Systemic lupus is an autoimmune condition which affects internal organs and usually produces a mild rash or flush on the face. Discoid lupus is confined to the skin and doesn’t affect other organs. It usually causes a much more pronounced rash on the face – scaly plaques that can cause pigmentary change and can also result in severe hair loss and scarring.
In some patients, a characteristic rash appears over cheeks and nose (butterfly or malar rash). The rash varies from a mild to a florid lumpy and disfiguring rash, which is intermittent. It is a feature of active disease. Skin can become thickened and scaly. Scalp involvement can be a key features, including patches of baldness.
Frequently affected sites are the front of the neck, the palms of the hands, the elbows and the soles of the feet. Patients also often get vesicles around the tips of the fingers. The nails are also frequently involved becoming brittle. The ears and mouth can also be affected.
The systemic features of SLE are numerous and include:
- Tiredness, malaise, chronic pain, fever
- Joint swelling or pain
- Pleural effusions
- Pericarditis or pericardial effusions
- Glomerulonephritis
- Seizures, myelitis, peripheral neuropathy
- Reduced number in all cell lines
Treatment
Steroids: topical steroids, steroid injections or oral steroids
Anti-malarials: hydroxychloroquine
Immunosuppressants/DMARDs