Lupus is an autoimmune disease that can affect various parts of the body, including the skin and face. Some of the most common facial manifestations of lupus include a butterfly rash across the cheeks and nose, painful mouth sores, and discoid rashes on the scalp or ears. Facial swelling, hair loss, and skin damage from sunlight exposure are also potential consequences of lupus. While the red butterfly rash is perhaps the most well-known facial symptom, the effects of lupus on the face can vary significantly between patients. Understanding the types of facial rashes, oral ulcers, and other symptoms that may arise can help patients identify a lupus flare and seek prompt treatment.
What is lupus?
Lupus is a chronic autoimmune disease where the immune system mistakenly attacks healthy tissue and organs, including the skin, joints, kidneys, brain, and other parts of the body. There are several types of lupus:
– Systemic lupus erythematosus (SLE) – This is the most common type, affecting the whole body. Facial rashes, joint pain and swelling are common symptoms.
– Cutaneous lupus – This type only affects the skin, causing rashes and lesions. About 10% of people with cutaneous lupus will develop SLE later.
– Drug-induced lupus – This temporary form is triggered by certain medications. Symptoms usually go away when the medication is stopped.
– Neonatal lupus – A rare condition affecting babies born to women with lupus antibodies. It mainly impacts the baby’s skin and heart.
Lupus is caused by a combination of genetic, environmental, and hormonal factors leading the immune system to mistakenly attack healthy tissue. It’s more common in women, especially during childbearing years. There’s no cure, but symptoms can be managed with medications and lifestyle changes.
How does lupus affect the face?
Up to two-thirds of people with lupus experience some type of skin involvement, including rashes and lesions on the face. Lupus can cause a variety of facial symptoms:
Butterfly rash
The classic lupus rash looks like a reddish butterfly shape across the nose and cheeks. Also called a malar rash, it may be flat or raised and is often aggravated by sun exposure. The rash tends to come and go.
Discoid rash
These coin-shaped sores have a scaly, scar-like appearance. They usually show up on the ears, scalp, nose, and cheeks. Discoid lupus rashes can lead to permanent scarring and hair loss if not treated.
Photosensitivity
Many lupus patients are photosensitive, meaning sunlight aggravates their symptoms. Exposure can trigger rashes, blistering, and abnormal scarring on the face and lips. Wearing sunscreen is essential.
Oral ulcers
Painful mouth sores are common, often on the roof of the mouth or gums. They can make eating, swallowing, and brushing teeth difficult.
Hair loss
Hair loss on the scalp or eyebrows is another possible symptom. Hair may thin out or fall out entirely, sometimes due to discoid rashes damaging hair follicles.
Other facial issues
Facial swelling, dry skin, acne, and redness or flushing are also seen with lupus. Some patients also experience vision problems like dry eyes or light sensitivity. Tendon inflammation can also cause facial pain.
Types of lupus rashes on the face
There are several types of rashes that can develop on the face due to lupus:
Butterfly rash (malar rash)
As described above, this reddish rash extends over the bridge of the nose and onto the cheeks in a butterfly wing pattern. It may be flat or raised. Ultraviolet light often triggers malar rashes.
Discoid rash
These large red sores have a disc-like shape. They are thick, scaly, and can cause scarring. Discoid rashes often show up on the ears, nose, scalp, and back of the neck.
Subacute cutaneous lupus
This photosensitive rash develops after sun exposure. It consists of reddish-purple lesions that don’t scar. The cheeks, arms, upper body, and neck are typical locations.
Tumid lupus
With this form, lesions are very red and swollen but don’t scab over. It usually happens on the cheeks or eyelids. Tumid lupus rashes are painful but don’t typically scar.
Vasculitic lesions
These spots look like tiny red or purple dots caused by bleeding under the skin. They occur when inflammation damages blood vessels. The legs and face are common sites.
Bullous lesions
These are fluid-filled blister-like lesions. They can develop on sun-exposed areas like the face. Bullous lesions are typically transient but very painful.
