Treatmemt would depend upon which type of Lupus rash you are suffering from. There are many different skin problems in lupus, which vary from person to person. The classic is the butterfly rash (malar rash) which covers the cheeks and over the bridge of the nose.
Some of us have discoid rashes that occurs in patches across the body. These patches tend to be well defined, thickened and scaly, they are slightly red in color and can itch. Their appearance can vary between people and also on different areas of the body on the same person. As the patches heal, they tend to leave scars and on darker skins, the pigment in the skin can be lost leaving white areas. If discoid lupus occurs on the scalp, you might lose your hair as the patches heal, often leaving permanent bald areas.
Subacute cutaneous lupus is a distinct type of rash that usually occurs in sun-exposed areas of the body. It starts as scaly patches which increase in size, to form circular areas which gradually heal up without leaving scars. This type of rash is somewhere between the systemic form of lupus and the discoid form of lupus: people with subacute cutaneous lupus often have some of the blood abnormalities found in systemic lupus and frequently joint pains, but they do not usually develop the serious complications that can occur in the systemic disease.
The difficulty is that practically any type of rash can occur in systemic lupus, they can be from widespread mild rashes (similar to those seen in viral illnesses such as German measles) to small distinct patches of rash on the elbows and knees resembling psoriasis.
Two particular skin problems that can occur with Lupus are panniculitis and urticaria. Panniculilis is inflammation of the fat below the skin resulting in tender red lumps beneath the surface of the skin; these heal slowly over time and can leave dimpling of the skin when fully healed. Urticaria is an itchy raised red rash similar to nettle rash that can occur with vasculitis or on its own; it heals without leaving scars.
A number of treatments are available for the skin problems in Lupus and they depend upon the type of problem presented. Most treatments are divided into topical, injection or oral treatments.
Topical treatments tend to consist of steroid creams and ointments. These can range from the mild creams such as hydrocortisone to the stronger types, such as betamethasone. These creams will sometimes be enough to control mild lupus rashes, but should not be used continually, particularly on the face. In discoid lupus particularly troublesome areas can be injected with long acting steroids under the skin to promote healing.
Most people require oral treatment to control their Lupus skin problems. The antimalarials, such as chloroquine, hydroxychloroquine (Plaquenil) and mepacrine have been very successful in controlling skin rashes. The problem is that they work slowly and need to be taken for a number of months before you see any effects. However, once the effects take place, the rashes rarely return.
Other oral treatments include steroids, which can also be given intravenously if the skin lesions are very severe. Oral and intravenous steroids obviously have a number of side effects and are, therefore, usually reserved for skin problems that have not responded to topical treatments and the antimalarials (Plaquenil etc.). Sometimes skin rashes cannot be controlled with the above treatments or they recur on steroid dose reduction. In these people, other drugs such as azathioprine or cyclosporin can be used. These drugs are often given for other problems in lupus, such as kidney disease, but they can be given for the skin rashes in difficult cases.
I hope that you are able to find a treatment that gives you relief. Bring the rashes to the attention of your doctor so that you can determine exactly what type of rash it is and what the best treatment will be.
Peace and Blessings
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