a person recover from flares, helps fight depression, lowers the risk of a heart attack, and promote an optimal well-being. Regular exercise also promotes good sleeping pattern, makes lungs and heart stronger for better functioning, strengthens the bones, reduces pain in the joints, increases range of motion and reduces any medical related complications.

However, one should start it slow without exerting too much pressure on any part of the body. Over exertion is always harmful and can worsen the existing medical condition. It is also important to give yourself enough rest in between the workouts so the muscles can buildup and recover again from the physical strain. Exercises which are seen to be beneficial for people suffering from lupus are swimming, brisk walking, yoga, cycling, Pilates and aerobics.

Adequate rest

People with lupus often experience fatigue or tiredness. Their level of fatigability is much higher compared to normal people. Thus, having plenty of sleep at night and getting naps during the day are important.

Reducing Stress

Emotional and psychological stress are known to worsen the lupus condition. It can lead to flare up of the symptoms. There are different kind of stress relievers which suite different people. Many of them have found that by performing yoga, meditation and acupuncture has led to numerous benefits in the health of the immune system. One can also practice breathing techniques, praying and exercising to keep stress at bay.

8 How to Use Apple Cider Vinegar for Lupus

Health professionals suspect that people who are diagnosed with lupus have a deficiency of hydrochloric acid.

A well-known product that helps increase the production of hydrochloric acid in the body is apple cider vinegar. In addition, apple cider vinegar improves the absorption of nutrients, helps build up the good bacteria in the gut, and aids in body detoxification. As a result, apple cider vinegar helps reduce the effects of lupus.

Moreover, apple cider vinegar has anti-inflammatory properties, which are very effective in giving relief from joint and muscle pain. It contains minerals, potassium, phosphorus, calcium, chlorine, magnesium, sulfur, iron, fluorine, sodium, copper, and silicon. These elements are known to be vital to have a healthy body.

Apple cider vinegar can be consumed by mixing it with warm water. Drink the mixture every day to attain its benefits. Apple cider vinegar does not only help in the treatment of lupus, but it is also a wonderful cure for several ailments.

9 Can they do a skin biopsy for a lupus diagnosis?

The diagnosis of lupus may be confirmed by performing a skin biopsy. The skin biopsy reveals vascular interface dermatitis, often in association with an epidermal atrophy, lymphocytic infiltrate with plasma cells, and mucin.

A direct immunofluorescence testing of the skin biopsy, known as the lupus band test, will reveal characteristic patterns, depending on the form of cutaneous lupus.

The lupus band test is done upon skin biopsy with direct immunofluorescence staining. If the result is positive, it means that the IgG and complement depositions are found at the dermoepidermal junction. Examination of tissues may be performed on the skin with lesions or healthy skin (without lesions). The lupus band test can be helpful in distinguishing SLE or systemic lupus erythematosus from cutaneous lupus. The reason is that in SLE, the lupus band test will be positive in both involved and uninvolved skin, while cutaneous lupus only involves the skin that will have a positive result.

The use and interpretation of the lupus band test vary according to the site of biopsy. Only 60 percent of patients with lupus test positive on lesional skin. While some usually those with systemic lupus erythematosus (SLE), have a positive lupus band test.

10 How long does a lupus rash last?

Lupus rash, as well as the other symptoms of lupus, can appear from time to time (called flares) and how long these symptoms will last vary from one person to another.

Lupus flares are unpredictable. Thus, there is no way of determining how long they may last. Flares can come and go or they could disappear completely for a period of time. When an individual with lupus experiences a flare, it means that the symptoms have appeared or are worse. An individual may have a lupus rash, muscle pain, and swollen joints for one week, and then no symptoms at all the following week.

Flares can be triggered by not having enough rest, too much sun exposure, injury, certain medicines, overwork, stress, infection, and not taking lupus medications. There are steps that can be made to prevent the symptoms if the individual knows how to recognize when the flare is coming. In addition, it can help prepare to cope with the symptoms.

The rashes may take a week or longer before they fade away. However, with the help of a topical medication, sunscreen protection, and lifestyle modification, a lupus rash can disappear within a month.

In many of the cases, a person suffering from drug induced lupus would not have major issues as SLE. The symptoms which would be experienced usually tend to go away after few days or weeks once the issue causing medication is stopped. In rare cases, due to the TNF inhibitors it can develop kidney inflammation. In such cases it would require treatment with the help of prednisone and immunosuppressive medicines. Also keep a note of such medicines and avoid consuming them in future as well. Symptoms can reoccur if the medications are started.