Lupus rash, also known as malar rash or butterfly rash, is a common symptom of systemic lupus erythematosus (SLE). It appears as a reddish rash that spreads across the nose and cheeks in the shape of a butterfly. While mild lupus rashes may come and go, severe rashes that cover large areas of the body can be uncomfortable and problematic.
There are several factors that can worsen or trigger a flare up of lupus rash. Being aware of these triggers is important for lupus patients to help manage their symptoms.
Sun exposure
Sun exposure is one of the most common causes of worsened lupus rashes. The ultraviolet rays of the sun cause inflammation and irritation that leads to redness, swelling, and sensitivity in areas of lupus rash. Even brief amounts of sun exposure can quickly worsen a lupus butterfly rash.
Wearing sunscreen, protective clothing, and avoiding prolonged time in the sun are critical for minimizing sun exposure. Wide-brimmed hats and tightly woven, loose-fitting clothing help provide protection from the sun’s rays. Sunscreen of SPF 30 or higher should be applied 15-30 minutes before sun exposure and reapplied every 2 hours.
Stress
High stress levels are a common trigger for flares of autoimmune disease activity and symptoms. Stress causes hormone changes in the body that can increase inflammation and stimulate the immune system. This often results in a worsening of lupus rash following stressful events, challenges, or anxiety.
Although daily stresses can sometimes be unavoidable, focusing on stress management techniques is important. Exercises like yoga, meditation, tai chi, deep breathing, and muscle relaxation help manage stress. Talking to a counselor or therapist provides support in coping with stress as well. Setting aside time for hobbies and relaxation is beneficial too.
Hormone changes
Hormonal shifts that occur during the menstrual cycle, pregnancy, and menopause can worsen lupus rashes due to their effect on the immune system. Many women with lupus experience a pre-menstrual flare of symptoms due to declining estrogen. Rashes may worsen just before or during their periods when estrogen and progesterone levels drop.
Pregnancy can also aggravate lupus rashes due to rising hormone levels. The immune-stimulating nature of hormones like estrogen and prolactin may cause inflammatory flares over the nine months. Menopause can trigger rash flares as hormone levels fluctuate erratically during this transition.
Medications
Certain prescription drugs used to treat lupus have the potential side effect of worsening rashes in some patients. Medications that commonly cause rash flares include:
- Antimalarials like Plaquenil/hydroxychloroquine
- Sulfonamides like Bactrim/trimethoprim-sulfamethoxazole
- ACE inhibitors like lisinopril, benazepril
- Diuretics
- NSAIDs like naproxen, ibuprofen
- Allopurinol
- Antibiotics
Rashes that develop while on a new medication require prompt medical evaluation. Switching to an alternate medication often resolves medication-induced rashes.
Infections
Infections can over-activate the immune system and worsen inflammation levels throughout the body, including the rash of lupus. Upper respiratory infections, urinary tract infections, strep throat, and yeast infections may all exacerbate lupus rashes.
Preventing infections through good hygiene and handwashing helps avoid this trigger. Seeing a doctor promptly at the first sign of infection allows for early treatment as well.
Food sensitivities
Food allergies or sensitivities to certain foods may trigger immunologic reactions that worsen lupus rashes in some people. Contributing foods can include:
- Dairy products
- Eggs
- Wheat
- Corn
- Artificial ingredients
- Processed foods
Keeping a food diary while tracking rash symptoms may help identify problematic food triggers. Allergy testing can confirm food allergies as well. Avoiding reactive foods and gradually reintroducing them one at a time may improve rash flares.
Environmental triggers
Irritants in the environment have the potential to aggravate lupus rashes in those who are sensitive. Triggers may include:
- Cigarette smoke
- Perfumes or fragrances
- Cleaning products
- Air pollution
- Plastics or epoxy resins
Being aware of rash reactions during exposure to irritants can help identify environment aspects to avoid. Aa well-ventilated indoor space helps dilute potential triggers.
Certain health conditions
Having another autoimmune or inflammatory health condition in addition to lupus can exacerbate rashes. Associated conditions like:
- Rheumatoid arthritis
- Sjogren’s syndrome
- Blood disorders
- Thyroid disorders
May worsen inflammation and stimulates the immune system, leading to increased lupus rash activity. Managing these co-existing diseases is important.
Non-compliance with medications
Not taking lupus medications as prescribed often results in disease flares and worsening of symptoms like rashes. Skipping doses of corticosteroids, antimalarials, immunosuppressants or other prescriptions leaves the immune system unchecked.
Sticking closely to prescribed lupus treatment plans helps control disease activity and prevents medication-triggered rash flares. Communicating with your doctor about any desired changes is essential.
Fatigue and over-exertion
Extreme fatigue and over-exerting yourself can stress the body and immunity, increasing susceptibility to lupus flares. Pushing past your limits may leave you exhausted and cause rashes to worsen.
Pacing activities with rest periods helps avoid over-exertion. Allowing time for adequate sleep and rest helps the body recover from fatigue. Light exercise benefits energy levels when done in moderation.
Summary of what makes lupus rashes worse
- Sun exposure
- High stress
- Hormone changes
- Certain medications
- Infections
- Food triggers
- Environmental irritants
- Co-existing health conditions
- Missing medications
- Fatigue and over-exertion
Treatments for worsening lupus rashes
Flare-ups of lupus rashes usually require additional medications for treatment. Doctors may prescribe:
- Corticosteroids – Short courses of corticosteroid pills or injections rapidly reduce rash inflammation.
- Topical creams – Over-the-counter hydrocortisone creams and ointments help relieve itching and redness.
- Antimalarials – Medications like Plaquenil calm the immune system and suppress rashes.
- Immunosuppressants – Drugs like methotrexate, Imuran and CellCept prevent the immune system from attacking the body.
- Biologics – Newer injections like Benlysta, Rituxan and Belimumab target the immune response.
Severe worsening rashes may require hospitalization for intensive treatment. Emergency medical attention is needed if the rash is accompanied by fever, mouth sores, chest pain or abdominal pain.
Lifestyle changes to prevent rash flares
Making certain healthy lifestyle adjustments can help decrease flares of lupus rashes:
- Use sun protection including hats, clothing and sunscreen
- Find healthy ways to manage stress levels
- Adopt a balanced, antioxidant-rich diet
- Quit smoking to avoid irritating rashes
- Exercise moderately to increase energy
- Get sufficient sleep and rest
- Reduce exposure to environmental irritants when possible
- Take medications as prescribed by your doctor
When to seek emergency care
Seek prompt emergency medical attention if a lupus rash is accompanied by:
- Fever over 100 F
- Severe headache or confusion
- Shortness of breath or chest pain
- Abdominal pain, nausea or vomiting
- A spreading rash
- Mouth or nose sores
- Unusual bleeding or bruising
These signs may indicate a serious complication or internal inflammation that requires urgent treatment.
The takeaway
Lupus rashes can flare due to sun exposure, stress, hormones, medications, infections, allergies, environmental triggers and fatigue. Avoiding rash triggers and taking prescribed lupus medications helps prevent worsening. Seek emergency care for severe rashes with concerning symptoms like fever or shortness of breath.
