Monday, November 28, 2011

Lupus and skin

     There are different types of lupus some of them are confined to just the skin and SLE is skin and systemic (affects the entire body).  However, not everyone with systemic lupus will get a skin manifestation of the disease.  The skin manifestations of lupus can be very challenging and life altering, especially if they scar or last a long time.  Here is some information SLE skin issues and lupus disease confined to the skin.

Skin Changes in People with Systemic Lupus

Lupus Foundation of America

Changes of the skin, hair, nails, and mucous membranes are very common in people with systemic lupus erythematosus (SLE), occurring in 85 percent of patients. In most of them, these abnormalities are not severe and are easily treated with corticosteroids (prednisone) or antimalarial drugs (hydroxychloroquine or chloroquine). In a small number of individuals, these problems are severe and may be somewhat unresponsive to the usual treatment. The rashes of SLE may be divided into specific and non-specific rashes.
Specific rashes
  1. The butterfly blush or rash is a faint or prominent red rash over the malar area and the bridge of the nose. The rash does not go into the sides of the nostrils or down the fold between the nose and the outer part of the lips. These areas are always spared and look white in contrast to the red rash of the cheeks and bridge of the nose. Sometimes the rash is flat, and sometimes it is elevated. It may be in the form of red blotches or may be completely red over the area. The rash may be itchy, especially if it looks more like a rash than a blush. This rash is typical of SLE but is present in only about 30 percent of patients.
    The butterfly rash is frequently confused by patients and by physicians with a similar red rash which also is over the cheeks. This rash is called acne rosacea. It does involve the areas of the outside of the nostrils and does involve the folds between the nose and the outer part of the lips. In addition, pimples may be seen on top of the red rash in acne rosacea.
     2) Subacute cutaneous lupus lesions are of two major types.
  • The first type looks like red pimples when the rash first comes out; as the rash persists, these pimples become bigger, and scales appear as the rash persists. Patients complain about the rash being very itchy. The rash usually appears on the face, chest, or arms and commonly comes on after sun exposure. The rash usually worsens after more sun exposure.
  • The second type starts out as a flat lesion and gets bigger by expanding outward. The center may become less red and may even clear up completely so that, after a while, this rash looks like many circular red areas with clear holes in their centers. The rash appears on the face, chest, arms, and back. It is very sensitive to the sun and, like the other form of subacute cutaneous lesions, usually is very itchy. The rash of subacute cutaneous lupus usually heals without scarring, or leaves a non-depressed scar or area of depigmentation where the rash had been.
People with subacute lesions are very sun-sensitive. These individuals also frequently have a specific nuclear autoantibody called anti-Ro. SLE patients with anti-Ro are more likely to have a sun-sensitive rash than SLE patients without anti-Ro.
  1. Chronic discoid lupus lesions are found in about 20 percent of people with SLE. Chronic discoid lupus also is found in people who have absolutely no trace of systemic lupus. In these people, the lupus is confined to the skin.

    These lesions are slightly elevated, pink or red areas which form crust or flakes on the surface. As the lesions mature, the central area becomes depressed and forms a scar. These lesions rarely are found below the chin and practically never on the legs. However, chronic discoid lupus frequently is found on the scalp and in the outer ear. Lesions are itchy and get bigger by spreading outward, leaving a central scar. In pigmented individuals, the central area may become depigmented; in all individuals, the outer red area may become hyperpigmented. These can be very disfiguring lesions and should be treated as soon as possible and as aggressively as necessary to stop them.
Non-specific rashes

Non-specific rashes are seen in diseases other than lupus, but are extremely common in people with SLE. Patients may develop a red blotchy rash similar to the rash caused by a number of viruses, and similar to the rash caused by a variety of drugs (so-called drug-rash). These blotches may or may not be elevated and may be pink or red. They generally are found on the face, chest, back, and upper arms, and may or may not be itchy. This type of rash disappears quickly if patients are treated with corticosteroids for their other complaints.

