The skin is made up of many layers of cells. Lupus is the blanket term given to a group of similar illnesses which mostly affect the skin and sometimes, internal organs. The condition can be difficult to live with, especially because the most visible parts of the skin (the face, chest, arms) tend to be affected. Here are the most common forms of lupus:

Discoid lupus erythematosus

Lupus erythematosus is the name given to a group of illnesses, Discoid lupus erythematosus (DLE) refers to a rare skin rash – with the word “discoid” meaning the condition only affects the skin. When it is severe, it’s called ‘systemic’ lupus erythematosus, and in that case, it can affect internal organs. DLE is very sensitive to light, sun exposure has a very damaging effect on the health of the skin.

What causes DLE?

DLE is linked to an autoimmune response, although its exact cause has not been identified, as yet. It is not contagious, and it is not as a result of a food allergy.

An autoimmune response is a malfunction in the body in which the body’s own defence system begins to attack the body itself, instead of the invading pathogens. In this case, the immune system identifies skin cells as an enemy and begins to attack them.

While there are no ‘causes’, DLE can be triggered. Elevated stress levels, trauma, certain medications, and infection are known triggers. These triggers can set it off or exacerbate the symptoms of the condition.

It rarely affects children, and men and women are both susceptible. That said, it seems to affect women between the ages of 20 – 40 years of age, most frequently.

While there is evidence to suggest a link between DLE and genetics, we don’t quite understand the role played by the gene in setting off the condition. It is thought that a combination of genes and environmental triggers come together to form DLE.

What are the symptoms of DLE?

DLE is a red rash of scaly patches which tend to tear easily. This causes the skin to thin or change colour. Sometimes, the scaling may cause thickened areas that almost resemble a wart. This rash is typically found on the face and on certain areas of the scalp. If it is on the scalp, hair thinning and permanent hair loss may occur. The rash can spread to other areas too, like the arms, shoulders, and torso.

The rash can be irritable and itchy. The healing process may leave behind scars and sometimes, permanent colour changes to the skin.

How is DLE diagnosed?

DLE can generally be diagnosed by looking at the rash, but further tests may be necessary. A skin biopsy, a urine sample, and a blood sample will offer a definitive answer.

Subacute lupus erythematosus (SCLE)

This form of lupus is also a chronic illness resulting from an autoimmune condition in which the antibodies of the immune system begin attacking certain parts of the body, most commonly the skin and it takes the form of a rash.

What causes subacute lupus erythematosus?

As mentioned with DLE, the exact cause of the condition is unknown but it is linked to autoimmune responses and tends to flare up if it is in contact with UV rays. It also tends to be more prevalent among women than men. It is also sometimes triggered by certain medications, like diuretics. While this may be frustrating, do not discontinue your medication without consulting your doctor.

Is subacute lupus erythematosus hereditary?

As with DLE, although it is rare, there does appear to be a common gene among family members, sharing the rare disease. During pregnancy, it is possible for the antibodies causing the symptoms to pass through to the baby, causing a rash and very rarely, a slow heartbeat in the baby.

What are the symptoms of subacute lupus erythematosus?

The rash typically appears in areas that are exposed to the sun; chest, arms, face etc. The rash is red and can sometimes appear scaly.

Many people feel well, while others feel tired and weak with other flu-like symptoms, like body aches. Severe illness is also possible but uncommon.

How is SCLE diagnosed?

As with DLE, an examination of the skin may be a clear indication that you have SCLE, but a skin biopsy and blood analysis will confirm this.

How is SCLE treated?

At this stage, there is no cure for SCLE, it is a chronic condition that needs to be managed. It is important to avoid sunlight which acts as a trigger for this condition. SPF 30 or greater sunblock should be used daily and supplementing with oral vitamin D to account for the lack of sunlight. A combination of topical corticosteroids and pimecrolimus ointments offer relief. Oral medications can also be effective should the next line of treatment be necessary.

Acute lupus erythematosus

Possibly the most common form of lupus, ACLE, is also an overactive immune system where the body’s own defence system attacks healthy tissue – like skin cells. Acute refers to sudden onset – so it didn’t build gradually, the symptoms suddenly appeared unexpectedly. In this case, the lesions may be on the face or anywhere else on the body, although typically triggered by sunlight.

