Quick Answers
There are several creams that can help relieve lupus rash symptoms. Some over-the-counter options include hydrocortisone cream, calamine lotion, and moisturizers. Prescription steroid creams are also commonly prescribed. Finding the right cream depends on the type and severity of the rash. Applying sunscreen and avoiding sun exposure are also important when managing lupus skin conditions.
What is Lupus?
Lupus is an autoimmune disease where the immune system attacks the body’s own healthy cells and tissues, causing inflammation and damage1. There are several types of lupus:
– Systemic Lupus Erythematosus (SLE) – This is the most common type, causing widespread inflammation and potentially affecting any part of the body.
– Cutaneous Lupus – This type only affects the skin, causing rashes and lesions. There are several subtypes of cutaneous lupus.
– Drug-induced Lupus – Caused by certain medications. Symptoms usually go away after stopping the medication.
– Neonatal Lupus – A rare condition acquired from the mother’s antibodies that can affect newborn babies.
Lupus is incurable but symptoms can be managed with medications and lifestyle changes. Flare-ups may occur periodically where symptoms suddenly get worse before improving again.
Symptoms
Some common symptoms of lupus may include2:
– Fatigue and fever
– Joint pain or arthritis
– Chest pain when breathing deeply
– Butterfly rash on cheeks and nose
– Photosensitivity to sunlight
– Hair loss
– Mouth or nose ulcers
– Swelling in legs or around eyes
– Fingers turning white or blue in cold temperatures (Raynaud’s phenomenon)
The specific symptoms experienced depend on the type of lupus. Skin problems are particularly common with cutaneous lupus.
Lupus Rashes and Lesions
Up to 70% of people with lupus experience some type of skin condition related to their disease3. The most characteristic lupus rash is a butterfly-shaped facial rash over the cheeks and bridge of the nose, but other problem areas can include4:
– Scaly, disk-shaped facial rashes
– Rashes with small red spots or petechiae
– Red rashes anywhere on body
– Patchy skin color changes
– Hair loss or mouth sores
– Raynaud’s phenomenon – fingers turn white or blue in cold
– Skin sensitivity to sunlight
There are several subtypes of cutaneous lupus erythematosus, which only affects the skin. These include5:
– Acute cutaneous lupus erythematosus – Raised red lesions and circular scaly patches on sun-exposed areas.
– Subacute cutaneous lupus erythematosus (SCLE) – Red, scaly patches on upper body that worsen with sun exposure. May cause scarring.
– Chronic cutaneous lupus erythematosus (CCLE) – Reddish-purple lesions on sun exposed areas. Usually milder than other subtypes.
– Intermittent cutaneous lupus erythematosus – Similar to CCLE but also has lesions on sun-protected areas.
– Lupus tumidus – Firm, red lesions that resemble hives. Generally photosensitive.
– Chilblain lupus erythematosus – Itchy, red patches on fingers, toes, nose, and ears in cold weather.
What Causes Lupus Skin Conditions?
The exact causes of cutaneous lupus are not fully understood. However, some contributing factors may include6:
– Genetics – Lupus runs in families, indicating a genetic component. Variations in genes involved in immune function may increase risk.
– Environment – Sun exposure is a major trigger for lupus rashes, but medications, hormones, stress, and infections may also provoke symptoms.
– Autoimmunity – Lupus is caused by the immune system mistakenly attacking the body’s own cells and tissues, including the skin. This leads to inflammation and damage.
– Blood Circulation – Some people with lupus develop inflamed blood vessels (vasculitis), which can block circulation and deprive the skin of oxygen and nutrients.
– Medications – Certain medications like terbinafine, some antibiotics, diuretics, ACE inhibitors, and TNF-alpha inhibitors may trigger lupus rashes in some individuals.
Managing these triggers can help prevent lupus flares and improve symptoms. Avoiding sun exposure and reducing stress are key.
Treatments for Lupus Skin Problems
While there is no cure for lupus itself, the related rashes and lesions can be managed with various medications and lifestyle measures. Some treatment options may include:
Topical Creams
– **Corticosteroids** – Prescription steroid creams like hydrocortisone can reduce inflammation and itching. Mild creams are used for the face and stronger ointments for the body.
– **Calcineurin inhibitors** – These immunosuppressant creams like tacrolimus (Protopic) and pimecrolimus (Elidel) dampen the immune response in the skin. They may be used on more sensitive areas like the face and neck.
– **Retinoids** – Creams derived from vitamin A help increase skin turnover. Tretinoin (Retin-A) is often prescribed.
– **Moisturizers** – Hydrating creams help soothe scaly, itchy skin. Lotions containing petroleum jelly, glycerin, or ceramides are recommended.
– **Antibiotics** – If lesions get infected, antibiotic creams may be used to clear bacteria and promote healing.
Photoprotection
Most lupus rashes are photosensitive, meaning they worsen with sun exposure. Using sunscreen and protective clothing can help prevent flares. Common tips include:
– Apply broad-spectrum sunscreen daily with SPF 30 or higher. Reapply every 2 hours outdoors.