Vasculitic rashes are seen frequently in people with SLE, especially in acutely ill patients. These rashes are non-specific because they may be present in patients who do not have lupus. For example, a small number of individuals with rheumatoid arthritis develop vasculitic rashes. There are a wide variety of rashes due to vasculitis, including: tender bumps in the tips of the fingers or toes; rashes that look like splinters under the nailbeds; ulcers that form around the ankle joints or on the legs; and tender red bumps on the shins.
Some lesions in people with lupus, such as hives, may be due to inflammation of the small vessels of the skin.
Other non-specific lesions include nail bed redness and redness of the palms of the hands. Rarely, blisters due to lupus may be present.
Hair loss (alopecia)
Hair loss occurs in about 45 percent of people with lupus at some time during the course of their disease. Most frequently the hair loss occurs at the onset of the illness, and may be one of the first symptoms of the disease recognized by the person. Most often, the hair loss is from all over the head, but sometimes the hair falls out in patches. When the disease is brought under control, the hair should grow back. Sometimes there is a rash in the scalp—usually subacute or chronic discoid—that interferes with the hair follicle. In this situation, the individual is left with a permanent area of alopecia. Drugs used to treat lupus, such as prednisone and immunosuppressive therapies, also may be the cause of reversible hair loss.
Nail changes
Nail changes occur in about 10 percent of patients and consist of cracking, curling, and even loss of nails. These symptoms are due to the changes in the small vessels of the nail bed.
Mucosal ulcers
Mucosal ulcers usually are found on the roof of the mouth. They are painless, but are found because the physician looks for them. Patients may mistake painful canker sores for mucosal ulcers. Some individuals with lupus will have mucosal ulcers in the nose - when these are severe, they can lead to a hole in the septum of the nose.
The mainstay of treatment is the use of antimalarial drugs such as hydroxychloroquine (Plaquenil). Some people are more responsive to chloroquine. Steroid creams should be used cautiously on the face since the strong creams may cause dilated blood vessels. Some lesions—particularly discoid lesions—can be injected with corticosteroids and may respond very well. Other agents that have been used include retinoids such as Accutane and thalidomide. Occasionally it is necessary to use moderate doses of corticosteroids or other immunosuppressive therapies orally, to control lesions. Vasculitic lesions may require the use of cyclophosphamide, especially when ulceration is present.
There also are a number of practical, general steps people with lupus can take to help their skin problems.
  1. The first rule is to stay out of the sun, especially during the middle of the day.
  2. The second rule is to wear a good protective sunscreen of SPF 30 or higher. Use the sunscreen on all exposed skin areas, including the hands.
  3. The third rule is to wear a hat with a broad brim.
  4. The fourth rule is to wear long sleeves.

What Are the Different Types of Lupus?
There are several types of lupus that are recognized today. These include:
  • Discoid lupus. This was the first type of lupus to ever be diagnosed. This form of the condition affects only the skin, causing thick, red, scaly rashes on the face, neck, and scalp. After the rash goes away it can leave scarring and can cause hair loss in the scalp area. The rash of discoid lupus may last for a few days or a few years. It can go away for a long time and then come back. Discoid lupus is much more common in women than men and usually occurs between the ages of 20 and 45. In about 10 percent of people with discoid lupus, the condition progresses to systemic lupus.
  • Systemic lupus. Systemic lupus is the type of lupus diagnosis that is usually referred to generally as "lupus." This kind of lupus can affect almost any part of the body. Ninety percent of people diagnosed with systemic lupus are women in their child-bearing years. In the United States, the highest incidence is found in African-Americans. Symptoms of systemic lupus can be mild or severe and tend to come and go over time. Common symptoms include:
    • Painful joints
    • Fevers
    • Rashes caused by sun exposure
    • Hair loss
    • Loss of circulation in toes or fingers
    • Swelling in the legs
    • Ulcers inside the mouth
    • Swollen glands
    • Extreme tiredness
  • Different Types Of Lupus

    There are different types of skin involvement in Lupus Erythematosus.

