Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Lupus is an autoimmune disease that affects more than 1.5 million Americans, according to the Lupus Foundation of America. In erythema multiforme, the characteristic target lesions remain fixed for multiple days, as opposed to the transient lesions of urticaria. If not, consider one of the subscription options below. Tinea infections are caused by close contact with infected persons, animals, or, occasionally, soil, and are spread to multiple body areas via autoinoculation when an infected region is scratched.1 Most infections occur in young adults and affect men more often than women.3 Warm environments, poor hygiene, contact sports, prolonged use of potent topical corticosteroids, and diseases that cause defects in the skin barrier facilitate these infections.4 Additionally, practices such as sharing towels, clothing, and toiletries, commonly seen in young athletes, are other important risk factors. When systemic lupus flares up, you may notice a sunburn-like rash on your face. EM often is confused with large urticarial lesions. As a general rule, the individual lesions last less than 24 hours. Small, violaceous, polygonal-shaped papules and plaques with a diffuse network of white streaking. These changes often appear on skin that gets sun like the: When lupus affects the skin, signs can also develop on skin that gets little, if any, sun like the: Some people develop lupus sores inside their mouth, nose, or vagina. It's most common in men and adolescent boys. Here's what to look for and how to treat it. People with lupus can have a variety of cutaneous manifestations. A person with lupus experiences fatigue, joint weakness, and flu-like symptoms. With round rashes, my differential was limited to tinea, if it had been there for a while, or urticaria and erythema multiforme, if it had just started. People lose hair on their scalp, legs, eyebrows, eyelashes, or elsewhere. Dermatologists care for people of all ages. 2018;18(3):e411-e412. In lupus, thrombosis may occur, causing clots to form where theyre not needed. It has a red, ring like pattern,sometimes with a little scaling in sun exposed areas, and may be confused withpsoriasis or ringworm. Oral and nasal ulcers or sores are one of the most common manifestations of lupus, according to Stojan. Learn more about how stress affects people with lupus and how stress management techniques can. Favor the face, neck, and areas of trauma. James WD, Berger TG, Elston DM. Let's look at the support available to you: Yes, about 1 in 10 of the people with lupus are men or assigned male at birth. In: James WD, Berger TG, Elston DM. Erythema multiforme (EM) is an acute and often recurrent eruption that commonly affects young adults.14 The reaction pattern represents an immune-mediated response to a variety of antigenic agents, most notably herpes simplex. This article interested me because it broadened my awareness about this type of rash. Discoid lupus can cause sores inside the mouth. Centers for Disease Control and Prevention. There are two kinds of subacute cutaneous lupus lesions: papulosquamous lesions and annular lesions. Put up UV-protective window coverings at home and work. Large, evolving erythematous plaque without scale. Find out what can help. Find out why dark spots appear and what can fade them. Lesions may be dry, scaly, and hairless, but most importantly, anesthetic.44,45 The superficial nerves supplying the area may be enlarged, tender, and palpable.1,45, The lepromatous form represents a poor cell-mediated immune response.45 Patients present with generalized disease, consisting of numerous, symmetrically distributed lesions characterized by small, poorly defined hypopigmented macules without associated anesthesia.45 Eventually, nodules and raised plaques of the face (leonine facies), ears, elbows, hands, and knees may appear.45 Nerve involvement can occur, but will present as a symmetric stocking-glove pattern neuropathy.45, Diagnosis of Hansens disease is made by identifying the infectious acid-fast bacilli in skin or nerve lesions with biopsy.45 In the United States, tuberculoid leprosy is treated with a combination of dapsone and rifampin for 12 months.45 Lepromatous leprosy is treated with a combination of dapsone, rifampin, and clofazimine for two years.45. To learn more, please visit our, It would be very easy for a dermatologist to tell you if you have. Though it. If you already have a subscription to this publication, please log in to view the full article. (2013, July 12), How does lupus affect the skin? The patches are thick, raised, and scaly, says Stojan. This type of lupus tends to be very photosensitive, says Werth. You may also have rashes on your forehead, arms, legs or other parts of your body. Morales-Burgos A, Snchez JL, et al. both enjoyable and insightful. Sometimes when people have active systemic lupus, they can have a diffuse loss of hair, says Werth. Lee LA, Werth VP. In about 1 in 5 people first diagnosed with CLE, the disease progresses to systemic lupus erythematosus (SLE). Ringworm Look-Alikes: A Host of Less Common Culprits. In: Bolognia JL, Schaffer