Lupus rash – Types, Effects, Diagnoses, Treatments, Prevention and Pictures

What is lupus?

Lupus is a chronic autoimmune disease, which can damage any part of the body such as skin, joints, and legs. Some people suffer chronic and lifelong disability with lupus whereas some people suffer only minor discomfort. It can affect any part of the body such as skin, blood vessels, joints, brain, lungs, kidneys and blood vessels.

Chronic describes the condition in which sign and symptoms remain for more than six weeks and sometimes for even longer periods, whereas autoimmunity defines as when the immune system of one’s body is not capable of differentiating between foreign invaders and antibodies (healthy tissues that are produced in response to foreign particles.

In lupus:

• The immune system of the body become hyperactive and starts producing auto-antibodies.
• Auto antibodies are produced due to improper function of immune system, these auto antibodies kill the healthy tissues of the body.
• Auto antibodies attacks and damages healthy tissues and these auto antibodies are responsible for inflammation, pain, and fever.
• Some most common symptoms of lupus are rashes, swelling in joints, fever, pain and tissue damage.
• Lupus is 8 times more common in women than men and it strikes in between the age of 15 and 44.

Different lupus types

Discoid lupus erythematosus (DLE):

DLE is the form of lupus, which does not affect the vital organs of the body but affects the skin that is exposed to sunlight. DLS is known to leave the scars after healing of lesions.

Systemic lupus erythematosus (SLE)

As the name indicates, it spread systematically and affects the skin and main organs of the body such as kidney, Lungs, Joints and Skin. It is responsible for well-known butterfly rash on the skin (bridge area of nose and cheeks) and often leaves scars on the face when remain untreated. Blood vessels come under attack of systemic lupus and they can sore the skin of fingers. The condition is more severe when patient suffers from Reynaud’s syndrome.

What is lupus rash?

The most common symptom of lupus erythematosus is skin rash or butterfly rash. It is also known as the tell-tale sign of lupus. It is a butterfly-shaped rash across nose and Cheeks Bridge.

It is also known as “malar rash”, and it is called so because the word “malar” derived from latin word mala that means cheekbone. These are the rashes that get better in few days or weeks but it can last for longer periods or even prove permanent. These rashes are itchy and painful and get worse when exposed to sunlight.

These are red colored or purple colored rashes in a blotchy pattern and it may appear as completely red over affected area. These rashes are not usually painful but can be itchy. Sometimes patient complaints about “hot” feeling with these butterfly rashes.

How lupus rash affects my skin?

Almost all people, who are suffering from lupus, knew that their disease is getting worse by exposure to sunlight and ultraviolet rays from sun damaging their skin. Just 2/3rd of people that are suffering from lupus observe some other type of effects in their skin.

When exposed to the sun, some people develop cutaneous lupus erythematosus in which lupus cause rashes, sores, and lesions on the exposed areas such as face, neck, arms, back and legs.

The rashes are diagnosed carefully under the microscope to determine the rash is due to cutaneous lupus or something else. This diagnosis is done by dermatologists or physicians only. They usually take a sample of skin tissue for proper identification of lupus which is also known as biopsy.

How lupus rash looks like?

Lupus rash are also known as “malar rash” or “butterfly rash” and it looks like this:

 

What are different types of lupus rash?

There are three types of lupus rashes:

Acute cutaneous lupus rash:

This type of rashes also known as “butterfly rash” or “malar rash”.  Its shape is similar to outstretched wings of a butterfly across nose and cheek bone. These rashes are the most recognized symptom of lupus. It occurs only in 40% of the patients suffer from lupus erythematosus.

Subacute cutaneous lupus lesions:

There are two types of subacute cutaneous lesions.

The first type is extremely sensitive to sunlight; the skin develops red colored dots all over the exposed area.

• These lesions look like psoriasis with red scaly patches on various parts of the body such as arms, shoulders, trunk, chest and neck.
• This type of lupus also has some patches on the face. As rash persists for longer time, the pimples become larger and scales appears on the body.
• It can cause moderate to severe itch and sun exposure worsens this kind of rash.

