How does Lupus affect our skin?

It is peak summertime now! Peak summer = peak sun = peak skin damage! Ah!

Living with Lupus can be an overwhelming experience. Lupus, or systemic lupus erythematosus (SLE), is an autoimmune disease that can impact multiple organs, including the skin. In this blog post, we will delve into how lupus affects the skin, exploring the various manifestations, and potential impact on your life.

Understanding Lupus and its Connection to the Skin:

Lupus is a complex autoimmune disease in which the immune system mistakenly attacks healthy tissues, including the skin. Although the exact cause of lupus remains unknown, research suggests that a combination of genetic, environmental, and hormonal factors contribute to its development. The skin manifestations in lupus can vary widely, making it crucial to recognize and understand these diverse presentations.

Cutaneous Lupus Erythematosus (CLE): Cutaneous Lupus Erythematosus (CLE) refers to skin-specific manifestations of lupus.

It encompasses three main subtypes: acute CLE (A

CLE), subacute CLE (SCLE), and chronic CLE (CCLE). Each subtype presents distinct characteristics and clinical features.

1. Acute CLE (ACLE): ACLE is characterized by a butterfly-shaped rash across the cheeks and nose, known as a malar rash. It typically appears after sun exposure and can cause redness, swelling, and a burning sensation. A study published in the Journal of Investigative Dermatology found that ACLE is associated with increased production of inflammatory molecules called cytokines, resulting in tissue damage in the skin (PubMed ID: 29221991).

2. Subacute CLE (SCLE): SCLE often presents as a scaly, erythematous (red), and annular (ring-shaped) rash that commonly affects sun-exposed areas such as the upper back, neck, and shoulders. A publication in the Journal of the American Academy of Dermatology highlighted the role of autoimmune antibodies, such as anti-Ro and anti-La antibodies, in the pathogenesis of SCLE (PubMed ID: 25128117).

3. Chronic CLE (CCLE): CCLE encompasses different subtypes, including discoid lupus erythematosus (DLE) and tumid lupus.

DLE also stated as discoid Lupus typically presents as circular or disk-shaped lesions with raised borders and central scarring. These lesions can cause permanent hair loss, skin discoloration, and scarring. (PubMed ID: 31769856).

The Impact of Lupus Skin Manifestations: Skin involvement in lupus can have significant physical, psychological, and social implications for individuals living with the disease. Visible skin lesions may cause embarrassment, self-consciousness, and a negative impact on self-esteem. The emotional burden of these skin manifestations should not be underestimated, as these can lead to increased anxiety and depression in people living with Lupus.

Management and Treatment: The management of lupus skin manifestations often involves a multidisciplinary approach, including dermatologists, rheumatologists, and other specialists. Treatment options may vary depending on the severity and type of cutaneous lupus. It typically includes sun protection measures, topical corticosteroids, antimalarials, and immunomodulatory medications.

Staying out of the sun is incredibly important in reducing flares from photosensitivity and preventing UV damage. The sun's UV rays are damaging for anyone with skin, let alone skin that is actively inflamed from Lupus.

Ongoing Research: Researchers and scientists continue to explore new therapeutic strategies and gain a better understanding of the underlying mechanisms of lupus skin involvement. Promising areas of research include the development of targeted therapies aimed at specific immune pathways and the identification of novel biomarkers to improve early diagnosis and monitoring.

Conclusion: Living with lupus can be challenging, particularly when the disease affects the skin. By understanding the various manifestations and their impact, we can foster empathy and provide support to those affected. The scientific studies cited show the ongoing efforts to uncover the mechanisms behind lupus skin involvement and develop effective treatments.

Let us continue to raise awareness, promote research, and create a compassionate environment for individuals navigating the complexities of lupus and its impact on the skin.

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References:

1. Werth VP. Clinical manifestations of cutaneous lupus erythematosus. Autoimmun Rev. 2005 Sep;4(7):296-302. doi: 10.1016/j.autrev.2005.01.002. PMID: 16146617.

2. Wenzel J, et al. The influence of cutaneous factors on the prognosis of cutaneous lupus erythematosus. Br J Dermatol. 2020 Mar;182(3):683-690. doi: 10.1111/bjd.18219. Epub 2019 Dec 19. PMID: 31769856.

3. Ansari MN, et al. Review of Autoimmune Bullous Diseases: The Descriptive Approach. Dermatol Res Pract. 2018 Jan 9;2018:2159108. doi: 10.1155/2018/2159108. PMID: 29423457.

4. Boukari L, et al. An update on the cutaneous manifestations of lupus erythematosus. Lupus. 2010 Feb;19(2):118-25. doi: 10.1177/0961203309346344. PMID: 19828451.