4 Lupus Subtypes Cutaneous Lesions What to Avoid Specialist

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4 Subtypes Lupus

Lupus is a chronic autoimmune disease. As a result it can involve your skin, joints, blood cells, kidneys, brain, heart and lungs. There are 4 lupus subtypes.

When people talk about lupus they are generally referring to SLE. Depending on the person symptoms may be permanent, suddenly vanish or occasionally flare up. Treatment can help manage the disease but it can’t be cured.

Disclaimer: This website is for informational purposes and not for diagnosis. More details.

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Causes for Lupus

Genetics

Genes have a major role as some people may be born prone to developing lupus. Many genes have been identified associated with the disease. Having a family member with lupus puts a person at higher risk.

More often with these genes, lupus occurs after being triggered by something in the environment. Someone even having one or more of these genes has a small chance to actually get this disease.

Environment

Possible triggers:

 

Hormones

Estrogen is at its highest during the childbearing years when lupus is more common.

Infections

Lupus can start or cause a relapse through having an infection in some people. There may be a connection with infections such as cytomegalovirus and Epstein-Barr.

Medications

Some kinds of blood pressure medications, anti-seizure medications and antibiotics can trigger lupus.

Hydralazine (Apresoline), procainamide (Procanbid) and quinidine used long term have a possible cause with lupus. This may lead to drug-induced lupus erythematous (DIL).

Also if you are taking TNF blocker to treat rheumatoid arthritis (RA), inflammatory bowel disease (IBD) and ankylosing spondylitis can lead to DIL.

Treatments for acne and rosacea such as tetracyclines like minocycline although rare may cause DIL.

5 Top Things to Avoid with Lupus

  • Sunlight
  • Bactrim and Septra (sulfamethoxazole and trimethoprim)
  • Garlic
  • Alfalfa sprouts
  • Echinacea

4 Subtypes of Lupus

Systemic Lupus Erythematosus (SLE)

Affecting about 70% having lupus this is the most common and more serious type. Risk for heart disease and osteoporosis health problems common to women are higher. SLE symptoms can affect all parts of the body.

Common symptoms:

  • Skin rashes
  • Hair loss
  • Sun sensitivity
  • Fatigue
  • Painful and swollen joints
  • Unexplained fever
  • Kidney problems

These may be some of the more serious complications:

Kidney inflammation can interfere with the way your body removes waste from your blood. This can damage your kidneys where you would need dialysis or a kidney transplant. There is also the chance of a disease called lupus nephritis.

Inflammation can affect your nervous system and brain leading to brain fog, headaches and strokes.

There could also be hardening of the arteries or deposit buildup on the artery walls leading to a heart attack.

Cutaneous Lupus Erythematosus (CLE)

This type is solely seen on your skin. Cutaneous occurs in about 10%. It can affect those with and without SLE.

Common symptoms:

  • Rashes
  • Hair loss
  • Swelling of the blood vessels
  • Sun sensitivity
  • Oral and nasal ulcers

Diagnosis involves your doctor taking a biopsy of the rash or sore.

Cutaneous Lupus is broken down even more:

Acute Cutaneous Lupus 

Acute contains the characteristic butterfly rash (AKA malar rash) across the nose and cheeks that can resemble sunburn.  It is flat, red and itchy typically appearing after sun exposure. This is often linked to SLE. It may occasionally be seen on the arms and legs.

Subacute Cutaneous Lupus

The appearing rash is red, raised and scaly on the body. Subacute develops skin lesions on parts of the body that were exposed to sun. These lesions aren’t itchy or painful rarely causes scarring after healing.

Subacute causes two kinds of lesions:

The first referred to as papulosquamous lesions are red, scaly patches looking similar to pimples but quickly spreading to cover large areas. These are triggered by sun exposure and usually seen on the shoulders, back and chest.

The second kind of lesion due to subacute cutaneous lupus is annular lesions. These have a flat appearance including pink circles with red border. Annular lesions have many sizes and could develop anywhere on the body except rarely the face.

4 Subtypes Lupus
Photo by Nappy- from pexels

Chronic Cutaneous Lupus

Discoid Lupus Erythematosus

Discoid (meaning round shape) sores or lesions that don’t itch or cause pain. They are thick, raised scaly patches usually pink in color and may flake or be crusty on the skin. These lesions usually occur on the face, ears, scalp, neck and hands.

The lesions may lead to dark spots or scars present after the skin heals. If there is scarring of the scalp this may destroy hair follicles and cause permanent hair loss.

