Causes and Symptoms of Lupus

Acute cutaneous lupus erythematosus (ACLE). Is characterised by a reddish rash (erythema) and swelling (oedema) in the cheeks area, and is called a “butterfly rash”. These patients also have an excessive sensitivity to the sun (photosensitivity), and almost 100% are associated with systemic lupus erythematosus (SLE).

Sub-acute cutaneous lupus erythematosus (SCLE). Is a rash of reddish (erythematous), scaly (flaky) lesions in the form of a ring (annular), although, sometimes they can be lesions very similar to other diseases of the skin, such as psoriasis or eczema. They usually appear on the chest, arms and the upper part of the back. When the lesions are cured, they do not leave and scars or signs. These lesions are also very often triggered by the sun and, in some cases, by some medications. In these patients, up to 50% may start to develop a systemic lupus erythematosus (SLE).

Chronic cutaneous lupus erythematosus (CCLE). It is the most common form of cutaneous lupus erythematosus (CLE). Four out every 5 patients with CLE have a CCLE. The majority of patients never have a systemic disease, and it is estimated that only 10-20% of these patients develop a systemic lupus erythematosus (SLE). There are different clinical forms of CCLE:

• Discoid. It is the most common form. The lesions are red (erythematous) and scaly (flaky) plaques that resemble those of psoriasis. It is very typical that the lesions eventually cause scars, hair loss (alopecia) and deterioration of the skin of the area. The scars and areas of alopecia are usually for the rest of the life. They are lesions that, in the majority of patients, appear on the face, ears, nose, and scalp. On rare occasions the lesions may appear on the trunk, the arms and the hands.
• Hypertrophic. It is a particular variant form of Discoid CLE. The lesions become very thick, and very flaky on the surface and there may be warts or skin tumours.
• Mucosal. The lesions of CLE may appear in the mouth in the form of reddish (erythematous) plaques that ulcerate.
• Lupus panniculitis. It is a form in which the subcutaneous cell tissue (fatty or hypodermis) is inflamed. The lesions are painful lumps (nodules) that can ulcerate. When they are cured, they leave deep (pitted) scars due to atrophy of the fatty tissue. The areas most affected are the arms and thighs, but they also affect the buttocks, the face, the scalp and the breasts in women.
• Lupus perniosis. They are lesions that appear with the cold, and look like chilblains. In reality they are a skin manifestation of lupus. They are reddish (erythematous) plaques that appear on the fingers and palms of the hands and toes and soles of the feet. They may leave scars on being cured, and occasionally also lead to changes in the nails.

Intermittent cutaneous lupus erythematosus (ICLE). Also called “lupus tumidus”. They are reddish (erythematous) plaques somewhat swollen (oedematous) that particularly appear on the face, neck, and the upper part of the chest and back. The lesions are often triggered by the sun. They are cured without leaving signs or scars. It is very rare that these patients will have systemic lupus erythematous (SLE).

In many patients with lupus, of which the large majority have SLE, it is relatively common to observe some non-specific skin lesions, for which a diagnosis is unable to be made. Among these lesions are:

• Diffuse hair loss (it is a phenomenon that is called telogen effluvium).
• Chronic urticaria (hives).
• Urticaria with purpura (urticarial vasculitis).
• Raynaud's phenomenon. In situations of cold, the fingers and toes turn completely white, then they turn a blue colour and, finally, a red colour.
• Alopecia areata. Plaques of hair loss appear on the scalp, which later recover.
• Mucinosis. Lesions in the form of papules and nodules that can appear on the face, trunk and extremities.
• Cutaneous vasculitis. Inflammation of the small vessels of the skin.
• Livedo reticularis. Changes in skin colouring from a red - bluish colour and in the form of a net on the lower limbs and buttocks.

Lupus nephritis can cause various signs and symptoms and the form of presentation of the disease varies widely from one individual to another. The signs of lupus nephritis include:

• Blood in the urine (haematuria). The inflammation may lead to leaks in the small blood vessels that filter body wastes in the kidney (glomerulae) and are eliminated in the urine. For this reason, the urine can be a clear pink or brown colour, although these changes are not visible on many occasions.
• Protein in the urine (proteinuria). The glomerular disease can lead to protein being eliminated in the urine. The urine may be frothy due to the loss of protein, but again this disorder may be asymptomatic in the initial phases of the disease.
• Oedema. Excess of fluid that the kidneys are unable to remove quickly and that causes swelling in the legs, ankles or around the eyes.
• Weight increase. Due to the excess fluid accumulated in the body.
• Elevated blood pressure. Due to the change in kidney function.