Types of Lupus Erythematosus: Acute Cutaneous

Lupus Erythematosus is a connective tissue disease that is immune system mediated. The acute cutaneous is a less severe type of lupus and manifests only on the skin. The butterfly rash is specific for this condition and it will typically disappear if the patient avoids sun exposure. However, patients with acute cutaneous lupus may also be affected by systemic lupus, which is active.

Acute Cutaneous Lupus

Acute cutaneous lupus refers to lupus flare-ups that manifest on the skin and in some cases, joint pain may also be present. Typically, this condition accompanies systemic lupus, which affects the connective tissues and internal organs. However, there are patients that develop solely the skin rash and have no other symptoms related to systemic lupus (SLE).

Triggers of Acute Cutaneous Lupus

The acute cutaneous lupus can be triggered mostly by sunlight and exposure to various chemicals such as silica or mercury. However, stress induced flare-ups are also met in patients with lupus. It's important that the patient knows about these triggers and avoids them as much as possible.

Symptoms of Acute Cutaneous Lupus

The acute cutaneous lupus will manifest through rashes that are visible on the cheek; the rashes have the form of a butterfly, with one wing on each cheek. Additional symptoms may include:

  • Fever
  • Fatigue
  • Lesions located in the mouth, nose or vaginal area
  • Joint swelling and pain
  • Depression
  • Psychosis

If the patient is also diagnosed with SLE, there may be additional symptoms, specific to systemic lupus.

Diagnosis of Lupus Erythematosus

A patient that displays the butterfly rash on the cheeks should be tested to see if the lupus takes only a cutaneous form or is indicative of the presence of systemic lupus. Blood tests are needed, but the patient will also be tested for levels of protein in the urine. The anti Smith and dsDNA test may also give conclusive results. If the patient tests negative for the typical tests that indicate the presence of systemic lupus, the diagnosis will be acute cutaneous lupus. If the patient tests positive for the ANA, anti Smith or ds DNA test, he will most certainly have systemic lupus as well.

Treatment Options

If the diagnosis is acute cutaneous lupus and the patient is not diagnosed with systemic lupus, the treatment may be made up of topical treatment and avoiding the sun or triggering factors of the skin rashes. Sun protection must be worn and the patient will be advised to rest for a few days. The patient should be tested regularly, as he may be likely to develop systemic lupus in time.

If the patient is affected by systemic lupus, treatment is necessary and may be needed for life. The drugs administered will focus on suppressing the immune system (i.e., corticosteroids such as Prednisone) and controlling the symptoms of the disease (pain and anti-inflammatory medications). The disease may present periods of remission and during these periods, medication can be discontinued, but constant monitoring will be required to detect flare-ups.

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