What Is a Lupus Rash and How Can You Treat It?

When you think about lupus, symptoms like fatigue and joint pain may come top of mind. However, this autoimmune condition can also heavily involve the skin, leading to a variety of skin rashes.

Usually, when people talk about lupus, they refer to systemic lupus erythematosus (SLE). This is the most common type of lupus that affects more than one organ. Skin rashes are common in lupus — plus, two out of three people with SLE also develop a skin disease called cutaneous lupus erythematosus (CLE), per the Cleveland Clinic.

There are various types of CLE, which can lead to different types of skin rashes.

You may suspect that a given rash is associated with lupus if it appears with certain triggers (like exposure to sunlight) or if you have other lupus symptoms or lupus comorbidities like joint pain flaring up. That said, it’s important to speak with a physician for proper diagnosis.

“The presentation of lupus rashes can vary dramatically, so it is best to consult with a rheumatologist or dermatologist for further evaluation,” says Dr. Faroqui.

If it is a new rash, your doctor may order a biopsy to further distinguish the cause of the rash. Dermatitis, cellulitis, rosacea, and dermatomyositis are conditions that may cause rashes similar to lupus.

What Are the Different Types of Lupus Rash?

Although lupus and its associated rashes can present differently in individual patients, the main types lupus rashes you may encounter include:

• Butterfly rash
• Discoid lesions
• Subacute cutaneous lupus erythematosus (SCLE) rashes

Here’s what you need to know about each of these rashes.

Butterfly Rash

If you’re still working toward a diagnosis for your symptoms, a butterfly rash may be a clear indicator to your doctor that you have lupus.

“Most well-known is the butterfly rash, which presents with redness over the cheeks and nasal bridge,” says Zeba Faroqui, MD, rheumatologist at PRINE Health and Founder and CEO of Dr. Zeba Consulting. “This rash occurs in approximately 30 percent of lupus patients. It can be present for days to weeks and may feel irritated.”

Butterfly rashes can be itchy and often occur after someone with lupus spends time in the sun, per the American Academy of Dermatology (AAD).

“This type of rash is usually raised and red or purple, and tends to spare the nasolabial folds — known as the smile lines,” adds Kichul Ko, MD, rheumatologist and Associate Professor of Medicine at The University of Chicago Medicine. “It can also occur in other body parts, particularly sun-exposed areas like the upper arms or chest.”

Discoid Lesions

Discoid lupus rash can result in raised, scaly patches that can stick around for years if they’re not properly treated.

These patches typically occur on the face, scalp, or ears, but may be widespread in rarer cases. While sun exposure seems to play a role, discoid lesions can also appear on sun-protected skin, per a 2021 review in the International Journal of Rheumatology.

“This rash can lead to scarring and thinning of the skin with a darker rim around it,” says Dr. Ko. “The center of the rash can cause loss of skin color, redness, and scales.”

Discoid lesions usually do not itch, but they can plug hair follicles and may lead to hair loss.

Sarcoidosis, another inflammatory disease, can also lead to a scarring rash that may resemble discoid lupus.

Subacute Cutaneous Lupus Erythematosus (SCLE) Rashes

SCLE lesions appear on your shoulders, back, chest, and legs. Unlike butterfly rashes or discoid lesions, they usually do not occur on the face.

“Ten percent of lupus patients may have subacute cutaneous lupus erythematosus, which unlike discoid lesions, do not tend to scar,” says Dr. Faroqui. “They can appear as red scaly patches or as flat pinkish circles with a red border.”

Like other types of lupus rashes, an SCLE rash is triggered by the sun. It can also look a lot like other types of rashes.

“It can resemble ringworm infection, with a red, circular rash,” says Dr. Ko. Dermatomyositis and Sjogren’s syndrome can also cause rashes that look like SCLE rashes or butterfly rashes.

What Causes Lupus Rash?

When you have lupus, your own immune system may attack the skin — and certain triggers can make the issue worse.

“Rashes in lupus are triggered by your immune system causing inflammation in your skin,” says Dr. Faroqui. “Although it may not always be possible to prevent a lupus rash, there are measures you can take to decrease the risk of it occurring.”

The most common trigger of lupus rash is sunlight. Dr. Ko recommends these sun-protective tips to help prevent a lupus rash:

• Wear sunscreen (at least SPF 30 or higher) when going outside and apply frequently (every two to four hours).
• Avoid the late morning/early afternoon sun, when the sun rays are the strongest.
• Wear a wide-brimmed hat and long sleeves with UV protection.
• Avoid tanning beds.

Lupus rashes can also be triggered by infections and, more rarely, certain medications. For instance, in about 20 to 30 percent of people with SCLE, the skin disease develops after taking medications such as antifungal medications, blood pressure medications, chemotherapy medications, proton pump inhibitors, or tumor necrosis factor inhibitors, per the Cleveland Clinic.

If you smoke, stopping may also help improve skin conditions associated with lupus. “Smoking can be another trigger of cutaneous lupus,” says Dr. Faroqui. “It can also make certain lupus treatments, such as hydroxychloroquine, less effective. Studies have shown that lupus patients who stop smoking have an improvement in skin symptoms.”

Finally, staying consistent with your lupus treatment is key. If you abruptly stop your medications without speaking to your rheumatologist or otherwise don’t take them as prescribed, it can lead to more disease activity that may trigger a flare (including skin rashes).

Does a Lupus Rash Cause Scarring?

Lupus rashes can cause scarring, but early detection and treatment of rashes — along with overall management of your lupus — can lower your risk.

Discoid lesions are the most likely to cause scarring. In fact, scarring from discoid lesions on the scalp can cause permanent hair loss, per the AAD. If you have darker skin, patches from discoid lupus erythematosus (the condition that causes discoid lesions) may be particularly likely to leave behind dark or light spots after clearing.

In one 2021 study in Lupus Science & Medicine, Black patients with discoid lupus erythematosus had 48.9 greater odds of dyspigmentation compared to non-Black patients with the condition. “If not controlled early, other types of lupus rashes can also lead to pigment changes, or darkening of the affected areas — which may take a long time to fade,” says Dr. Ko.

How Can You Treat a Lupus Rash?

The most important first step is to manage general systemic lupus disease activity as much as possible. When your lupus is flaring, it’s more likely to cause skin rashes.

“Make sure you see a rheumatologist regularly so they can monitor your disease activity, which they will do by completing a physician exam and additional blood tests,” says Dr. Faroqui. “If rashes continue to occur despite these measures, medications may be needed to control symptoms.”

In this case, your doctor may explore a variety of treatments based on the severity of your rash.

“If the rash is not extensive, then a topical steroid ointment can be used to control the rash,” says Dr. Ko. “However, if the rash is extensive — meaning it covers many parts of the body — or the topical treatment does not work, then systemic treatment like oral steroids may be needed.”

You might need long-term treatment if your rash comes back frequently or doesn’t respond to topical treatments. Hydroxychloroquine is one of the most commonly used medications for systemic lupus and for more persistent CLE.

“If corticosteroids and antimalarials such as hydroxychloroquine are unsuccessful, a rheumatologist may recommend using stronger immunosuppressants for better control of disease,” says Dr. Faroqui.

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