JV, Cerroni L. Barrett M, Luu M. Differential diagnosis of atopic dermatitis. The word subacute refers to the fact that the rash comes on somewhat quickly and isnt present all the time. They'll look for signs of a fungal infection. JAK inhibitors are helping patients with alopecia areata, eczema/atopic dermatitis, psoriasis, and vitiligo. I have lupus & very sensitive skin what kind of sunscreen or block do you recommend or what other things should i do to prevent skin rashes? We hope you found our articles (See Figure 2.) Healthline Media does not provide medical advice, diagnosis, or treatment. It affects many different organs of the body, including the kidneys, lungs, brain, and arteries. Lesions have a predilection for the trunk and proximal extremities, sparing the hands, feet, face, and mucosa.14 When pressed, lesions should blanch. RELATED:Speaking Lupus a Glossary of Terms You Need to Know. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol. If you already have a subscription to this publication, please. If you have ringworm, common symptoms include: A circular or ring-like rash that may be raised along the edges A rash that may be scaly, itchy, red, or burning Hair loss in the area where the rash has appeared The rash may develop several red, raised rings at once, some of which may overlap. It's just a thinning which we see," she says, adding that theres usually no redness or scale on the scalp. Wont scar but might lighten or darken your skin. Lesions are mildly pruritic and oriented along cleavage lines.12 When stretched, scale hangs, resulting in the pathognomonic hanging curtain sign. Multiple lesions may coalesce, forming a diffuse rash that, when present on the back, exhibits a Christmas tree pattern along Langers lines, the natural folds of the body. In: James WD, Berger TG, Elston DM. SCLE is characterized by the rapid appearance of small or large, erythematous to pink-colored plaques with raised borders, central clearing, and an easily detached scale.41,42 The eruption is extremely photosensitive and, thus, most commonly will present on the face, upper trunk, and the backs of the arms.41, In differentiating SCLE from other annular lesions, a history of sun exposure in correlation with the appropriate distribution supports the diagnosis. Although rashes are not usually an emergency, it is common for emergency physicians to see patients come in with a rash. As the kidneys are damaged, fluid begins to build up in the body. Natalie tried many acne products without success. Elsevier, China, 2018: 662-80. Jock itch: Tinea cruris, or jock itch, causes a red, itchy rash in your groin, upper thighs or rectum. RELATED: Diagnosing Lupus: Tests and Screenings, Early Diagnosis, and Your Doctors. Discoid sores on your lips or inside of your mouth may develop a type of skin cancer called squamous cell carcinoma. For potential or actual medical emergencies, immediately call 911 or your local emergency service. (2013, August 11), How does lupus affect the musculoskeletal system? Lesions are oval-shaped, scaly, skin- to salmon-colored papules or plaques. Find out how a board-certified dermatologist helped Natalie see clear skin before her wedding. Last reviewed by a Cleveland Clinic medical professional on 05/26/2022. However, treatment generally is not required, as the eruption spontaneously remits in three to eight weeks.12 If patients experience intense pruritus, second-generation antihistamines, topical corticosteroids, a short course of systemic corticosteroids, or narrowband ultraviolet B (UVB) phototherapy can provide symptomatic relief.10. Both eczema and ringworm tend to inflame and redden the skin and can make it dry, swollen, crusty, and itchy. Navarro-Trivio FJ, Ruiz-Villaverde R. Chronic discoid lupus: An uncommon cause of nail atrophy. Sultan Qaboos Univ Med J. When lupus affects the skin, swelling can be one of the first signs of lupus. Other conditions that occasionally look like ringworm include seborrhea, psoriasis, pityriasis, contact dermatitis (such as poison oak), drug reactions, tinea versicolor, vitiligo, erythema migrans (a rash seen in Lyme disease), and even lupus. Diseases Resulting From Fungi and Yeasts. Kaushik N, Pujalte GG, Reese ST. Superficial fungal infections. Patients often are Caucasian women aged 15 to 40 years.42, Because of the transient nature of the eruption, treatment is centered around sun protection.42 If medical therapy is preferred, topical corticosteroids or antimalarial agents, such as hydroxychloroquine, can be used.41, Sarcoidosis is an idiopathic systemic disease characterized by non-caseating granulomas in multiple organ systems mainly the lungs, but also the skin, lymph nodes, eyes, and salivary glands.7,9 The disease is more common in women and typically begins between the ages of 20 and 40 years.9 Interestingly, in the United States, there is marked racial variation, with sarcoidosis affecting African Americans more often than Caucasians.9, Skin involvement is seen in up to one-third of those affected and may be the first and/or only clinical sign of disease.7,9 Lesion morphology varies, presenting as multiple round papules, patches, or