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What is cutaneous lupus?

Cutaneous lupus occurs when the immune system attacks only skin tissue, leading to painful sores and rashes on the face, neck, arms, legs, and ears. Cutaneous lupus can occur alongside systemic lupus erythematosus (SLE) or as a precursor to SLE. Researchers are still trying to determine whether it’s possible to have cutaneous lupus and never develop SLE. There are three types of cutaneous lupus: subacute cutaneous lupus, acute cutaneous lupus, and chronic cutaneous lupus. Differences between the three include the locations and types of lesions along with other factors.

Women and people of color are at the highest risk of developing cutaneous lupus, and the disease onset most often occurs between the ages of 20 and 50 years old.

What is lupus?
In order to best understand cutaneous lupus, it’s important to understand lupus. Lupus is a group of autoimmune diseases in which the body’s immune system attacks the body itself, which can lead to extensive damage in major systems. There are four types of lupus: cutaneous lupus, systemic lupus erythematosus, drug-induced lupus, and neonatal lupus.
Subacute cutaneous lupus erythematosus
Subacute cutaneous lupus produces raised, scaly, red lesions on the shoulders, neck, arms, and body. In some cases, the lesions are ring-shaped. These patches of skin typically don’t produce itching or scarring, but exposure to the sun can lead to exacerbation of symptoms. Avoiding sun exposure, using sunscreen, and monitoring lesions will be important for patients with subacute cutaneous lupus erythematosus.
Acute cutaneous lupus
When systemic lupus erythematosus flares up, acute cutaneous lupus flares as well, producing a butterfly-shaped rash across the nose and cheeks referred to as malar rash. Malar rashes are typically flat, photo-sensitive, and non-scarring, but they can lead to darkening of the skin in those areas after they heal. Patients should take special care to avoid sun exposure during acute cutaneous lupus flares.


Chronic cutaneous lupus
Chronic cutaneous lupus produces round lesions on the face, scalp, and sometimes other areas of the body. While the sores typically aren’t itchy or painful, they can result in permanent discoloration or scarring or, when they’re found on the scalp, focal hair loss.

It’s important to note that cancer develops at the site of a chronic cutaneous lesion, so avoiding direct exposure to the sun, using sunscreen consistently, and monitoring lesions for changes is key for patients with chronic cutaneous lupus.

Systemic lupus erythematosus can range from minor to life-threatening depending on the complications that result from the disease. The most serious complications that can occur include inflammation in the blood vessels of the brain, kidney inflammation, and coronary artery disease, all of which can increase the risk of life-threatening conditions like heart, stroke, and kidney failure.


Diagnosis of cutaneous lupus
In most cases, cutaneous lupus is diagnosed based on the results of a physical examination combined with lab tests, but sometimes skin biopsy is necessary for diagnosis.


Treatment of cutaneous lupus
There are several medications approved for use in treating cutaneous lupus, including topical steroid ointments, topical calcineurin inhibitors, low-dose methotrexate, anti-inflammatory medications, or systemic oral medications like antimalarial drugs. There is no single treatment that is effective for all patients, so working with an experienced provider to develop the right treatment plan is important.
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