Lupus and your skin: Diagnosis and treatment

When lupus affects your skin, a dermatologist may be part of your care team

A board-certified dermatologist has the expertise needed to create a treatment plan that can help manage skin, hair, and nail problems caused by lupus.

If lupus could be affecting your skin, it’s important to find out ASAP. Treating the condition early can prevent cutaneous (skin) lupus from progressing and causing damage.

A board-certified dermatologist can tell you what type of cutaneous lupus you have and develop a treatment plan to control it.

How do dermatologists diagnose cutaneous (skin) lupus?

If lupus could be the cause of a rash, sores, or other skin problem, your dermatologist will closely examine your skin, hair, and nails.

Your dermatologist will also ask questions, such as whether you have:

• Sores inside the mouth, nose, or elsewhere

• Rashes, sores, or other skin problems that come and go

• Been taking a medication and noticed the skin problem afterward

• Blood relatives who have lupus or another autoimmune disease

You may also need blood tests. A blood test cannot tell whether you have lupus. If certain proteins are found in your blood, that gives your dermatologist information that can help give you an accurate diagnosis.

Your dermatologist may also perform a skin biopsy, which involves removing a small amount of skin. The removed skin will be sent to a lab where it will be looked at under a microscope. This close-up view gives your dermatologist more clues about what is happening with your skin.

Your dermatologist can perform a skin biopsy during an office visit while you remain awake.

It takes time to diagnosis cutaneous lupus

No single test can tell whether you have any type of lupus.

When you have signs of lupus on your skin, your dermatologist will carefully consider the results from your skin exam, medical history, and lab tests. You may need more testing before getting your diagnosis.

If your dermatologist determines that lupus is affecting your skin, your dermatologist will tell you what type of lupus you have and create a treatment plan tailored to your needs.

How do dermatologists treat lupus on the skin?

When treating cutaneous (skin) lupus, dermatologists seek to:

• Reduce (or clear) the rashes, sores, and other skin problems

• Relieve symptoms like itch and pain

• Diminish flare-ups

• Prevent scarring (some types of lupus can cause scarring)

• Stop irreversible hair loss (discoid lupus)

• Even out skin tone if you have color changes

• Treat scarring (if has happened)

When a dermatologist creates a treatment plan for lupus on the skin, the plan usually includes the following:

Sun protection: Sun protection can prevent new flare-ups and stop lupus from worsening.

To help you protect your skin from the sun, your dermatologist will talk with you about seeking shade, wearing sun-protective clothing, using sunscreen, and planning outdoor activities for times when the sun’s rays are less intense.

Sun protection helps to prevent flare-ups and stop lupus from worsening in people of all skin tones

That’s why dermatologists include sun protection in a treatment plan for cutaneous lupus.

Medication: Dermatologists prescribe medications to treat a lupus rash and other skin problems, help regrow hair, and alleviate symptoms like pain. A treatment plan for cutaneous lupus may include one or more of the following medications:

• A corticosteroid: Cutaneous (skin) lupus often responds quickly to a corticosteroid. You may apply this medication to your skin or take it as a pill. Once your skin responds, your dermatologist will lower the dose or prescribe a different medication. This helps to reduce the risk of side effects due to the corticosteroid.

• A corticosteroid that your dermatologist injects: This can help clear a thick lupus patch on your skin.

• Antimalarial medication: Used to treat malaria, this medication can also clear skin rashes due to lupus and prevent lupus flares. Antimalarial medication works slowly. It may take 2 to 3 months before you see results. Research suggests that smoking cigarettes can prevent an antimalarial from working as well as it can. Be sure to tell your dermatologist if you smoke.

• Tacrolimus ointment: This may be an option for skin that cannot be treated with a corticosteroid. This ointment may also help regrow hair, but only if scarring hasn’t started.

Cutaneous lupus can be difficult to treat. Sometimes, it takes months to find the right treatment. If you’re not getting results, your dermatologist may add one or more of the following to your treatment plan:

• Medication that calms the immune system: These medications include methotrexate, cyclosporine, and mycophenolate mofetil.

• Biologic: Lupus causes inflammation and is an autoimmune disease.Many biologics have been developed to treat inflammatory and autoimmune disorders.

• Other medication: Some patients see results when they try medication like a retinoid or dapsone. The latter is an antibiotic that can reduce inflammation.

Laser therapy: This may be an effective treatment for people who have one of the following:

• Thick patches of discoid lupus that remain on the skin despite treatment.

• Dark patches called hyperpigmentation, which often appear on darker skin tones when lupus rashes, raised patches, or sores clear.

• Scarring caused by acute cutaneous lupus or discoid lupus.

If laser therapy is an option for you, the laser treatments should be performed by a board-certified dermatologist who has experience using lasers in people who have a skin tone similar to yours.

When laser treatments are performed by someone who lacks this experience, you’re more likely to develop a complication. You may experience a burn, spots that are lighter or darker than your natural skin tones, or scarring.

Your dermatologist will follow you closely

It can take months to find a treatment plan that can reduce lupus on your skin. Until then, you may need to see your dermatologist once or twice a month.

Once the lupus on your skin is under control, most patients see their dermatologist once every 3 to 6 months.

To help their patients with cutaneous lupus get the best results from treatment, dermatologists often recommend self-care. You’ll find the self-care that dermatologists recommend at: Lupus and your skin: Self-care.

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References
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Written by:
Paula Ludmann, MS

Reviewed by:
Brendan Camp, MD, FAAD
Mario J. Sequeira, MD, FAAD

Last updated: 9/23/22