Have you ever wondered where the name Lupus Erythematosus comes from? It certainly is a mouthful. Let’s take a little history lesson together and see when and how this autoimmune condition got its title.
- It is believed that the very first recorded diagnosis of lupus was made by Hippocrates in 460–375 BC. He called it herpes esthiomenos and was describing it as ulcerative skin lesions. Then in 916 AD, Herbernus of Tours called a certain skin disease which resembled wolf bites “lupus”. After this in 1846 – 1851, French doctors coined the term “lupus erythematosus” when they identified malar or butterfly rash as a symptom of lupus. The word “erythematosus” comes from the Greek word “erythros”, which roughly translates to “red”. It’s no coincidence that such language is used to describe the red and inflamed lesions associated with lupus. It is in fact what most people think of when they hear about the condition.
Lupus rashes are used as diagnostic tools for lupus because about 20% of patients have them on initial presentation. They also occur in one form or another during the course of disease in 70 – 80% of diagnosed patients. Let’s explore what makes these skin manifestations unique. For starters there are four different rash types which rheumatology experts look for in the diagnostic process:
- malar rash (butterfly rash) – The most well known skin change associated with lupus. This is characterized by a flat or raised red rash which is spread across the cheeks and nasal bridge. Malar rash is seen in 30% of patients with systemic lupus erythematosus. Treatment focuses on ending the active SLE flare, while some topical corticosteroids may be used to treat these lesions directly.
- photosensitivity – refers to an unusual rash or symptom which is associated with a condition and is exacerbated by exposure to sunlight. Treatment of photosensitivity involves sun protection (SPF lotion and protective clothing) and treatment of the underlying disorder.
- discoid rash – refers to disk-like lesions that are photosensitive and can worsen with increased sun exposure. These scaly and red lesions can produce permanent scarring and skin discoloration. When they appear on the scalp, they can cause permanent hair loss. They may be part of systemic lupus or may represent discoid lupus without organ involvement. Treatment can include corticosteroid ointments, anti-inflammatory, anti-malarial, and immunosuppressive drugs.
- Alopecia – Hair loss which affects the temporal regions or creates a patch like pattern. It is a frequent occurrence in SLE and is present in more than half of the patients at some point during the course of the disease. However, alopecia is not always specific to lupus and may just be coincidental. It is important to determine its cause because this changes the course of treatment. Treatment is focused on the systemic disease and it is inferred that non scarring alopecia will also improve during remission.
One of the biggest things to remember about all types of cutaneous lupus is the focus on prevention, healing, and improving the appearance of skin. Here are some tips on skin care:
- Reducing triggers to prevent lupus flares.
- Wear protective clothing
- Use sunscreen and minimize direct sunlight.
- Gentle skin products and makeup can be used to conceal scars.
By Nadia Bhatti
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