    Lupus Erythematosus – Specific Skin Disease:

    Discoid lesions:

    These are scarring, coin-shaped lesions commonly seen in areas of skin that are exposed to light, such as the scalp, and ears, and the central portion of the face and nose. More rarely, your lips, mouth, and tongue might be involved. These lesions can produce a scarring baldness, and because they often affect your face, you may consider getting cosmetic treatment. Only 1 in 10 to 1 in 20 of patients who are initially diagnosed with this type of skin involvement, will eventually develop the severe form of the disease that involves other organs in your body.

    Subacute cutaneous lesions:

    These are non-scarring, red and scaly lesions that are very photosensitive, that is they get worse when they are exposed to ultraviolet light. They tend to occur on the face in a butterfly shaped distribution or can be more widespread on the body. Even though these lesions do not result in scarring, their extent and color change can cause you major cosmetic concerns. About half of the patients who are diagnosed with this type of skin involvement will, in time, develop other organ involvement (also called systemic involvement or systemic disease), such as arthritis conditions with their blood. Kidney disease is unusual in patients with this type of skin disease.

    Lupus Profundus:

    This is a rare type of skin lupus erythematosus in which the subcutaneous fat is involved giving rise at first to tender nodules that can leave, in time, saucer like depressions in the skin surface. This type most commonly affects the upper arms and trunk. Patients with this type of skin involvement may have either systemic disease or disease limited to the skin.

    Acute Lutaneous Lupus Lesions:

    The malar rash or butterfly rash occurs in association with systemic lupus erythematosus. It is seen in up to 2/3 of patients with systemic disease and may be the presenting feature in up to 40%. It may vary in degree from a mild redness or "rosy cheeks", to multiple swollen red areas or plaques.

    Lupus Erythematosus – Non-Specific Skin Disease:

    The following are skin changes that are noted in some patients with lupus erytheamtosus but also occur in many patients without lupus erythematosus. Thus having one of the conditions listed below does not mean that there is a predisposition to developing lupus erythematosus.

    Hair loss:

    Up to 1/3 of patients with systemic lupus erythematosus get reversible form of hair loss associated with flares of their systemic disease. They may also note, that their hair is more brittle than previously and breaks easily giving rise to shortened hair ("lupus hair"). Another form of reversible hair loss that leaves distinct bald spots, alopecia areata, may also be more common in patients with lupus erythematosus.


    Patients with systemic lupus erythematosus may develop inflammation of their blood vessels, this can result in varied manifestations running a spectrum from multiple scattered red bumps, that may crust and ulcerate to painful nodules.

    Varied skin manifestations:

    Raynaud's phenomenon:

    This is the blanching of the skin of the fingers and toes when exposed to cold and may be followed by a blue or red discoloration.


    This is a cold induced injury that results in tender nodules and plaques on the fingers and toes. 
  • The Skin

    Approximately two-thirds of people with lupus will develop some type of skin disease. Skin disease in lupus can cause rashes or sores (lesions), most of which will appear on sun-exposed areas, such as your face, ears, neck, arms, and legs. In addition, 40-70 percent of people with systemic lupus will find that their disease is made worse by exposure to ultraviolet (UV) rays from sunlight or artificial light.
    Lupus skin disease, called cutaneous lupus erythematosus, can occur in one of three forms: chronic cutaneous (discoid) lupus erythematosus, subacute cutaneous lupus erythematosus, and acute cutaneous lupus erythematosus. Lupus skin rashes and lesions should be treated by a dermatologist, a physician who specializes in caring for the skin. To determine whether a lesion or rash is due to cutaneous lupus, your physician will usually want to look at the tissue under a microscope. Taking the tissue sample is called a biopsy.