The second type of lesions is red colored ring shaped lesions and they expand outwards creating a ring.

• They are flat, red colored, ring-shaped lesions and they get bigger as they expand.
• The center of these reddened rashes lightens over time and the rash appears like circular rings with holes in the center.
• These rashes get worse upon exposure to sunlight and become itchy.
• These rashes are responsible for pigmentation after healing as they seldom leave any scars.

Chronic cutaneous (discoid) lupus rash:

This is also called as discoid lupus erythematous, and is found in only 20% of patient suffering from systemic lupus erythematosus. Some features of chronic lupus are:

1. Lupus is confined to skin only.
2. The lesions usually found in on the scalp and outer ear.
3. The lupus associated with discoid lupus is rarely found below the chin, never on the legs.
4. These rashes are usually red or pink areas that are slightly elevated and they create flakes or crusts on the surface of the skin.
5. These lesions leave the skin with a scare as they mature.

In discoid lupus, lesions and rashes are itchy and bigger, they leave a central scar as spreading outwards. In darker individuals, the skin becomes lighter in color in the center of the scar.

Why lupus does create lesions on the skin?

• There are three types of lupus erythematosus named as Chronic or discoid lupus, Subacute cutaneous lupus, and cutaneous lupus.
• In chronic discoid lupus, around 10% of people develop lupus in other organs apart from skin. Usually, round lesions appear on face and neck in this particular form of lupus.
• Whereas the lesions which are photosensitive develop in subcutaneous lupus. The lesions present in this condition are scaly, red and ring-shaped with clear edges. These types of lesions and rashes become worse when exposed to skin and appear on skin, neck, legs and arms.
• Explained by Lupus Foundation of America, When systemic lupus is active, the rashes start appearing on the face that looks like sunburn which is also affected by sunlight or florescent lights and does not produce scarring.
• According to the Lupus Foundation of America, some other skin conditions that can occur with lupus are calcinosis, cutaneous vasculitis lesions, Raynaud’s phenomenon and petechiae and can worsen due to the presence of lupus.

What are the symptoms of lupus?

Lupus may cause following signs and symptoms:

• Achy joints (arthralgias)
• Fever over 100 degrees F
• Swollen and painful joints (arthritis)
• Prolonged fatigue
• Skin rashes
• Anaemia
• Swollen ankles (kidney involvement)
• Chest pain upon deep breathing (pleurisy)
• Butterfly-shaped rash across cheeks and nose
• Sensitivity to sun (photosensitivity)
• Unusual hair loss
• Problems with abnormal blood clotting
• Pale or purple fingers from cold or stress
• Seizures
• Mouth ulcers (often painless, at roof of mouth)

What causes itchy rashes in lupus?

Lupus can be extremely itchy and the main reason of itchy rashes in lupus in lupus flares. Or it can also be understood as exacerbation of lupus rash can be the sign of lupus flares. The lupus flare can be caused by exposure to ultra violet rays, stress, smoking cigarettes, viruses, hormone fluctuations etc.

It is very important to look for an exact cause of lupus flare and lupus rash or it can make lifestyle discomfort able. You can kill the root cause of lupus flare by working on proper medications, lifestyle changes and you can reduce the risk of recurring of lupus flares.

One person can have lupus flares if he or she has worsening of lupus symptoms. Alternatively, if one has exposed to sunlight for longer periods, they are more prone to get lupus rash.

The main reason for lupus rash is Exposure to ultraviolet rays. When our skin is exposed to sunlight or Ultra violet rays (UVA & UVB), these rays cause skin damage but these dead skin cells are short lived which is also called as sunburn and it goes away quickly.

Whereas when a person is suffering from lupus, the skin damage by sunlight is always dangerous because the skin cells of lupus patient are more sensitive to UV rays and the dead skin cells do not vanish efficiently and the content of dead cells (also called as nuclear antigens) come out easily from the cells and it interacts with antinuclear antibodies and thereby disturbs immune system of the person suffering from lupus, making it more active and damage various parts of the body.