plaques that favor the face, neck, and areas of prior injury such as tattoos and scars.7 Color ranges from red to purple to brown.7 Annular configurations may be present when multiple papules coalesce or when plaques clear centrally.7 Applying pressure to the firm lesions causes blanching, sometimes revealing a yellow-brown (apple-jelly) color.7 Lesions are almost always asymptomatic, although rarely may itch.9, Diagnosis may be straightforward in a patient with a known history of sarcoidosis; however, with no prior history, a biopsy of the lesion will reveal non- As many as 40 percent of all people with lupus and up to one-third of all children with lupus will develop kidney-related complications, according to the Lupus Foundation of America. Images 14-15: Used with permission ofDermNet NZ. Consider one of the subscription options below to receive full access to this article and many more. Is it lupus or ringworm? It's a fungal infection that often forms a ring-shaped rash. When available, the diagnosis can be confirmed by observing branching hyphae under the microscope using a potassium hydroxide (KOH) preparation. With treatment, it heals without scarring. A butterfly rash (malar rash) on the face affects many people with lupus, but lupus rashes can appear anywhere on your body. Exposure to ultraviolet (UV) light from the sun or artificial light sources may bring on a lupus rash. Within a few days, smaller lesions appear. In: Bolognia JL, Schaffer JV, Cerroni L. Rudikoff D. Differential diagnosis of round or discoid lesions. "Candida is a yeast," says Weinberg . During an eruption, lesions begin small then extend peripherally, becoming more erythematous over time.32 As lesions mature, desquamation occurs, leaving a collarette of scale at the margin, which often is accompanied by intense pruritis and burning.32,33. To diagnose EM, several lesions must evolve into the classic, target-shaped ones described above.43 In addition, EM lesions remain fixed for multiple days, whereas individual urticarial lesions last less than 24 hours. MD Candidate, Wright State University Boonshoft School of Medicine, Dayton, OH, Richard A. Miller, DO, Program Director, Dermatology Residency Program, Nova Southeastern University College of Osteopathic Medicine/Largo Medical Center, Largo, FL. Psoriasis is suggested when lesions occur on the extensor surfaces of the limbs, umbilical region, and sacrum. Sometimes the rash is new onset, and sometimes it has been present for a while and refractory to treatment. Weston G, Payette M. Update of lichen planus and its clinical variants. All rights reserved. Lupus is an inflammatory disease that causes a rash to form on the body and, in an initial form, can resemble a ringworm rash. Tinea can be diagnosed confidently when characteristic lesions described below are observed. All rights reserved. The most common type affects young adults, usually on the hands and feet. Lupus that affects the skin (CLE) comes in different forms, and causes different types of rashes. Acute cutaneous lupus lesions or rashes happen when systemic lupus is active, according to the Lupus Foundation of America. It produces a coin-shaped red, scaly rash on the cheeks, nose, and ears. If the fungal test is negative . 2013 Jun;27(3):391-404. Find out what may be causing the itch and what can bring relief. The different types of lupus can also cause the following changes to your skin: Lacy pattern on the skin called livedo reticularis, Poor blood flow in the fingers and toes when exposed to cold (Raynauds phenomenon). This rash reaches across your nose, from cheek to cheek, in a shape that resembles a butterfly. Do you know which one? Differential diagnosis of annular lesions. van de Kerkhof PCM, Nestle FO. If you have a darker skin tone, the long-standing patches of discoid lupus will eventually clear and can leave behind dark spots (A), light spots, or permanent scars (B). Dr. Kellawan (author), Mr. Andrasik (author), Dr. Schneider (editor), Dr. Stapczynski (editor), Ms. Light (nurse planner), Ms. Mark (executive editor), Ms. Coplin (executive editor), and Ms. Hatcher (editorial group manager) report no financial relationships with companies related to the field of study covered by this CME activity. If left untreated, the bald spots can grow bigger and become permanent. Read More Created for people with ongoing healthcare needs but benefits everyone. Doesn't itch or cause pain. Sometimes, visible blood vessels appear around the nails. access to 500+ CME/CE credit hours per year, and access to 24 yearly In: James WD, Berger TG, Elston DM. People who have discoid lupus develop these patches. