A patient with Lupus is usually in one of these stages: acute, subacute, chronic, or quiescent stage.\u00a0 The skin signs are different at different stages, and so is the care of the skin.<\/p>\n
In acute Lupus, the disease is not yet controlled.\u00a0 It is typified by a\u00a0\u2018butterfly rash\u2019<\/b>\u00a0on the face, but it can also appear as a non-descript rash on the body.\u00a0 Patients often suffer from recurrent\u00a0mouth ulcers<\/b>\u00a0which impair enjoyment and intake of food.\u00a0 One way to manage these ulcers is to numb them by applying salicylate gel (e.g. Bonjela gel), or to simply swish and swallow a mixture of one part (2.5ml) antacid (e.g. Mylanta, an over-the-counter syrup that reduces stomach acidity) with one part (2.5ml) diphenhydramine (e.g. Benadryl, a pharmacist-only medication with anti-histamine effects).\u00a0 Alternatively, one can reduce the inflammation by applying a steroid gel (e.g. Oracort E or Kenalog in Orabase), which can be purchased from a pharmacy.\u00a0 To reduce further aggravation of pain, avoid fried, sour, spicy, crispy, caffeinated and alcoholic food and beverage.<\/p>\n
Another common complaint in the acute stage of Lupus is\u00a0hair-fall<\/b>.\u00a0 Some people may even recognize this as a symptom of disease relapse.\u00a0 The good news is hair-fall that is associated with acute Lupus is often temporary, and will reverse gradually as the disease gets under control.\u00a0 However, most females are very disturbed by this.\u00a0 To accelerate the regrowth of hair, one can purchase minoxidil 2% solution from a pharmacy, and massage it into the entire scalp twice daily.\u00a0 Upgrade to a 5% solution when the hair-fall fails to improve after 4 months of regular use.\u00a0 Alternatively, one can see a dermatologist to discuss the use of lasers and\/or other medications.<\/p>\n
A person with chronic Lupus has rashes on the body that are relatively more difficult to eradicate.\u00a0 These\u00a0recalcitrant rashes<\/b>\u00a0are most often found on the ears and face, and are characterized by thick scaly dotty red-to-brownish islands.\u00a0 Such rashes necessitate the use of strong topical steroid creams\/ointments.\u00a0 However, indiscriminate use of these topical steroid creams\/ ointments can cause side-effects such as skin thinning and the appearance of fine blood vessels and stretch marks.\u00a0 To avoid these problems, apply the creams sparingly without rubbing onto surrounding unaffected skins.\u00a0 Apply no more than twice daily, and reduce to once daily or every other day when the lesions clear.\u00a0 Occasionally stick a plaster onto the affected skin overnight (after applying the topical steroid) to achieve a more powerful effect.\u00a0 A dermatologist can inject steroids directly into very difficult-to-treat lesions.\u00a0 Where side-effects have developed, a dermatologist can discuss with you the use of steroid-sparing ointments.<\/p>\n
Skin complications of medication<\/i><\/p>\n
Many patients with Lupus are on long-term oral steroid therapy.\u00a0 Steroids reduce one\u2019s immunity, so a person can be more prone to developing a\u00a0fungal infection<\/b>\u00a0on the skin.\u00a0 It typically manifests as circular red scaly patches (\u201cringworm\u201d).\u00a0 One can apply an anti-fungal cream (e.g. miconazole, clotrimazole, terbinafine) twice daily.\u00a0 When the rash clears, it is important to continue using the cream for another 2-3 weeks to ensure that the fungus is thoroughly eradicated.\u00a0 Fungal infections may manifest as whitish patches on the tongue or sides of the mouth (\u201cthrush\u201d), or irritation and redness on the angles of the mouth.\u00a0 One can use miconazole oral gel twice daily to handle these infections.<\/p>\n
Another common problem associated with long-term steroid therapy is\u00a0acne<\/b>.\u00a0 If there are few whiteheads, blackheads and red bumps, one can apply over-the-counter benzoyl peroxide cream or acne cream (or lotion) twice daily.\u00a0 A salicylic acid-based cleanser can help manage the whiteheads and blackheads.\u00a0 Anti-bacterial cleansers (containing trichlosan, cetrimide or chlorhexidine) cleansers are useful where there are predominantly red bumps.\u00a0 When the skin starts to clear, apply a retinol or retinaldehyde-based cream onto the whole face nightly for maintenance.\u00a0 For those with moderate to severe acne (many more inflamed lesions \u2013 red bumps, big bumps, pus-filled bumps), it is advisable to see a dermatologist.<\/p>\n
Prevention of Lupus flare-ups<\/i><\/p>\n
Whatever the stage of Lupus, it is imperative that all patients with Lupus protect themselves from the sun.\u00a0\u00a0Ultraviolet radiation\u00a0<\/b>is a well-known trigger of Lupus and can cause skin flare-ups, or other Lupus organ flare-ups.\u00a0 Although staying indoors and actively avoiding outdoor movement between the peak periods of 10am to 4pm are helpful, one cannot totally avoid ultraviolet radiation in Singapore.\u00a0 It is strongly advisable to apply a good sunscreen on all sun-exposed areas of the body at least twice daily.\u00a0 Use a sunscreen of SPF 30 and above (ultraviolet B protection), and one with adequate ultraviolet A protection (PPD >15 or PA +++).\u00a0 Choose the appropriate sunscreen for one\u2019s needs and skin type. Consider whether you need a water-resistant sunscreen, whether your skin is acne-prone (select only a \u2018non-comedogenic\u2019 product), or whether you have a sensitive skin (select products with purely or mostly physical agents).<\/p>\n","protected":false},"excerpt":{"rendered":"
A patient with Lupus is usually in one of these stages: acute, subacute, chronic, or quiescent stage.\u00a0 The skin signs are different at different stages, and so is the care of the skin. In acute Lupus, the disease is not yet controlled.\u00a0 It is typified by a\u00a0\u2018butterfly rash\u2019\u00a0on the face, but it can also appear […]<\/p>\n","protected":false},"author":1,"featured_media":883,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-614","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/www.lupus.sg\/index.php?rest_route=\/wp\/v2\/posts\/614","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.lupus.sg\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.lupus.sg\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.lupus.sg\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.lupus.sg\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=614"}],"version-history":[{"count":0,"href":"https:\/\/www.lupus.sg\/index.php?rest_route=\/wp\/v2\/posts\/614\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.lupus.sg\/index.php?rest_route=\/"}],"wp:attachment":[{"href":"https:\/\/www.lupus.sg\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=614"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.lupus.sg\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=614"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.lupus.sg\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=614"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}