    The Forms of Cutaneous Lupus

    Chronic cutaneous lupus (discoid lupus) appears as disk-shaped, round lesions. The sores usually appear on your scalp and face, but sometimes they will occur on other parts of your body as well. Approximately 10 percent of people with discoid lupus later develop systemic lupus, but these people probably had systemic lupus to begin with, with the skin rash as the first symptom.
    Discoid lupus lesions are often red, scaly, and thick. Usually they do not hurt or itch. Over time these lesions can produce scarring and skin discoloration (darkly colored and/or lightly colored areas). Discoid lesions that occur on your scalp may cause your hair to fall out. If the lesions form scars when they heal, your hair loss may be permanent. Cancer can develop in discoid lesions that you have had for a long time, so tell your doctor about any changes in the appearance of one of these lesions.
    Discoid lupus lesions can be very photosensitive, so preventive measures are important:
  • avoid being out in the sunlight between the hours of 10 a.m. and 4 p.m.
  • use plenty of sunscreen when you are outdoors
  • wear sun-protective clothing and broad-brimmed hats
  • limit the amount of time you spend indoors under fluorescent lights
Subacute cutaneous lesions may appear as areas of red scaly skin with distinct edges, or as red, ring-shaped lesions. The lesions occur most commonly on the sun-exposed areas of your arms, shoulders, neck, and body. The lesions usually do not itch or scar, but they can become discolored. Subacute cutaneous lesions are also photosensitive so preventive measures should be taken when spending time outdoors or under fluorescent lights.
Acute cutaneous lupus lesions occur when your systemic lupus is active. The most typical form of acute cutaneous lupus is a malar rash -- flattened areas of red skin on your face that resemble a sunburn. When the rash appears on both cheeks and across the bridge of the nose in the shape of a butterfly, it is known as the "butterfly rash." However, the rash can also appear on your arms, legs, and body. These lesions tend to be very photosensitive. They typically do not produce scarring, although changes in skin color may occur.

Other Skin Problems

There are several other conditions that can occur when you have lupus:
Calcinosis is caused by a buildup of calcium deposits under your skin. These deposits can be painful, and may leak a white liquid. Calcinosis can develop from a reaction to steroid injections or as a result of kidney failure.
Cutaneous vasculitis lesions occur when inflammation damages the blood vessels in your skin. The lesions typically appear as small, red-purple spots and bumps on the lower legs; occasionally, larger knots (nodules) and ulcers can develop. Vasculitis lesions can also appear in the form of raised sores or as small red or purple lines or spots in your fingernail folds or on the tips of your fingers. In some cases cutaneous vasculitis can result in significant damage to skin tissue. Areas of dead skin can appear as sores or small black spots at the ends of your fingers or around your fingernails and toes, causing gangrene (death of soft tissues due to loss of blood supply).
Hair loss can occur for other reasons besides scarring on the scalp. Severe systemic lupus may cause a temporary pattern of hair loss that is then replaced by new hair growth. A severe lupus flare can result in fragile hair that breaks easily. Such broken hairs at the edge of your scalp give a characteristic ragged appearance termed "lupus hair."
Raynaud’s phenomenon is a condition in which the blood vessels in your hands and feet go into spasm, causing restricted blood flow. Lupus-related Raynaud’s usually results from inflammation of nerves or blood vessels and most often happens in cold temperatures, causing the tips of your fingers or toes to turn red, white, or blue. Pain, numbness, or tingling may also occur. If you have Raynaud’s phenomenon try to avoid cold conditions, and, if necessary, wear gloves or mittens and thick socks when in an air-conditioned area.
Livedo reticularis and palmar erythema are caused by abnormal rates of blood flow through your capillaries and small arteries. You will have a bluish, lacelike mottling under your skin, especially on your legs, that gives a "fishnet" appearance. Like Raynaud’s phenomenon, these conditions tend to be worse in cold weather.
Mucosal ulcerations are sores in your mouth or nose or, less often, in lining of vaginal tissue. These ulcers can be caused by both cutaneous lupus and systemic lupus. It is important to differentiate lupus ulcers from herpes lesions or cold sores, which may be brought on by the use of immunosuppressive drugs. Lupus ulcers are usually painless and signs of inflammation will show up in the biopsy.
Petechiae (pah-TEE-kee-eye) are tiny red spots on your skin, especially on the lower legs, that result from low numbers of platelet in your blood, a condition called thrombocytopenia. Although thrombocytopenia is common in lupus, serious bleeding as a result of the low number of platelets usually does not occur.

