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Lupus erythematosus

What is it?

Lupus Erythematosus (LE) is an autoimmune disease, which means that the immune system starts to produce antibodies against its own cells, causing inflammation and damage to the organs, including the skin. The cause of this immune imbalance is unknown.

The disease occurs most often in young women, men being little affected. An important feature is photosensitivity. Sunlight can cause the onset or worsening of skin lesions, which are located mainly in the sun exposed areas. Another factor that may trigger the onset of the disease is severe emotional stress.

Characteristics and symptoms

There are different forms of lupus. One of them affects only the skin and is known as cutaneous LE or chronic LE. Another, more serious, is the systemic LE or acute LE, in which there is involvement of skin and internal organs. An intermediate form is the subacute LE, which presents more numerous skin lesions and less severe involvement of internal organs.

In the skin, lesions are flat, reddish, pink or violet. Present scaling, small dilated blood vessels on the surface and may have darker edges. The older lesions may lead to skin atrophy, leaving scars with loss of skin color and hair.

Skin lesions appear more frequently in areas of skin exposed to sunlight, especially in the face. When located in the malar regions and nose, they can acquire the shape of butterfly wings, characteristic of the disease (photo below).

Other usual locations are the ears, lips and scalp, where they can cause permanent hair loss (scarring alopecia). Less frequently, they occur in the thorax (neck or V neck), shoulders, forearms and hands.

In systemic LE, in addition to skin lesions, which are present in 80% of cases, fever and joint pain frequently appear. Other changes, less frequent, are anemia, convulsions, inflammation of the membranes surrounding the lungs and heart, and kidney disorders. The involvement of the kidneys can cause severe and irreversible damage, with permanent loss of functioning.

To diagnose the disease, it is necessary to perform skin biopsy, blood tests and urine tests, among others, according to the symptoms.

Treatment

Treatment aims to stop self-injury caused by antibodies, reducing inflammation and damage to the organs.

It is important to avoid sun exposure and to use sunscreens with high protection factor when going outdoors. The skin lesions can be treated with topical medication in the form of creams, ointments and lotions.

In cases with more pronounced skin lesions or involvement of internal organs, oral drugs should be used to fight inflammation. These drugs can cause significant side effects and patients must be strictly followed by the physician.

When the kidneys are seriously affected or conditions that can be life threatening, such as the involvement of central nervous system, treatment requires hospitalization for intravenous medication.

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