More than 90% of people with lupus have skin symptoms, and it was seen that these symptoms are more common in whites than in African Americans.
In those patients who have systemic lupus erythematosus there can appear many types of rashes, while the classic lupus rash is a redness on the cheeks.
A special characteristic rash is the one brought by discoid lupus, which manifests as red skin patches on the skin and scaliness and can lead to scarring. It often appears on the face and scalp and can lead to loss of scalp hair.
Hair loss can also occur because of the immunosuppressive medications, or with flares of systemic lupus erythematosus, even without skin rashes in the scalp.
An erythematous rash in a butterfly distribution on the face can show the presence of the acute cutaneous lupus erythematosus. Located in both cheeks and across the bridge of the nose, this blush is slightly edematous and appears usually after sun exposure, persists a few days and heals without scarring. It is known that there can appear erythematous lesions in other areas of the body too.
The subacute cutaneous lupus erythematosus is dealing with localized or generalized lesions, may involve any part of the body and the erythematosus lesions may resemble a drug reaction as they involve palms and soles. The lesions are usually pruritic, and the maculopapular rash usually occurs after sun exposure. Most of the time, these lesions heal without scarring, but there exists the possibility that persistent lesions that become crusty to heal with only slight atrophy of the skin.
Chronic cutaneous lupus erythematosus can appear anywhere, although usually it affects scalp and ears, and the rash may be pruritic. At the beginning, the lesions are erythematous, slightly elevated papules or plaques, in time they become raised, bright red, edematous, then the center becomes depressed, the colour fades and becomes atrophic, and the edematous red periphery slowly enlarges and becomes irregular with some telangiectasias. We must also mention that there are follicular plugging characterized by small round areas of hyperkeratosis in older lesions. It was seen that usually, these lesions heal with scarring and hyperpigmentation or hypopigmentation.
If the lesions that are involving the scalp are erythematous and scaly, the hair usually grows back, but if the lesion heals with scarring the hair loss is permanent.
Lupus Panniculitis, appears as deep nodules, shows lesions situated below the skin in the subcutaneous tissue, and it is known to heal with a deep atrophy of the involved area.
Neonatal Lupus is seen in newborn babies, develops rash similar to the annularpolycyclic rash seen in subacute cutaneous lupus erythematosus, and the bullous lupus erythematosus develops blisters which contain a clear seurous fluid, and may range from 3 to 40mm in diameter, the lesion resolving spontaneously usually without a scar after a week, but reappearing periodically.