Ultraviolet A and Ultraviolet B is responsible for damaging the keratinocytes and cause skin aging, sunburn, and skin cancer. Therefore, lupus rashes become worse by exposure to ultraviolet rays say it from the sun or florescent lights.

Lupus rash is a “butterfly shaped rash” that is most common identifiable symptom of lupus. Many causes cause lupus rash such as:

• Lupus rash can be caused by systemic lupus erythematosus (SLE) is the main cause of lupus rash in which organs, tissues, and cells of the body become dysfunctional. The main cause of SLE is unknown but genetics and environmental pollutants can aggravate this disease. The most affected organs with this disease are kidneys, liver, brain, blood vessels and joints. Women are most affected by this disease and the suitable age is 15 – 44. Around 40% of lupus patients suffer from butterfly rash.
• Another cause for lupus rash is Bloom Syndrome in which pattern of chromosomes arrangement got changed and causes abnormalities. This syndrome is also responsible for the formation of rashes like butterfly rash.
• Dermatomyositis is one of the root cause of rashes like lupus rash. A connective tissue disorder causes skin and muscular inflammation.
• Lupus rash is caused by photosensitivity and overexposure of ultraviolet rays of the sun can cause butterfly rash or lupus rash.
• Lyme disease is also responsible for lupus rashes and ticks of mice that affect eyes, heart, nervous system; musculoskeletal system and skin cause this disease.
• Seborrhea is one of the main cause which is responsible for lupus rash and is a chronic disease Along with dandruff formation in the hairs and scaling of the skin it also develops malar rashes on the skin and inflammation of the skin, neck, and chest.
• Streptococcal is a bacteria responsible for Erysipelas that is a disease responsible for inflammation of the skin and cause red and painful lupus.

Is lupus rash contagious?

Lupus is not a contagious condition. It cannot be transferred from one person to another even not by means of sexual contact. It is unlike cancer and HIV because, in HIV and CANCER, the immune system is underactive whereas in lupus the immune system is over active. Because lupus is an autoimmune disorder, the immune system of the body becomes unable to differentiate between foreign cells and body’s own cells.

How is lupus rash diagnosed?

The rashes associated with lupus can be identified only on basis of lab test, symptoms, physical exams and history of the patient. Because the rashes on the skin can be present due to any other diseases or you may have some other features of lupus. One should contact his/her physician if concerned.

The lupus rash  can be diagnosed as a classic malar rash that is a red, scaling rash that usually presents on the bridge of nose and cheeks but not in the grooves between the nose also known as nasolabial folds.

The most common symptom of lupus is butterfly rash that is very similar to Rosacea. But the presence of only butterfly rash is not the reason for concern because we all know that rashes can also occur due to allergies, illness, body temperature shifts, use of different soaps or detergents or eczema.

One should consider other body symptoms such as fatigue, stiff joints, weight changes, fever or painful joints to confirm whether it is lupus or not? One should also check if they have Reynaud’s syndrome.

So simply having a rash is no reason to panic. Sometimes physicians find it hard to identify and differentiate between rosaceous rash and butterfly rash and making it more confusing for them.

The American College of Rheumatology chose 11 specific criteria to be diagnosed with lupus to assist the physician in making a diagnosis of lupus. We are mentioning here 4 must have criteria for the diagnosis of lupus but still it is important to remember that having these symptoms does not confirm the presence of lupus.

1. Butterfly Rash: A butterfly shaped rash that is usually found on the bridge of nose and cheeks, which is itchy, red and sometimes painful.
2. Sunlight sensitivity: Photosensitivity can also be used to diagnose of lupus, the skin or rashes start flare up, when exposed to ultra violet rays of sunlight.
3. Discoid Rash: When you see the ring shaped red rashes on head, arms, chest or back.
4. Inflammation/stiffness/pain or swelling of Joints is another identifiable remark of lupus.

Differentiate diagnosis between lupus rashes and other types of rashes?

As described above, lupus rashes are butterfly rashes where as rosacea have different stages. The distinction between the two is difficult. Where lupus have acute cutaneous lesions, subacute cutaneous lupus or chronic cutaneous lupus. If you find any rash, which is unexplainable or persistent, you should seek medical attention immediately.