Treating Cutaneous Lupus

The medication used to treat lupus-related skin conditions depends on what kind of cutaneous lupus you have. The most common treatments are ointments, such as steroid cream or gel. In some cases liquid steroids will be injected directly into the lesions.
A new class of drugs, called topical immuno-modulators, has been developed to treat serious skin conditions without the side effects found in corticosteroids: both tacrolimus ointment (Protopic®) and pimecrolimus cream (Elidel®) have been shown to suppress the activity of the immune system in the skin, including the butterfly rash, subacute cutaneous lupus, and possibly even discoid lupus lesions.
In addition, thalidomide (Thalomid®) has been increasingly accepted as a treatment for the types of lupus that affect the skin; it has been shown to greatly improve cutaneous lupus that has not responded to other treatments.

Treatments for Cutaneous Lupus

Preventative Treatments

  • Avoidance/protection from sunlight and artificial ultraviolet light
  • Seek shade
  • Sunscreens -- physical and chemical
Local/Topical Treatments

  • Corticosteroid creams, ointments, gels, solutions, lotions, sprays, foams
  • Calcineurin inhibitors
    • tacrolimus ointment (Protopic®)
    • pimecrolimus cream (Elidel®)
Systemic Treatments for Mild to Moderate Disease

  • Corticosteroids -- short term
  • Antimalarials
    • hydroxychloroquine (Plaquenil®)
    • chloroquine (Aralen®)
    • quinacrine (available from compounding pharmacies only)
  • Retinoids
    • synthetic forms of vitamin A—isotretinoin (Accutane®), acitretin (Soriatane®)
  • Sulfones
    • diaminodiphenylsulfone (Dapsone®)
Systemic Treatments for Severe Disease

  • Corticosteroids -- long term
  • Gold
    • oral—auronofin (Ridura®)
    • intramuscular—gold sodium thiomaleate (Myochrisine®)
  • Thalidomide (Thalomid®)
  • Methotrexate
  • Azathioprine (Imuran®)
  • Mycophenolate mofetil (CellCept®)
  • Biologics
    • efalizumab (Raptiva®)
It should be noted that most of the above treatments are not FDA-approved for cutaneous lupus.
Related Information
The Many Faces of Cutaneous Lupus
Spring 2008 issue of Lupus Now magazine
The Mysterious Aspects of Skin Lupus15 Questions with Dr. Victoria Werth Your Skin and Lupus
July 2009 webchat transcript with Dr. Andrew Franks
Skin Disease and Lupus
December 2006 webchat transcript with Dr. Victoria Werth

Frequently Asked Questions

I want to avoid the butterfly red marks across the face. Is there anything I can do with lotions or creams to help avoid them?
There are several helpful approaches for this. First, patients prone to getting a butterfly rash should practice sun avoidance and use of high SPF sunscreens with good UVA blocks, such as Mexoryl or Antihelios. There are some anti-inflammatory creams, such as mild topical steroids, tacrolimus, or pimecrolimus than also can be of benefit in treating the red marks.

How might chemical peels affect someone with cutaneous lupus, and are they contraindicated for people with lupus?
Chemical peels may irritate the skin, and thus could potentially induce skin lesions in patients with the underlying disease. This phenomenon can occur with scratching or any skin irritation and thus could be a potential risk. This procedure should be discussed with your dermatologist before using it.

Is the use of tanning beds okay for people with lupus?
In general those with lupus should not use tanning beds. The bulbs in tanning beds produce ultraviolet light rays. It is the ultraviolet light rays that cause the skin to tan. The majority of people with lupus tend to be unusually sensitive to ultraviolet light. That is to say, exposure to excessive ultraviolet light, especially the UVB sun burning rays, can cause lupus skin lesions to appear, or make existing lupus skin lesions worse. Ultraviolet light can also activate the internal, or systemic, manifestations of lupus in some people.