– Wear wide-brimmed hats, long sleeves, sunglasses, and other sun-protective gear when outside.
– Avoid peak sun hours between 10am-2pm when the sun’s rays are strongest.
– Use UV-blocking films or curtains on car and home windows.
– Seek shade whenever possible when outdoors.
Systemic Medications
For severe, widespread rashes, systemic immunosuppressant or immunomodulating drugs may be prescribed. This can help calm the overactive immune response causing inflammation. Common options include:
– Corticosteroids – Prednisone and other steroids reduce swelling and pain. Long-term use can have significant side effects.
– Antimalarials – Hydroxychloroquine (Plaquenil) can treat fatigue, joint pain, and rashes. Retinal toxicity is a concern with long-term use.
– Immunosuppressants – Drugs like methotrexate, mycophenolate, and cyclophosphamide may be used for more severe cases. Close monitoring is required due to risks like infection.
– Biologic drugs – Rituximab, belimumab (Benlysta), and others target specific parts of the immune system. Used for SLE patients not responding to standard treatments.
Other Medical Treatments
– Light therapy – Brief controlled exposure to UV light, sometimes with creams or medication, can help some lupus rashes. Phototherapy requires close supervision by a doctor.
– Laser therapy – Pulsed dye laser and Nd:YAG laser treatment can reduce lesions by targeting blood vessels in the skin. Multiple sessions are usually needed.
– Surgery – Rarely, plastic surgery may be done to remove chronic, highly visible skin lesions.
– Plasmapheresis – This blood filtering technique is used in severe cases to remove antibodies causing symptoms.
Lifestyle Measures for Lupus Skin Problems
In addition to medical treatment, these self-care tips can help avoid triggers and improve cutaneous lupus lesions7:
– Use gentle skin care and bath products labeled “fragrance-free” to avoid irritation.
– Take short, lukewarm showers instead of hot baths, which can dry the skin. Pat skin dry instead of rubbing with a towel.
– Avoid harsh soaps. Use gentle, moisturizing cleansers.
– Shave carefully using an electric razor instead of blades. Use shaving cream to protect skin.
– Avoid picking at scabs or scars to prevent infection and scarring.
– Wear loose cotton clothing to avoid irritation. Avoid wool and synthetic fabrics that can irritate sensitive skin.
– Identify and avoid medications that worsen your rash, if applicable.
– Use humidifiers to add moisture to dry indoor air.
– Maintain healthy diet and exercise routine to support skin health.
– Reduce stress through relaxation techniques like meditation, yoga, or Tai Chi.
– Join a lupus support group to help cope with the condition.
When to See a Doctor
See a doctor promptly if you notice any of the following8:
– A new rash or skin lesion
– An existing rash that is getting worse or not improving with over-the-counter treatment
– Rash accompanied by fever, nausea, or generally feeling unwell
– Open sores, blisters, or peeling skin
– Skin pain, swelling, or excessive redness
– Rash that covers a large portion of the body
– Rash that is impacting quality of life or emotional wellbeing
Sudden onset or spreading rash may indicate a lupus flare needing medical attention. Some skin infections can also resemble lupus lesions. It is important to have any new skin conditions evaluated.
Diagnosis of Cutaneous Lupus
To diagnose cutaneous lupus, doctors will9:
– Assess symptoms and medical history
– Examine the skin condition and appearance of lesions
– Order blood tests to look for elevated antinuclear antibodies (ANA) and other antibody markers characteristic of lupus
– Perform a skin biopsy to look at the sample under a microscope
– Assess reaction to sunlight and UV light exposure
– Rule out other potential causes like skin infections, dermatitis, psoriasis, etc.
Blood tests and skin biopsies can help confirm lupus, narrow down the specific skin condition, and guide appropriate treatment.
Key Points
– Lupus is an autoimmune disease that commonly affects the skin, causing rashes, lesions, and photosensitivity.
– Characteristic lupus skin conditions include a butterfly facial rash, scaly disk-shaped facial lesions, patchy skin color changes, hair loss, and lesions on sun-exposed areas.
– Topical steroid creams, antibiotics for infection, photoprotection, and systemic immunosuppressant medications are mainstays of treatment.
– Lifestyle measures like gentle skin care, sun avoidance, moisturizing, and stress reduction also help manage lupus skin problems.
– Seek prompt medical attention for any new, worsening, or unusual skin rashes or lesions to receive proper diagnosis and treatment.
The Bottom Line
There are many over-the-counter and prescription creams that can help relieve lupus rashes, including topical steroids, moisturizers, antibiotics, and more. Sun protection is also key. Working closely with a rheumatologist or dermatologist knowledgeable in cutaneous lupus allows customizing treatment based on the specific type, location, and severity of skin lesions. With proper management, most patients can keep lupus skin problems under relative control.