Whereas Rosacea can be identified by seeking its different stages:

• Pre-rosacea: It is primary stage of rosacea, in this you flush easily but it vanishes away.
• Vascular rosacea: In this type of rosacea, the skin become more sensitive, you flush easily and it stays in your capillaries for longer time.
• Inflammatory rosacea: It is severe case of rosacea, nose become enlarged and bulbous in men. You may flush and skin stays red for most of the time.

Rosacea may feel hot due to inflammation and irritation. A moisturizer should never be applied on a rosacea unless any healthcare practitioner recommends it. One should sseek medical condition in the case of rosacea because it have tendency to worsen with time or it can be clear up by its own.

How long lupus rash lasts?

Lupus rash may be permanent issue and it can leave scars on the face and is often worse after exposure with sun. It can resolve after treatment with medications and proper treatment.

How lupus rash can be treated?

Lupus can be treated with medication and proper care. Treatment of lupus depends upon signs, symptoms and progression of the disease. Many medications have adverse events such as immunosuppressant has inhibited the immune system and therefore can cause infection.

Here are some medications used to control lupus symptoms:

• Corticosteroids for example : prednisone
• Anti malarial drugs for example: hydroxycholoroquine.
• NSAIDs example: Ibuprofen or naproxen
• Immunosuppressant is example: azathioprine & mycophenolate.

Preventative Treatments for lupus rash

The most important factor in causing sunburns is sunlight and UV lights. The exacerbations of the lupus erythematosus occur during daytime and in the exposure to harmful rays coming from the sun. You may not get a rash after UV exposure, but an abrupt increase in auto antibodies can create disbalance in lupus status, therefore, one, who is suffering from lupus erythematosus, should try to protect their sun from the UV rays maximally.

These rays are not only responsible for skin damage but also makes the lupus rashes more prominent and leaves scars even after cessation of the disease.

Seek Shade

It is most important to protect your skin from the sun, when you are suffering from a dangerous disease like LE. Sometimes one cannot avoid the sun all the time, so if it necessary to go out in the daytime, seek for the shades and try to avoid the sun to the maximum.

Wear eye shades in the daytime (if you are out of your house), try oversized shades because it will help you to cover your nose and cheeks bridge area which the most damage prone area by sun rays.

Doctors recommend a sun protective clothing can do wonder in avoiding ultraviolet rays. A basic white T-Shirt has SPF 4 that you should use to cover your chest area. You can buy clothing that has built-in SPF protection for double protection.

Sunscreens – Physical and chemical

There are various types of sunscreens available in the market that reduces the harmful effects of sun rays and ultraviolet rays. As a physical sunscreen, you can use an umbrella and cover yourself (mainly face), If you are out in the sun. You can also cover your skin with a soft cotton cloth as it will protect your skin as well as allow your skin to breathe properly.

Chemical sunscreen is also readily available in the market and is quite easy to afford. These chemical sunscreens are considered best for protection if the skin from the ultraviolet rays as they make a layer over the skin and make ultraviolet rays unable to penetrate through the skin. People often wear chemical sunscreens in the sun and then cover themselves with any physical sunscreens (Umbrella or cloth) in order to get complete protection.

What sunscreens should I use for lupus rash? 

The highest SPF will work best for protection from ultra violet rays. But doctors recommends the use of precautions such as umbrella or sun protective clothing instead of sunscreens.

Best sunscreen which is nonirritating, broad-spectrum sunscreen is that which contain antioxidants like vitamin C, that can neutralize free radicals and are beneficial in reducing inflammation (another result of exposure to sunlight). Whenever you choose a sunscreen, make sure that it should be packed in an opaque container so that the antioxidants, present in it are still effective.

Noelle Sherber, MD, a dermatologist in Baltimore, suggest a broad spectrum sunscreen that can be wear everyday is La Roche Posay’s Anthelios SX Daily Moisturizing Cream SPF15: “The active ingredient of this preparation is Meroxyl SX which has an extremely broad spectrum of UV protection and this is a moisturizing and gentle preparation.

