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.