Treating lupus

Sun protection

Sunscreens are mandatory in the management of cutaneous lupus erythematosus. Lesions of ACLE, SubAcute LE, DLE can be precipitated and worsened by Ultraviolet (UV) Light.

Topical therapy

Topical corticosteroids, intralesional steroids for severe lesions. As well as topical tacrolimus can be used.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These over-the-counter medications are used to treat fever, pain, and swelling associated with lupus. Stronger medications may be prescribed if necessary.

Antimalarial drugs

These medications can help to relax the immune system, reducing the severity of the lupus episodes. They need to be used with caution as they can upset the stomach – and regular eye examinations are necessary as there is a chance of the medication damaging the retina.

Corticosteroids

These medications ease inflammation levels. They are available at various strengths depending on what is needed on a case-by-case basis. While the relief is welcome, some of the potential side-effects include weight gain, diabetes, thinning bones, and easy bruising.

Immunosuppressants

Lupus occurs as the result of an overactive immune system, with the body’s own antibodies attacking healthy cells. By suppressing the immune system, the symptoms of lupus can be eased. This medication is used in severe cases as the potential side effects include increased risk of infection, liver damage, and decreased fertility.

Biologics

This group of medication (belimumab) is administered intravenously. It relieves the symptoms of lupus. The side effects some people may experience include nausea, diarrhoea, and infections.

Lupus and other organs

The kidneys:

Lupus can affect the kidneys. The primary role of the kidneys is to filter waste and water from the blood, thereby creating urine which is excreted from the body. Sometimes, lupus nephritis can occur, in this case, the inflammation affects part of the kidneys, causing swelling and difficulty in eliminating urine. This causes water retention, decreased urination, cloudy/pink urine (due to blood or protein) and fatigue. This condition is treated with steroids and blood pressure medications like ACE inhibitors.

The nervous system:

CNS (central nervous system) lupus affects the brain and spinal cord, causing seizures, brain fog, confusion, memory problems, and personality changes. This condition is rare but extremely difficult to diagnose as there are so many potential factors that can cause the same symptoms. It is usually diagnosed with an A CT scan/MRI, an EEG (electroencephalogram), and a lumbar puncture (to evaluate spinal fluid).

The blood:

Lupus of the blood can affect the different components of the blood. Sometimes it may result in low white blood cell count, sometimes it may result in low red blood cell count, or it may affect the platelets, leading to clotting difficulties. A phlebotomy is performed to evaluate the blood and make an accurate diagnosis. The condition is treated with steroids or other accepted lupus treatment medications.

The heart:

Lupus can cause problems with heart valves, and is commonly associated with pericarditis. Pericarditis is inflammation of the lining of the heart (pericardium) causing severe chest pains and sometimes, fluid forms around the heart. Myocardiopathy (weakening of the muscle around the heart) can cause the heart to beat with less energy than it should, leading to weakness and lightheadedness. This is generally treated with recommended lupus medications, anti-inflammatories (especially for pericarditis) and in severe cases, the fluid that has built up around the heart will be drained.

Complications of lupus and the skin

While most people with lupus (around 90%) will continue to live a normal life, complications can occur. These include:

• Mild or severe nephritis (kidney infection)
• Pleural effusion (fluid around the heart)
• Increased risk of stroke due to blocked blood vessels
• Myocarditis (inflammation of the heart)
• Inflammation of the brain
• Depression and short-term memory loss
• Increased risk of complications and miscarriage during pregnancy

Taking care of yourself

Self-care is the best way to manage any form of lupus, along with a comprehensive medical treatment plan. It is a lifelong autoimmune disease, so there is no cure, but there are great treatments to keep the symptoms manageable. Here a few ways to improve your conditions through your daily habits and lifestyle choices:

• Do not smoke.
• Use sun protection (including UV protective sunglasses) and sunblock SPF 30 or higher.
• Supplement with an oral vitamin D supplement to make up for loss of sunlight.

For more information on caring for yourself, a loved one, or to get a diagnosis and a proper treatment plan, contact Dr. Khoza. We will offer you the best help available.