Topical preparations for lupus rash

• Corticosteroid creams, ointments, gels, solutions, lotions, sprays, foams
• Calcineurin inhibitors
  • tacrolimus ointment (Protopic®)
  • pimecrolimus cream (Elidel®)

Can corticosteroids injections be used in treatment of lupus rash?

• Corticosteroids are the medications that are prescribed for autoimmune diseases that are different from anabolic steroids.
• In the cases of skin lesions of cutaneous lupus, the steroids are given in the systemic form as injectables. These are given in muscles or intravenously for several hours.
• Corticosteroids also called as glucocorticoids are synthetic hormones, which are similar to those hormones, which are produced by adrenal glands.
• Cortisol is the most potent anti-inflammatory hormone that regulates blood pressure and immune system of the body.
• Topical corticosteroids (creams and gels) are mainly used for treatment for cutaneous lupus.
• Pulse steroids are large liquids that is given in large doses intravenously over several hours and its effects lasts for several hours.
• Pulse doses are also given in the case of a severe lupus flare.

What are some systemic treatments for lupus rash?

Syestemic corticosteroids are the glucocorticoids that to be given in injectable forms and these are mainly used for the treatment of discoid lupus erythematosus.

Here is a list of some systemic treatments of lupus in which most of them are approved by FDA. There are two type of systemic treatments that can be given to the patients:

For mild to moderate Lupus erythematosus disease:

• Short term corticosteroids
• Antimalarials for example : hydroxychloroquine (Plaquenil®), chloroquine (Aralen®) and quinacrine
• Retinoids: This is synthetic forms of vitamin A – isotretinoin and acitretin.
• Sulfone agents: for example: Dapsone (diaminodiphenylsulfone)

For severe lupus erythematosus disease (DLE)

• Long term corticosteroids
• Gold
  • oral—auronofin (Ridura®)
  • intramuscular—gold sodium thiomaleate (Myochrisine®)

• Thalidomide (Thalomid®)
• Methotrexate
• Azathioprine (Imuran®)
• Mycophenolate mofetil (CellCept®)
• Biologics
  • efalizumab (Raptiva®)

Tacrolimus ointment (Protopic®) for lupus rash

Tacrolimus was isolated from Streptomyces tsukubaensis and is successfully emerged as an anti-inflammatory and immune-suppressive agent. Due to its anti-inflammatory action, USFDA approved tacrolimus ointment for the treatment of dermatitis. Its efficacy is proved better than corticosteroids without any adverse effects. Tacrolimus also proved effective for many skin conditions such as resistant cutaneous lesions associated with psoriasis, dermatitis, rheumatoid ulcers, and rosacea.

Tacrolimus is considered as an alternative and effective treatment of lupus erythematosus. 0.1% of tacrolimus ointment is proved beneficial for treatment for malar rash or butterfly rash of SLE. It is successfully used for treating lesions associated with SLE.

Pimecrolimus cream (Elidel®) for lupus rash

Pimecrolimus is an effective immunomodulating agent that is mainly used for eczema. Its efficacy is tested for treatment of systemic lupus, erythematosus cutaneous lesions, and discoid lupus erythematosus.

• 1% pimecrolimus cream were applied to the patients for 3 to 8 weeks whereas the regimen is varied and duration of the treatment is also varied.
• Pimecrolimus cream showed marked improvement in skin lesions associated with systemic lupus erythematosus.
• It is proved more effective for the treatment of systemic lupus erythematosus as compared to cutaneous lupus erythematosus
• It showed significant improvement in quality of life of the patients associated with SLE and DLE

Is Thalidomide effective for lupus rash?

Thalidomide is established for the treatment of severe anti-inflammatory dermatoses (which is unresponsive to other therapies) such as chronic cutaneous graft, pyoderma gangrenosum and mucosal ulceration associated with HIV infection.

• It is proved effective for the treatment of Discoid lupus erythematosus.
• The starting dose of 50-100 per day has been given and it showed partial and complete remission of the skin disease (DLE, SCLE).
• Rapid relapse have been shown in patients following drug withdrawal.
• It shows no detectable improvement on patients with systemic disease.
• Thalidomide proved beneficial in treatment of severe skin manifestations of lupus erythematosus.
• It can safely be used in rheumatologic practice associated with lupus.