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. This means the disease is active, causing symptoms. The rash typically isnt itchy or painful and rarely leaves scars. What steps can I take to prevent scarring? Hansens Disease. These tiny vessels can be dilated or broken near the surface of the skin and appear as fine pink or red lines. Sometimes, a rash or other sign of lupus causes a symptom like itch or pain. May have a characteristic bulls-eye appearance. With treatment for lupus, the hair often regrows. This usually starts as an. The rash is distinctive for its butterfly-like appearance: It spreads across the nose and fans out on both cheeks. (2013, July 12). If the rash is on the scalp, hair loss may occur. Systemic Symptoms in the Progression of Cutaneous to Systemic Lupus Erythematosus. Effective sun-protection helps to prevent this rash, which usually develops on the upper back, upper chest, or arms. [emailprotected]. It can be an indication of systemic lupus, but it can also happen on its own, according to NYU Langone Health. Most cases occur on the feet, hands, and buttocks where larvae can penetrate the skin easily.28 Shortly after infection, patients experience intense pruritus localized to the area of inoculation. Widespread disease is treated with oral albendazole or invermectin.27, Porokeratosis of Mibelli is a rare, genetically inherited disorder of epidermal keratinization that arises during childhood or adolescence.29 Lesions begin as small, skin- to brown-colored papules that enlarge over the course of years, forming plaques with raised, ridge-like borders and atrophic, hyper- or hypopigmented centers.30 (See Figure 7.) Sometimes hair loss may be permanent. Your Guide to Treating Lupus-Related Pain, How Lupus May Affect Your Eyes and Eyesight. An antigen is any substance that causes the immune system to react, often by producing antibodies to fight against it. Genodermatoses and Congenital Anomalies. This type of reaction indicates that your skin is photosensitive. The other change that you can see is a rash or reddening of the skin around the nail, which is referred to as a periungual rash or periungual erythema, says Stojan. It can also prevent the flare-up of other lupus symptoms like fatigue and joint pain. Our All Access Subscription provides unlimited access to our entire publication Raynauds is a reversible vasoconstriction of blood vessels in the fingers that is induced by cold. Fungal Diseases. Images 6,7: Used with permission of theJournal of the American Academy of Dermatology. Your dermatologist can explain which you have. Even during a global pandemic, lupus researchers have made strides in understanding this rheumatic disease, who is at highest risk, and what treatments Shannon Hester was diagnosed with lupus nearly 20 years ago. Appear on your lip or inside of your mouth. Many isolated tracts may be present, each representing the course of an individual larva. Erythema Multiforme, Stevens-Johnson Syndrome, and Toxic Epidermal Necrolysis. In: James WD, Berger TG, Elston DM. If you have discoid lupus, hair loss can be permanent because scarring develops. J Am Acad Dermatol 2016;75:1081-99. Chronic discoid lupus rashes or sores may put you at risk for skin cancer. Scalp ringworm ( tinea capitis): This causes scaly, red, itchy bald spots on your scalp. Having SCLE can make you more sensitive to the sun, so you need to be careful when going outside or sitting under fluorescent lights. Sometimes the rash is new onset, and sometimes it has been present for a while and refractory to treatment. As mentioned earlier, individual lesions should not last longer than 24 hours, although an attack may last much longer.21 If lesions persist beyond 24 hours, other causes must be considered and a biopsy may be warranted.22 If food is a suspected trigger, a food diary may be helpful. Some rashes can scar. There are many at-home and prescription treatments available to treat lupus-related pain. ACLE causes the facial butterfly rash (malar rash). When will the vaccine be available? Your physician can differentiate these from . Superficial mycotic infections are those limited to keratinized environments such as the skin, hair, and nails. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Vasoconstriction means that the blood vessels constrict and limit the blood supply to the fingers, says Stojan. Wieczorek IT, Propert KJ, Okawa J, et al. In many cases, the diagnosis may not be obvious, even for the experienced clinician. It appears by the malar area of the cheeks around your cheekbones "and it has the shape of a butterfly as it goes across the bridge of the nose, says Dr. Werth. A discoid lupus rash typically appears on your face and scalp, but it can affect any part of your body. Several tests will be needed to diagnose lupus to rule out other conditions. Discoid lupus occurs in people with chronic cutaneous lupus (CCLE). Papulosquamous lesions appear as red scaly areas and can be on the shoulders, back, and chest, whereas annular lesions can appear in circular, ring-type patterns and can look like a fungal infection, says Stojan. