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Diagnosis of Lupus (Part 1)

In this two-part report, the diagnosis of systemic lupus erythematosus (SLE) is presented. SLE is an autoimmune inflammatory condition. Skin and joint changes are the two most common signs of lupus. Lupus-associated skin (cutaneous) disease is the focus of this first part. However, many organs of the body can be affected by SLE.

Many skin changes can occur with lupus. The doctor must be careful not to think every skin change is a sign of this condition. The most common skin lesion linked with lupus is a butterfly rash across the nose and cheeks.

A patchy, red rash across these two part of the face forms the shape of a butterfly. A lupus rash can also affect other parts of the body such as the arms, hands, and fingers.

The rash may be flat but can be raised up, forming scales or blister-like lesions called vesicles. The skin is photo-sensitive meaning it gets worse when the skin is exposed to the sun.

The skin lesions do heal and usually do so without scars. Many patients have a permanent change in skin color with a loss of skin pigmentation. Sometimes there are tiny, but permanent blood vessels or spider veins across the skin.

The authors describe in detail skin changes seen with an acute, subacute, and chronic case of SLE. There is a form of lupus erythematosus (LE) that only affects skin. This type of lupus is called discoid lupus. Discoid lupus refers to the disc-like or coin-shaped lesions on the skin. Various medications can bring on discoid lupus. These drugs are listed for the reader.

Treatment of cutaneous LE is the subject of the second part of this report. The second article will be printed in a later issue of this journal.

References: Renee H. Grau, MD, and Richard D. Sontheimer, MD: Cutaneous Clues to Diagnosis of Lupus. In The Journal of Musculoskeletal Medicine. June 2007. Vol. 24. No. 6. Pp. 247-263.

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