Dermatologic Manifestations of Lupus

article syndicated from NIAMS
updated about 1 year ago

Systemic lupus erythematosus (SLE, or lupus) is a chronic, inflammatory, multisystem disorder of the immune system. Lupus: A Patient Care Guide for Nurses and Other Health Professionals is concerned primarily with this form of lupus.

Dermatologic Manifestations

Approximately 80% of patients with SLE have skin manifestations and often suffer from itching, pain, and disfigurement. The classic sign of SLE is the "butterfly" rash extending over the cheeks (malar area) and bridge of the nose. This rash ranges from a faint blush to a severe eruption with scaling. It is photosensitive, and it may be transitory or fixed. Between 55 and 85% of patients develop this rash at some time in the course of the disease.

Other rashes may occur elsewhere on the face and ears, upper arms, shoulders, chest, and hands. DLE is seen in 15-30% of patients with SLE. Subacute cutaneous LE, seen in about 10% of SLE patients, produces highly photosensitive papules that itch and burn. Skin changes, especially the butterfly rash and subacute cutaneous LE, can be precipitated by sunlight.

Some patients may develop mouth, vaginal, or nasal ulcers. Hair loss (alopecia) occurs in about one-half of SLE patients. Most hair loss is diffuse, but it may be patchy. It can be scarring or nonscarring. Alopecia may also be caused by corticosteroids, infection, or immunosuppressive drugs.

Raynaud's phenomenon (paroxysmal vasospasm of the fingers and toes) frequently occurs in patients with SLE. For most patients, Raynaud's phenomenon is mild. However, some SLE patients with severe Raynaud's phenomenon may develop painful skin ulcers or gangrene on the fingers or toes.

Varying levels of pain and discomfort due to skin alterations may occur. Pruritus accompanies many types of skin lesions. Attacks of Raynaud's phenomenon can cause a deep tingling feeling in the hands and feet that can be very uncomfortable. Both pain and itching may affect a patient's ability to carry out activities of daily living (ADL).

Skin alterations in the lupus patient, particularly those of DLE, can be disfiguring. As a result, patients may experience fear of rejection by others, negative feelings about their body, and depression. Changes in lifestyle and social involvement may occur.

Potential Dermatologic Manifestations

Butterfly rash on cheeks and bridge of nose
Scaly, disk-shaped scarring rash (DLE)
Erythematous, slightly scaly papules (subacute cutaneous LE)
Psoriasiform or arcuate (curved) lesions on the trunk of the body (subacute cutaneous LE)
Itching and burning
Ulcers in the mouth, vagina, or nasal septum
Atrophy (including striae or stretch marks)
Impaired wound healing
Easy bruising
Petechiae
Increased body hair (hirsutism)
Steroid-induced ecchymosis
Ulcers or gangrene on fingers or toes
Alopecia

Potential Problems

Alteration in skin integrity
Alopecia
Discomfort (pain, itching)
Alteration in body image
Depression

Nursing Interventions

Objective: Minimize appearance of lesions

Document appearance and duration of lesions and rashes.
Teach patient to minimize direct exposure to UV rays from sun and from fluorescent and halogen light bulbs. (Glass does not provide complete protection from UV rays.)
Instruct patient to use a sunscreen with an SPF of 15 or greater and wear protective clothing. Patients who are allergic to PABA will need to find a PABA-free sunscreen.
Provide information on hypoallergenic concealing makeup.
Instruct patient to avoid topical applications, such as hair dyes and skin creams, and the use of certain drugs that may make her or him more sensitive to the sun.

Objective: Alleviate discomfort

For patients with mouth lesions, suggest a soft-food diet, lip balms, and warm saline rinses.
Instruct patient to take medications that may help to alleviate discomfort and itching as ordered. (The doctor may give the patient intralesional steroid injections.)
Suggest self-help measures for patients with Raynaud's phenomenon, including:

keep warm, particularly in cold weather; use chemical warmers, gloves, socks, hats; avoid air conditioning; use insulated drinking glasses for cold drinks; wear gloves when handling frozen or refrigerated foods;
quit smoking;
control stress; and
exercise as tolerated.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health (NIH)
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