We know it’s counterproductive to fight among ourselves. We see it in families, organizations, and politics all too frequently. But what happens when our own body fights itself? This isn’t productive either, and it often results in an autoimmune disorder.
Autoimmune conditions occur when the body incorrectly identifies something not native to the body and creates an immune response to reject it. When the immune system works right, it keeps you healthy by fighting off intruding unhealthy organisms and even cancerous cells. But with autoimmune conditions, the body revs up your immune system to fight against its own cells, which causes a multitude of problems.
Autoimmune disorders can attack any part of the body. However, some of these become most apparent in how they affect the skin. With most autoimmune disorders of the skin, patients experience both systemic manifestations and symptoms on the skin.
Autoimmune skin diseases most commonly associated with skin symptoms include:
- Mixed Connective Tissue Disease
- Autoimmune blistering disorders
For most of these autoimmune disorders of the skin, patients experience systemic complications such as ulcers, joint inflammation, weakened muscles, and damage to internal organs. Few autoimmune disorders only attack the skin.
Lupus is one of the exceptions — it can affect the body and the skin or only the skin depending on the type. Here’s the difference:
Systemic Lupus vs. Discoid Lupus
The most common form of lupus is systemic with skin manifestations. Other times, lupus may strictly affect the skin (discoid lupus). Less than 5% of discoid lupus patients have any form of systemic manifestations.
Systemic lupus erythematosus (SLE) appears with skin manifestations, most commonly a red, burning rash on the central part of the face that’s very similar to rosacea. The malar rash, also known as the “butterfly rash,” is a red or purple outbreak on both the nose (the center of the butterfly) and the cheeks (the wings). It can be extremely sun-sensitive. In fact, sun exposure is often what first makes the patients aware they may have an autoimmune skin disease.
A systemic lupus diagnosis often unfolds like this: A young woman goes out in the sun. She gets what she assumes is a sunburn, but it doesn’t go away.
It feels a little different from sunburns she’s felt before, and it stays red in the central part of the face after other areas of sun irritation have faded. She may also have other complaints such as joint pain, easy bruising, fevers, or other systemic issues that she doesn’t associate with the redness on her face.
She visits her dermatologist.
The dermatologist sees the rash and suspects lupus, so they proceed with a biopsy and/or labs. If the biopsy and labs favor lupus, the doctor tests other symptoms and makes a diagnosis.
The patient is then referred to a rheumatologist for further evaluation. The dermatologist and rheumatologist with work together to treat the patient. With regular treatment, she’ll be able to live a long, healthy life.
Discoid lupus only affects the skin — no other systemic symptoms such as joint pain, bruising, swelling, or fever are present. This autoimmune disorder of the skin also doesn’t present a malar or butterfly rash.
While people of any age, gender, race, or ethnicity can develop discoid lupus, this autoimmune skin disease most commonly affects women and African Americans. On dark skin tones, discoid lupus appears as firm atrophic lesions that are white with a dark center. On light skin tones, it appears as a red, beefy area that looks similar to a psoriasis plaque.
These lesions are commonly associated with hair loss and can be seen on the face, ears, and scalp. A well-known case, albeit extreme, of chronic discoid lupus is the singer, Seal.
If the doctor suspects discoid lupus as the autoimmune skin disease causing these symptoms, they’ll conduct a biopsy. While the doctor will often test for systemic lupus or other autoimmune conditions with blood tests and urinalysis, rarely are there any systemic results..
For both discord and systemic lupus, we treat the skin manifestations of these autoimmune disorders of the skin with topical steroids. However, treatment can be difficult because lupus lesions tend to persist.
If topical steroids cannot fully address the severity of the lesions, we’ll use injectable steroids, injected directly into the lesions. We may then also prescribe topical immune modulators to further combat the lesions.
If necessary, we’ll add systemic therapy to the treatment plan. Systemic medications such as immunosuppressants and antimalarials (developed to treat malaria) are commonly used to treat both systemic and discoid lupus. These medications pose an increased risk of infections as they are aimed to decrease your immune system response. However, when used in the right patients to treat lupus, they can be highly effective.
In very severe cases where the patient is unresponsive to other therapy, we may recommend the medication thalidomide or lenalidomide. To proceed with this medication, both the doctor and patient enroll in a program designed to provide checks for patient health and prevent pregnancy.
If we’re treating systemic lupus, we’ll work with your rheumatologist for the right approach to using these systemic therapy options for you.
What Do I Do If I Suspect An Autoimmune Disorder of the Skin?
Anytime you experience a persistent skin rash, schedule an appointment with your dermatologist. You may be dealing with a simple topical allergy, eczema, or a more complicated issue like an autoimmune skin disease. A dermatologist is best suited to check the skin for an accurate diagnosis and begin a treatment plan to provide relief to your symptoms right away.
Dr. Stan Tolkachjov is a board-certified dermatologist in Frisco and Rockwall, TX. He has a particular interest in skin cancers and rare adnexal malignancies, Mohs surgery and complex facial reconstruction, pyoderma gangrenosum, and neutrophilic dermatoses. In his spare time, Dr. Tolkachjov enjoys spending time with his family, trivia, sports, travel, and mentoring students, residents, fellows, as well as sharing ideas with his colleagues to improve patient care.