Who should avoid thalidomide preparations for lupus rash?

Systemic corticosteroids such as Thalidomide should be avoided in patients with cutaneous disease (not severe conditions) because if thalidomide in accurate dose and duration of therapy, given in cutaneous disease in order to control the disease can result in substantial steroid – related adverse events.

What are some antimalarial agents that can be used for treatment of lupus rash?

Systemic lupus erythematosus disease progression is reduced by the administration of antimalarial therapy. In most patients, the thalidomide is given to the patients who are resistant to antimalarial drugs. Antimalarial drugs should be continued during thalidomide therapy. Lenalidomide can also be useful in some patients.

Hydroxychloroquine and Chloroquine for lupus rash:

Hydroxychloroquine is the effective and first line treatment for DLE and Chloroquine is second-line antimalarial therapy for lupus. These two medications should never be used in combination as it causes the risk of ocular toxicity and has the ability to deposit in the retina and cause irreversible retinopathy.

Traditionally, antimalarials have been considered to be less effective in patients who smoke; however, it is also possible that DLE is worse in these patients. A 2011 study demonstrated that cigarette smoking did not have a significant impact on response to hydroxychloroquine in patients with DLE. Rather, disseminated DLE and the presence of concomitant systemic lupus erythematosus (SLE) were both significantly associated with decreased therapeutic efficacy.

What is mechanism of antimalarial drugs for treating lupus?

Antimalarial agents are beneficial in treating skin diseases and in the management of inflammatory polyarthritis and skin disease. The mechanism of action is as follows:

• It increases the pH in the intracellular components and interferes with phagocytic action, which enables them to interfere with antigen processing.
• Another mechanism of action includes inhibition of platelet aggregation in the patients in which phospholipids antibodies aggregate and leads to recurrent arterial.
• Hydroxychloroquine also known to reduce serum lipids such as cholesterol, triglycerides and low-density lipoproteins.
• Patients suffering from SLE are at the main risk for accelerated atherosclerosis and multiple heart disease.
• Antimalarials are responsible for arthritis, skin diseases as well as heart diseases.

What retinoids drugs can be used for lupus rash?

These are synthetic derivatives of vitamin A, which possesses antineoplastic and immunomodulatory actions. They are highly beneficial in treating leukemia and inflammatory diseases such as psoriasis and rheumatoid arthritis.  Retinoids are proved highly effective in the treatment of lupus nephritis and are shown to be effective in improving renal pathological findings and proteinuria.

Retinoid has the ability to regulate cell proliferation and the manage immune system. Some retinoids, which are beneficial in treating lupus rashes, are:

• Acitretin (Soriatane): This retinoic acid drug is similar to Etretinate and isotretinoin. The mechanism of action of this metabolite is unknown and it demonstrates clinical effects similar to etretinate.
• Isotretinoin (Claravis, Sotret, Amnesteem): It is a drug with a structure similar to Vitamin A and isomer of naturally occurring tretinoin.

What is the mechanism of action of retinoid (Isotretinoin) for relieving lupus rash?

Isotretinoin, which is similar to Vitamin A, acts by reducing the size of sebaceous gland (gland responsible for producing sweat) thereby decreasing sebum production. It is also known to inhibit sebaceous gland differentiation and abnormal keratinization.

USFDA also mandated a registry, which is a place for people prescribing, taking or dispensing isotretinoin.

What studies tell? Are retinoid safe and effective?

The second line therapy for cutaneous lupus erythematosus is Acitretin and Isotretinoin. Retinoid is used for the treatment of acne, psoriasis and T cell lymphomas. The first successful use of etretinate was in the treatment of CLE but it is soon replaced by Acitretin due to its shorter half-life.

• Acitretin was given in 28 patients with CLE in a dose of 50mg/day.
• It showed marked improvement in treatment and treated hypertonic lesions on palms and soles.
• When Isotretinoin is tried in patients with DLE and SLE, it showed a success rate of 86.9% in treatment.

