Because systemic lupus erythematosus can affect any organ system, no two people have identical forms of the disease. However, most people with systemic lupus erythematosus report periods of time in which their symptoms seem to be mild or absent (remission) and other periods of time when the inflammation is more severe (flare or relapse).
Although it is not directly inherited, lupus and other autoimmune diseases may run in families. Inheriting certain genes may make some people more susceptible to developing lupus.
In addition, certain environmental factors may trigger lupus in those who have a family (genetic) tendency toward the disease, including:
- Ultraviolet light, especially sunlight
- Certain medications, especially hydralazine and procainamide
- Antibiotics, especially penicillins or sulfa-containing medicines
- Hormonal changes, especially related to pregnancy and menstrual cycles
- Face, especially cheeks and nose
- Sun-exposed skin on arms, backs of hands, upper chest, and upper back due to increased sensitivity to sunlight (photosensitivity)
- Fingers and fingernails
- Mouth or nose
A rash can develop in sun-exposed skin (photo-distribution), especially on the backs of the hands and fingers. This rash, which appears as red, scaly patches, can also affect the arms and trunk.
The skin around fingernails (nail folds) can be red and inflamed, and tiny, dilated blood vessels (telangiectasia) may be seen. In addition, people may develop Raynaud phenomenon, in which the fingers (and sometimes toes) turn pale and numb after exposure to cold temperatures.
Small, painless ulcers can develop in the nose or, more commonly, in the mouth, especially on the roof of the mouth.
When lupus affects the scalp skin, you may notice hair loss. It may be patchy, or there may be thinning across the scalp, especially at the temples.
In addition to the skin lesions of lupus, people may have:
- Joint pain or swelling, especially in hands, wrists, and knees
- Blood problems, including anemia and clotting disorders
- Kidney disorders
- Lung problems, such as painful breathing
- Seizures or other brain disorders
- Swollen lymph glands
- Avoid intense sun exposure.
- Apply sunscreen with SPF of 30 or higher every day.
- Maintain healthy habits such as resting well, eating a balanced diet, and exercising regularly.
- Reduce stress.
- Avoid smoking and limit alcohol use.
If you have a rash that is suspicious for lupus, you nay need a skin biopsy. The procedure involves:
- Numbing the skin with an injectable anesthetic.
- Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a suture or two may be placed and will need to be removed 6–14 days later.
- Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).
- Anti-malarial drugs such as hydroxychloroquine, chloroquine, or quinacrine
- Anti-inflammatory medications such as aspirin, ibuprofen, naproxen, or indomethacin
- Immune-suppressing medications including azathioprine, cyclophosphamide, methotrexate, cyclosporine, chlorambucil, or mycophenolate mofetil