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Ringworm . Should I look out for signs of complications? Discoid lesions on your scalp may cause temporary or permanent hair loss. Laboratory tests rarely are indicated and generally are not recommended. ringworm? Rosenbach M, et al. When scars develop on the scalp, hair cannot grow where there are scars. James WD, Berger TG, Elston DM. Use these professionally produced online infographics, posters, and videos to help others find and prevent skin cancer. While tinea may be readily identifiable, a wide variety of clinical entities mimic these infections, leading to confusion and, often, misdiagnosis. ACLE rashes occur when you have a lupus flare-up. They have headaches and a fever, and their joints become swollen or painful. There are different types of CLE, each with different skin rashes. You may see a rash, sores, swelling, or other changes. This damage can lead to a range of symptoms, including: When lupus attacks nerves to the hands and feet, it can cause Raynauds phenomenon, which causes the tips of the fingers or toes to turn red, white, or blue. Symptoms, Causes, Diagnosis, and Treatment, Lupus Treatment: Medications and Complementary Therapies, Types of Lupus: Symptoms, Diagnosis, Treatment, What Causes Lupus? Dermatology. The minor variant is not associated with systemic symptoms, but EM major is accompanied by symptoms such as fevers and arthralgias.14, EM minor is characterized by distinctive target-shaped or iris-shaped lesions.14 Lesions evolve over several days, beginning as round, sharply demarcated erythematous macules that progress to raised, edematous papules.4 Mature lesions have three distinct zones a dull red center, a pale outlining ring, and an encircling macular erythema.14 (See Figure 11.) If left alone, one half of cases will resolve within two years.8 If treatment is preferred, high-potency topical corticosteroids or intralesional triamcinolone can be used.8,9 Although most cases heal without residual skin findings, recurrence is common regardless of treatment.9, Pityriasis rosea is a common eruption primarily seen in adolescents and young adults.10 The etiology remains unknown, but given its seasonal variation, occurring mostly in the spring and fall, a viral cause is suspected.11 The eruption is aptly named pityriasis, meaning scaly, and rosea, meaning pink. Other rashes can look like ringworm, including spider. A discoid lupus rash typically: Has circular, coin- or disk-shaped red patches that are thick and scaly. Ring-shaped rash. Image 1: Used with permission of theJournal of the American Academy of Dermatology. The ACLE rash is very sensitive to light. Scars are often permanent, although they may fade over time or with treatments. The hair loss may be patchy or widespread. Lupus vs ringworm Cause: The exact cause behind lupus is not clear, Genetics, environmental factors and the immune system may play a role in it. Systemic lupus erythematosus can have dramatic skin involvement that comes in three variants acute, subacute, and discoid. This patient developed a lupus rash after spending time under fluorescent lighting. Avoid going outside when the suns rays are strongest, between 10 a.m. and 4 p.m. The location is suggestive when plaques are confined to the extensor surfaces of limbs, umbilical region, and sacrum.33 Physically removing scale can produce pinpoint bleeding, referred to as the Auspitz sign, characteristic of psoriasis.32 Extracutaneous manifestations including nail changes and asymmetric, oligoarthritis of the hands and feet commonly are seen in conjunction with cutaneous findings.34. In: Bolognia JL, Schaffer JV, Cerroni L. James WD, Berger TG, Elston DM. Lupus can also weaken muscles, especially in the pelvis, thighs, shoulders, and upper arms. Red, circular rashes on the skin are a telltale sign of ringworm, but your doctor may also test a sample to confirm. Most patches appear on the face, scalp, or ears, but patches can develop elsewhere on the skin. Erythema annulare centrifugum (EAC) belongs to a group of disorders characterized by raised, erythematous lesions that form annular, polycyclic, or arcuate arrangements.14 Although the etiology is unclear and most patients do not have an identifiable trigger, an association with leukemias and lymphomas has been reported.15 The eruption is seen in both men and women and peaks in the fifth decade of life.16 Lesions begin as firm, pink papules that expand slowly over weeks, clear centrally, and progress to annular, erythematous, minimally elevated lesions that remain relatively asymptomatic beyond mild pruritis.14,16 Just inside the erythematous border is a trailing white scale that represents desquamation at the inner margin, characteristic of EAC. In addition, both can happen almost anywhere on the body, head to toe. (See Table 1.) They can look like a ring with a darker red circle on the ring's outer edge. Tinea corporis is associated with a fine scale and commonly affects the trunk, unlike NE, which has a thick crust and occurs almost exclusively on the extremities. Flaky, visibly greasy, white to yellow scaling overlies affected areas.36 Most cases are pruritic, and symptoms generally intensify with sweat.32,36, Seborrheic dermatitis may closely resemble tinea or psoriasis, especially in the groin. Leukemia rash may look like tiny red spots, bruising, and petechiae. These can include: Fungal Infections: Ringworm can cause circular, red. 800-688-2421. Researchers are still learning why, but treatments are similar across. (Be sure to follow your state laws). Within days, erythematous papules followed by characteristic thin, red, torturous tracts begin to appear.26 (See Figure 6.)