Chilblain lupus
This rare form causes itchy, scaly patches triggered by cold temperatures and humidity. It usually appears on the nose, ears, fingers, and toes. For some with lupus, the condition is chronic.
What causes lupus facial rashes?
Facial rashes and skin lesions of lupus are triggered when the immune system attacks the skin, causing inflammation. Certain antibodies are believed to target skin cells, blood vessels, and connective tissues.
Specific triggers that provoke lupus rashes and flares include:
– Sun and UV light exposure
– Stress
– Infections or illnesses
– Hormonal changes
– Medications
– Cold temperatures
– Damage or scarring from previous flares
The malar butterfly rash is also closely linked to lupus disease activity or a flare. People tend to notice this rash when their systemic lupus symptoms worsen.
Lupus symptoms beyond the face
While facial rashes are a common concern, lupus can impact many other parts of the body:
– Joint pain, swelling, and stiffness
– Fatigue, headaches, memory issues
– Shortness of breath, chest pain
– Fever, dizziness, mood changes
– Swollen legs or ankles
– Sensitivity to sunlight
– Fingers turning white or blue in the cold (Raynaud’s)
– Anemia, bruising easily
– Hair loss
– Mouth ulcers
– Swelling in the legs, around the eyes
– Dry eyes, blurred vision
– Kidney problems
Patients may alternate between periods of flares when symptoms worsen, and remission when they improve. Managing lupus requires paying close attention to all physical symptoms and alerting one’s doctor promptly about any flares.
When to see a doctor
Any new rashes, lesions, or other skin changes on the face should be evaluated promptly. People noticing these signs along with fatigue, joint pain or other systemic symptoms should consult a rheumatologist or dermatologist for a lupus assessment. Facial rashes can sometimes indicate a lupus flare needing treatment.
Seek emergency care for symptoms like:
– Chest pain, trouble breathing
– Confusion, memory loss, seizures
– Severe headache with fever and stiff neck
– Ankle swelling, rapid weight gain
– Vision issues, eye pain or redness
– Unrelenting mouth ulcers coupled with fever
Diagnosing lupus affecting the face
Diagnosing lupus requires a combination of:
– Medical history – The doctor will ask about symptoms, family history of autoimmune disease, and potential lupus triggers like infections and medications.
– Physical exam – Checking for facial rashes, swollen joints, and enlarged lymph nodes.
– Blood tests – Bloodwork can detect lupus antibodies like ANA and anti-dsDNA, low blood cell counts, and proteins like antiphospholipid.
– Urine test – A urine analysis may reveal increased protein levels, common with lupus kidney involvement.
– Skin biopsy – Taking a small sample of facial lesions to examine under a microscope can help confirm discoid lupus.
– Imaging – X-rays, CT scans, and MRIs can spot internal organ damage and inflammation.
Doctors also analyze symptom patterns, flare frequency, and response to treatments when determining a systemic lupus diagnosis. No single test confirms lupus, making a combination of clinical findings critical.
Lupus facial rash treatment
Treatment focuses on reducing inflammation from lupus facial rashes, preventing flares, limiting sun damage, and avoiding scarring. Typical treatment approaches include:
Sun protection
Sunscreen, protective clothing, and hats are vital for shielding photosensitive skin. Broad-spectrum SPF 30 sunscreen should be applied every 2 hours when outdoors.
Skin care
Gentle cleansing and moisturizers help defend against irritation. Products with hydrocortisone relieve itching and redness.
Topical steroids
Prescription steroid creams, gels, or ointments applied directly to rashes help relieve inflammation and itching. High-potency steroids often used for the face.
Oral steroids
For moderate or severe rashes, doctors may prescribe prednisone or similar oral corticosteroids to reduce swelling and pain. Long-term use can have significant side effects.
Antimalarial drugs
Medications like Plaquenil (hydroxychloroquine) prevent lupus flares and help protect the skin. They interfere with immune complex formation.