In addition there may be sores in the mouth or nose.  Because you have chronic cutaneous there is a bit of a chance you could get SLE later on.

Subacute and chronic cutaneous lupus types generally only involve the skin. Lesions connected to other types may be present at the same time.

Lupus Profundus

This type of chronic Involves nodules that can cause painful dents in the skin.

Lupus Tumidus

A red plaque appears on the face extending deep below the surface which doesn’t cause a scar. This is not common and difficult to distinguish from other kinds of skin rashes due to sun exposure.

Chilblain lupus

Symptoms are red and somewhat purple colored nodules on the finger and toes.

Drug-Induced lupus (DIL)

This type also affects about 10% of those with lupus. Medicines commonly used to treat seizures, high blood pressure or rheumatoid arthritis can cause drug-induced lupus. However it doesn’t mean everyone taking these medicines will get drug-induced lupus.

Usually with discontinuing the medication within six months the symptoms go away. The symptoms are similar to SLE except it rarely involves major organs so considered not as serious.

Common symptoms:

  • Joint pain
  • Muscle pain
  • Fever

Neonatal lupus

This is a rare condition concerning infants.  Some antibodies from the mother affect the fetus while in the womb. But it is not definite that you will pass it on to your baby if you have lupus. For infants of mothers with lupus most are healthy.

Also it is possible that an infant could have neonatal lupus when the mother currently does not have lupus. If the baby has lupus at birth usually the mother will develop lupus later in life.

The baby may be born with a skin rash, liver issues or low blood cell counts. Typically these symptoms completely go away after six months having no lasting effects. These newborns having mothers with lupus are at increased risk of developing very rare but serious heart defects.

A mother who is at high risk can now be identified with proper testing  by the doctor. Also the infant may be treated at or even before birth.

Women and Lupus

Lupus is seen more in women between ages 15 to 44. This is considered childbearing years. With lupus comes the risk of other health issues. Lupus can also cause these issues to occur earlier in life versus women not having lupus.

Health issue risk:

Heart disease

Lupus presents a risk for the most common kind of heart disease known as coronary artery disease (CAD). Those having lupus have more risk factors for CAD. These are high blood pressure, high cholesterol and type 2 diabetes.

Another risk for CAD is inflammation which lupus causes. Due to fatigue, joint problems and muscle pain women with lupus can be less active. This presents another risk for heart disease.

Osteoporosis

Medicines used to treat lupus can also cause bone loss. This in turn can lead to osteoporosis with weak and broken bones. Being active is important to prevent bone loss as well.

Kidney Disease

A common problem is lupus nephritis. This involves the kidneys and affects more than half with lupus. Usually kidney issues start within the first five years when lupus symptoms appear.

As well as kidney inflammation not typically causing pain there are no signs this is happening. This is the importance for those with lupus to regularly check for kidney disease. Getting a urine and blood test will look at kidney function. Treating lupus nephritis is best when caught early.

Lupus and Ethnic Groups

African American and Hispanic women often develop lupus when younger. They have more serious symptoms with kidney problems compared to other groups. African Americans having lupus will have more issues with seizures, strokes and dangerous swelling of the heart.

As well as Hispanic women with lupus have additional heart problems compared to other groups.

Treatment for Lupus

Nonsteroidal anti-inflammatory drugs (NSAIDS) these are to help reduce inflammation and pain in muscles, joints as well as other tissues.

Anti-malarial drugs can help with joint and skin problems along with fatigue.

Steroids work fast to relieve pain, stiffness and swelling but have unpleasant side effects. Once the disease is controlled the dosage will be decreased. There are also steroid creams with a prescription.

Immuno-suppressive medications can help with suppressing the immune system.

Specialist to Help With Treatment

  • Rheumatologist – arthritis and other rheumatic diseases
  • Cardiologist – heart disorders
  • Pulmonologist – respiratory tract diseases
  • Nephrologist – kidney disorders

Wrapping it up

There are 4 subtypes of Lupus. Cutaneous lupus involving just the skin is separated further by lesions. All types can be managed.

Lupus is a combination of genetics and environmental factors. Certain ethnic groups are at risk. Kidney disease is a common complication.

Symptoms may overlap or other types of lupus may develop symptoms at the same time.  Avoid sunlight and foods increasing inflammation. Treatment may include different specialist and regular kidney test are a must.

Do you have lupus affecting your skin?

Header Photo by Andrea Piacquadio from pexels

Mary
Mary is the founder of All About Our Skin. Former esthetician and CPC. Enjoys researching skincare and has been studying our skin for the past fourteen years.
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