Can I use Dapsone for lupus rash?

Dapsone exhibited excellent results in the treatmentof LE whereas it was unable to show any effect on the discoid lesions and macula popular rash of systemic and disseminated chronic forms of discoid lupus erythematosus.  Dapsone is indicated in the treatment of:

1. Non-scarring form of chronic LE
2. Chloroquine intolerance

The mechanism of action of dapsone is unknown, despite its wide use in dermatology. It is known to influence the action of neutrophills since an effect is observed in diseases characterized by neutrophilic infiltration. Dapsone proved worth trying in the mucous membrane lesions in LE. Alone Dapsone showed considerable improvement in treating chronic LE and showed complete clearing of fresh and exudative lesions associated with the disease.

What are some gold preparations that can be used for treating lupus rash?

The gold treatments are proved superior to any other treatment for the treatment of lupus erythematosus. When patients were treated with gold preparations, Out of 56 cases of lupus erythematosus, 18 were arrested, and 30 improved. The condition is completely cleared up by the supplementary treatment with gold sodium thiosulphate or with carbonic acid snow.

Gold sodium thiosulphate had given the most beneficial effects, despite of the higher percentage of toxic reactions caused by it.

Is Auranofin beneficial in treating my lupus rash?

• Auranofin is novel gold treatment that were previously used for the treartment of rheumatoid arthritis and tested for the treatment of DLE (Discoid lupus erythematosus).
• It have been given in the dose of 6-9 mg for upto 1 year.
• It showed maximum improvement in early stages of treatment.
• Lupus rashes and rashes on face and trunk responded most to this therapy.
• The commonest side effect was mild diarrhea that was settled without stopping the treatment.
• Macular rashes and pruritus are also some other side effects were noted.

Methotrexate for lupus rash

Methotrexate was mainly developed for cancer and also used as an immunosuppressant to treat cancer. It is known as a Gold standard drug for rheumatoid arthritis, apart from rheumatoid arthritis, it is also used in patients with vasculitis, uveitis and inflammatory bowel disease.

When it is studied in the treatment of SLE (Systematic lupus erythematosus), it is shown to reduce the disease activity and reduces the dose of corticosteroids. Methotrexate is proved very effective in treating skin lesions, pleuritis, and arthritis associated with Lupus erythematosus. Some major side effects are nausea, mouth sores, and headaches.Methotrexate also appears to cause sun sensitivity, liver damage, and lung infections.

You should avoid alcohol, NSAID’s and Aspirin, if you have kidney disease or even history of it.

Azathioprine (Imuran®) for lupus rash

• Azathioprine was invented to prevent rejection of kidney transplants.
• The mechanism of action involves the blockage of inflammation pathways in lupus erythematosus
• It is advised to maintain blood count test and liver function test regularly because it can cause pancreatitis and hepatitis.
• It is given to reduce steroid dosage given in LE.

Mycophenolate mofetil (CellCept®) for lupus rash

• Mycophenolate mofetil is an immunosuppressive agent which is mainly used in organ transplantation.
• It showed good results in cutaneous manifestations of SLE, DLE, and dermatophytosis
• In severe skin conditions, it is failed to show the desired effects in systematic lupus erythematosus.

Can Efalizumab (Raptiva®) be used as treatment of lupus rash?

Efalizumab is an antibody that has been shown to be effective in autoimmune skin disorders such as psoriasis, dermatomyositis and lichen planus. It is also known to be effective in cutaneous lupus erythematosus. The mechanism of action involves the targeting of lymphocyte function-associated antigen and prevents it from stick to skin tissues.

• Efalizumab acts by inhibiting the adhesion of rolling lymphocytes to endothelial cells.
• It showed dramatical improvement in patient with annular eruption of face associated with lupus erythematosus.
• In one study, Efalizumab also induced cutaneous LE with erosive oral lichen and the mechanism involved remains unclear.
• Therefore, controlled studies are still needed to evaluate the potential of efalizumab in lupus erythematosus.

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