Immune-suppressing drugs
For severe lupus, drugs like methotrexate, azathioprine, mycophenolate, and cyclophosphamide suppress an overactive immune system. They help reduce systemic symptoms along with skin rashes and lesions. Long-term risks include increased susceptibility to infections and certain cancers. Close monitoring is required.
In some cases, intralesional steroid injections directly into lesions may help reduce discoid rashes and prevent scarring. Severe blisters or ulcerations may need special wound care. Alternative therapies like stress reduction and dietary changes can also aid in lupus management.
Outlook for facial lesions from lupus
With proper treatment, many lupus patients see their facial rashes and lesions resolve. However, discoid rashes often recur over time, and new lesions can develop in sun-exposed skin. Scarring from chronic discoid lupus is difficult to reverse.
For SLE patients, the butterfly rash tends to come and go along with flares, while photosensitivity remains constant. Avoiding triggers like sunlight and infections helps prevent recurrences. Long-term use of medications that suppress the overactive immune system is usually required to keep systemic and cutaneous lupus symptoms controlled.
While facial issues from lupus may be upsetting for patients, vigilant sun protection and working closely with a rheumatologist helps minimize lasting effects on appearance and prevent damage. Learning to recognize the facial warning signs of a lupus flare enables patients to seek swift treatment when needed. With proper management, most can find an effective treatment plan to manage lupus and maintain a good quality of life.
Coping with facial changes from lupus
Because lupus often impacts the face through rashes, scarring, and hair loss, patients may struggle with self-esteem issues. Some helpful coping tips include:
– Joining a lupus support group to share experiences and advice
– Talking to a therapist or counselor about handling self-image challenges
– Practicing self-care techniques like meditation and yoga
– Focusing on inner strengths and positive qualities, not just appearance
– Exploring cosmetic solutions like scar creams, hair loss treatments, and makeup to conceal reddened skin
– Wearing hats, scarves or clothing with built-in sun protection
– Using humor and maintaining a positive attitude
– Educating friends and family about what you experience with lupus
– Express your feelings creatively through art, writing or music
While lupus can alter facial appearance, remembering one’s inherent worth and focusing less on looks is important. With support and proper treatment, most lupus patients can cope with and overcome the cosmetic effects of the disease.
Questions for my doctor about lupus and the face
If you are experiencing facial rashes, lesions, or other symptoms of possible lupus, be prepared to ask your doctor:
– What types of lupus rashes commonly affect the face?
– How can you tell the difference between malar, discoid, and other facial rashes?
– What factors likely triggered this facial rash? Things like medications, sun, stress, or infections?
– Could this rash be something else like rosacea, dermatitis, or eczema?
– Do I need any skin biopsies or blood tests?
– Is the distribution or appearance of this facial rash concerning to you?
– What treatment options do you recommend for my rash?
– What over-the-counter creams or other products can I use on my face?
– How can I protect my facial skin from sun damage?
– What symptoms would require me to see you immediately?
– Will this rash cause scarring or hair loss if left untreated?
– What makeup or other cosmetic techniques can I use to conceal redness or flaking?
– What lupus medications could improve this rash and my other symptoms?
– How might lupus or its treatment affect me facially as time goes on?
Don’t hesitate to voice any cosmetic or psychological concerns you have about facial lupus to your doctor as well. Speaking up can help guide treatment and coping strategies.
Takeaways
– Lupus often causes skin issues on the face like malar rash, lesions, and photosensitivity.
– Red butterfly rashes across the cheeks are classic, but facial effects vary.
– Discoid rashes can lead to permanent scarring if untreated.
– Sun protection with sunscreen and hats is critical for photosensitive lupus skin.
– Medications like steroids, antimalarials, and immunosuppressants help manage symptoms.
– Support for self-esteem and cosmetic techniques can aid coping with facial changes.
– Alert doctors about any new rashes or flares for prompt evaluation and care.
– With treatment, most facial manifestations can be managed well to limit lasting damage.