There have been many examples of lupus skin disease patients who were thought to have psoriasis instead, and were then treated for psoriasis in medical phototherapy cabinets that are similar to tanning beds. A number of these people almost died from severe activation of their systemic lupus following such mistaken treatment.
Some research suggests that very long ultraviolet light wavelengths, in what is called the "UVA-1" range, can improve certain forms of lupus skin disease and mild forms of systemic lupus. This research has been somewhat controversial, because other research has found that higher doses of the same UVA-1 wavelengths are capable of aggravating the systemic manifestations of lupus. Therefore, the biological effects that people with lupus might experience (i.e. getting worse or better) are likely to be critically dependent upon the amount of the different wavelengths of ultraviolet light energy that their skin receives.
In a routine commercial tanning bed setting, it would be quite difficult for people with lupus to know how much of the various UV wavelengths they are receiving. Thus, for people with lupus, visiting a tanning salon may be too risky.
  • Pictures of lupus skin rashes
  • Lupus pictures 

    This site is a collection of lupus pictures and treatment tips.
    Lupus pictures

    Lupus pictures Lupus rash pictures Discoid lupus pictures Tumid lupus pictures
            Lupus is one of the most common autoimmune diseases in the world. Three out of five people who suffer from this type of illnesses are diagnosed with lupus. The problem with lupus is that it is a tricky disease: it cannot be predicted, it cannot be stopped and, most certainly, it cannot be cured. In recent years, scientists studying the issue have discovered that lupus has a definite genetic cause and several environmental factors can trigger a latent condition. Thus, it is best to study your families' health file and check out the places you live in before you start to think that your deteriorating physical health is somehow related to lupus. However, once everything has been eliminated and the only answer that remains is that you do suffer from this autoimmune disease, be prepared for a lifetime long battle to alleviate the symptoms of lupus. Do not lose hope because, according to physicians, the cure is on its way. Not very close, but closer than it might have seemed ten years ago.
    Butterfly lupus pictures Lupus skin pictures Lupus symptoms pictures

    Lupus rash pictures

           One of the most important lupus symptoms is the lupus rash. It not only cannot be missed, but it is a certain sign of what the medical doctor is dealing with. On the upside of this problem, the rash can be easily alleviated and it even disappears with proper treatment. On the downside, scarring is inevitable when talking about a lupus - related skin problem.
    Lupus rash pictures Lupus rash pictures Lupus rash pictures Lupus rash pictures
           There are three types of lupus rashes that a patient should be aware of: the acute rash, the chronic rash and the subacute rash (this can be considered a passing point between the acute and the chronic phases of the rash). These three stages are not necessarily happening in order, nor do all three affect one person. There are people who will never stop having and acute lupus skin condition and people who will find their lupus rash getting worse by the day.
            ...see more Lupus rash pictures

    Discoid lupus pictures

           Discoid lupus is the most serious of all the forms of skin lupus out there. It usually appears in the cases where only the skin is affected by this autoimmune disease, but it can be a symptom of a more disturbing condition, one that could lead to some rather important changes in the body. The image that discoid lupus presents resembles a poorly treated case of measles: round, inflamed and red pustules that tend to itch. Do not, under any circumstances, scratch that particular itch. If you do, scarring will be almost unavoidable. In some cases, with the help of proper medication and diet, some of that scarring might go away, but that is not a certainty.
    Discoid lupus pictures Discoid lupus pictures Discoid lupus pictures Discoid lupus pictures
            ...see more Discoid lupus pictures

    Tumid lupus pictures

           Tumid lupus is a feminist disease: it affects, usually, only young women, from the ages of nineteen to twenty eight, of whatever race and social status. Because lupus, in any shape or form, is an autoimmune disease, it does not have a cure. However, very few forms of lupus can evolve into something else. Unfortunately, tumid lupus is one of those that can very easily turn into systemic lupus erythematosus, a full - body condition that can lead to some very serious health concerns.
    Tumid lupus pictures Tumid lupus pictures Tumid lupus pictures Tumid lupus pictures
            ...see more Tumid lupus pictures

