Skin manifestations

Skin manifestation is common in lupus patients and is seen in around 70-80% cases. It is the initial presentation in approximately 20% of the patients (1).
Cutaneous manifestations present in SLE patients include:

• malar rash
  • the classic “butterfly” rash is characterized by an erythematous rash over the cheeks and nasal bridge
  • occurs in around 30% of patients
  • acute lupus rash may be seen in other parts of the body as well
  • lasts from days to weeks
  • occasionally painful or pruritic (1)
• photosensitivity
  • UVB is the usual precipitant
  • can appear even after mild sun exposure
• discoid rash
  • characterised by plaque like lesions with follicular plugging and scarring
  • may occur as part of SLE or separately as discoid lupus without organ involvement
• alopecia
  • can be diffuse or patchy
  • often affects the temporal region
• Raynaud's phenomenon
• livedo reticularis - usually on the lower extremities, around the elbows, knees and ankles. Most active when the skin is warm
• panniculitis (lupus profundus)
  • often chronic
  • may cause cutaneous and subcutaneous atrophy and occasional ulceration
• mucosal ulceration - usually on the palate, but may involve the vaginal, larygneal or nasal mucosa. It is associated with more severe skin lesions
• vasculitis with ulceration - most frequently on the extensor surfaces of the forearms, but also, may occur on or near the small joints of the fingers, the dorsa of the hands, the palms, and around the nail folds
• bullous lesions
• telangiectasias
• urticaria and multiforme erythema - rare - but may signal increased disease activity
• Sjogren' syndrome - associated with anti-Ro and anti-La antibodies
• occasionally, there may be erythematous lesions with white porcelain centres - atrophie blanche - and splinter haemorrhages
• gangrene - rare - typically follows severe Raynaud's phenomenon or livedo reticularis

Reference:

• (1) Cojocaru M et al.Manifestations of systemic lupus erythematosus. Maedica (Buchar). 2011;6(4):330-6.
• (2) Callen JP. Cutaneous lupus erythematosus: a personal approach to management. Australas J Dermatol. 2006;47(1):13-27.