Lupus and Skin Involvement

Lupus and Skin Involvement

On May 14, Hospital for Special Surgery and the S.L.E. Lupus Foundation hosted a Facebook chat on Lupus and General Health. Participants asked more than 160 questions, but our room full of experts could only answer 61 during the one-hour, live event. We categorized the remaining questions, and will run a series of our experts answers over the next month. For our third installment, rheumatologist Dr. Kyriakos Kirou answered questions on skin involvement. Read the others in this series here, here, and here.

The information provided is for informational and educational purposes, and doesn’t constitute medical or health advice for any individual problem. Please consult with your health care providers for any health problem and/or prior to starting any new medication or changing or discontinuing any medication you have been prescribed. This chat is not intended to create a doctor-patient relationship, or any other duty, between you and any member of the HSS interdisciplinary team or the S.L.E. Lupus Foundation.

Why do lesions often appear on the face – The answer can’t be simply due to sun-exposed areas, as lesions also appear on the upper arms of people who never expose that area.

The sun or UV light is definitely the major factor in causing the discoid rash. Of course genetics are also important. I am not aware of any other contributing factors.

I have had hair loss in patches with ulcerations on my scalp for about 15 years. Is there anything that could help this? My doctor says it is lupus, but I’m taking 200 mg of imuran a day.

The hair loss can be due to lupus, but one has to also consider other causes, such as thyroid disease, iron deficiency (low iron stores), drugs (usually the chemotherapy drugs do this) and stress/illness. Also hair loss can be due to scar formation and in that case it is irreversible. Hydroxychloroquine (plaquenil) is an effective medication for skin inflammation and hair loss due to active lupus. Another medication that may help the skin is quinacrine. You can ask your rheumatologist whether this is appropriate for your condition. Skin rash from inflammation due to lupus may also respond to topical injections of steroids, by a dermatologist.

I started methotrexate for RA and lupus. Now I have discoid lesions on my abdomen. What can I do about this?

Plaquenil can help. Also consider topical application of steroids. A rheumatologist or dermatologist may prescribe those.

Will there ever be treatment to help stop scarring alopecia?

Whenever scar forms there is no hope to get hair back. However, if someone treats the rash on the scalp when it is still red and therefore due to inflammation, we can prevent scars and permanent hair loss.

Why do bruises take so long to go away (sometimes years)?

Regular bruises are due to bleeding in or underneath the skin. These go away in a few weeks after their color changes from purple to yellow/green. However, sometimes, if there are repeated injuries/bruising the skin becomes darker or hyperpigmented from the iron in the blood.

I have dry mouth a lot. Sometimes I get a painful rash in my mouth. Is that common with lupus?

Yes, people with lupus may also have another related condition called Sjogren’s syndrome. Usually they have certain autoantibodies in their blood called anti-Ro and anti-La. Sjogren’s syndrome causes inflammation of the glands that produce saliva and that causes dryness, mainly in the mouth and eyes. Lupus also commonly causes mouth and nose sores that may or not be painful.

Dr.Kyriakos Kirou is a rheumatologist at Hospital for Special Surgery and is Clinical Co-Director at the Mary Kirkland Center for Lupus Care at Hospital for Special Surgery.

Topics: Rheumatology
The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. Hello, I am a nurse of a medical laser hair removal center in Barcelona, Spain:
    Occasionally we have patients with lupus who are interested in getting a treatment. Whenever this procedure is contraindicated in patients with photosensitivity, do you have any experience with it?, Do you contraindicate it too?. Thanks

    1. Hi Merce, thank you for reaching out. Dr. Joanna Harp, Dermatologist, says: “I don’t consider lupus or photosensitivity a strict contraindication to getting laser hair removal. I usually consider on a case by case basis. If they have a lot of cutaneous disease in the area to be treated I might avoid, but usually I find it is okay if you have someone who is experienced with the laser and starts with a low setting a small treated area (test spot) to make sure the patient doesn’t have a reaction.”

  2. My mother had lupus. I noticed in my twenties I started to get some of the symptoms that she experienced. I’ve seen doctors and they told me something, stating that I have traits of lupus, but my blood work does not imply that I do have lupus. I get the butterfly rash that I washed for years daily hoping it was just pimples and with care it would go away. I also have serious joint pain.

    1. Hi Brandy, thank you for reaching out. Dr. Kyriakos Kirou, Rheumatologist, says: “The risk of getting lupus if a first-degree relative has the disease is relatively small: <5%. The butterfly rash can be mistaken for other types of rashes such as rosacea, seborrheic dermatitis, etc. A good clue to tell these apart is the fact that the lupus butterfly rash usually gets worse with exposure to sunlight. People who have negative tests for lupus such as a negative ANA test are very unlikely to have lupus, or at least the form that affects the whole body and not just the skin. When lupus affects only the skin, we call it cutaneous lupus. In difficult cases, we may do a skin biopsy to tell them apart, but this may not be a good idea when the rash is only on the face because it may leave a scar behind." If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  3. I live in England and my friend has lupus
    and doctors here don’t seem to be able to control it is there any advice that would maybe help she hair, and suffers from cramp an her skin is discoloured it is black , and does certain food cause lupus flare ups and if so what are they thank you

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