    Cutaneous lupus pictures

           Cutaneous lupus is the scientific name for skin lupus. Exactly like the name says, cutaneous lupus describes every lupus - related skin condition out there. From a simple, yet so telling, butterfly rash, to the more complex discoid skin problems or even to some subacute conditions, everything is encompassed in that one term. Unfortunately, what it does not describe at all is the relation between cutaneous lupus and the evolution of this autoimmune disease.
    Cutaneous lupus pictures Cutaneous lupus pictures Cutaneous lupus pictures Cutaneous lupus pictures
            ...see more Cutaneous lupus pictures

    Butterfly lupus pictures

           Butterfly lupus is one of the most common lupus forms out there, affecting the skin of the face, appearing especially on the nose and the cheekbones. Its unique butterfly shape makes it easy to identify in its more serious phases, but in the beginning, for a less than experienced physician or nurse, the rash can be easily mistaken for sunburn.
    Butterfly lupus pictures Butterfly lupus pictures Butterfly lupus pictures Butterfly lupus pictures
           If left untreated for longs periods of time, it can escalate, invading the upper back, the shoulders and, eventually, the entire body. It itches, sometimes, and it leaves behind some pretty telling scars.
            ...see more Butterfly lupus pictures

    Lupus treatment pictures

           There is one thing that any lupus patient must be told from the moment he or she is diagnosed: lupus has no cure. Not yet. The question then becomes what is the role of the treatment if the disease itself cannot be cured. Well, the answer is pretty obvious and may seem somewhat anticlimactic: the same as the flu treatment. It cannot cure, but it does a great job at alleviating the symptoms, which can be truly bothersome in some cases. Just like with any other full - body condition, lupus treatment implies both a medical approach, trying to keep the unnatural antibodies at bay with drugs, and a lifestyle change, which the patient must be willing to make in order to prolong his or hers existence.
    Lupus treatment pictures Lupus treatment pictures Lupus treatment pictures Lupus treatment pictures
            ...see more Lupus treatment pictures

    Lupus skin pictures

           Lupus skin conditions are known for being extremely troublesome and, more importantly, scarring. They can be classified in several groups, starting with the chronic conditions, going down for the subacute ones and ending with the acute problems. All of them are symptoms of a much more severe underlying condition: systemic lupus erythematosus.
    Lupus skin pictures Lupus skin pictures Lupus skin pictures Lupus skin pictures
            ...see more Lupus skin pictures

    Lupus complications pictures

           Sometimes patients tend to forget that lupus is a full - body illness. That is understandable under the idea that this condition attacks only one system at a time, in its early stages. Thus, the patient and the doctor will most likely be concerned with that specific problem and ignore the changes happening in other parts of the body.
    Lupus complications pictures Lupus complications pictures Lupus complications pictures Lupus complications pictures
           Lupus complications are known for their viciousness and their instability, as well as their diversity. The damage caused by an untreated complication can extend to the lungs, the liver, the kidneys, the skin or even the central nervous system.
            ...see more Lupus complications pictures

    Lupus symptoms pictures

    Lupus symptoms pictures Lupus symptoms pictures Lupus symptoms pictures Lupus symptoms pictures
            ...see more Lupus symptoms pictures
           The easiest to spot lupus symptoms are the rashes, the pain in the joints and the muscles and the unexpected fever bouts. However, if somehow the patient does not report those to the physician, then the medic should be able to discern that his or her patient suffers from lupus simply on their sleeping pattern: if the patient is a night - owl, preferring to lead his or hers existence during the sun - deprived hours of the day, than they might be affected by lupus.



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  45. I am Tom Kingsley. It's been a while since I've written to thank you for my life Dr OHIKHOBO who helped me in my life. I was infected with HERPES SIMPLEX VIRUS in 2016, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution out so that my body can be okay. One day my Aunt Rosa introduce me to Doctor OHIKHOBO having seen so many testimony online about his herbal medication to cure HERPES and gave me his , so i mail him. He told me all the things I need to do and also give me instructions to follow, which I followed properly. Before I knew what is happening after one weeks the HERPES that was in my body got vanished. so if you are you are having herpes or any kind of disease listed below *DIABETES *CANCER* HIV *STROKE *INFERTILITY *HEART DISEASE and you also want cure, you can also email him and call him via+2349053294137 or whatsapp him via +2348103601042 here is his website

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