What to know about lupus rash on African American skin

Lupus is a chronic autoimmune disorder that causes the immune system to attack healthy tissue in the body. Many people with lupus may experience a malar rash that extends over the face in the shape of a butterfly.

Lupus is an autoimmune disease that affects at least 5 million people worldwide. However, the condition is more common in African American people. Females are also more likely to get lupus than males, and it occurs most often in those aged between 15–45 years.

Lupus can cause many symptoms, including skin rashes, joint swelling, and headaches. Another common symptom is a malar rash, or butterfly rash, on the face. Lupus may also cause sores to appear on the skin.

This article explores the symptoms and prevalence of lupus on black skin, along with causes and treatment options.

Symptoms of lupus may include:

  • malar rash, which appears as a butterfly-shaped red or different color rash across the cheeks and nose, that may feel painful or itchy
  • a raised, scaly rash on the skin
  • sores in the nose or mouth
  • pain and swelling of joints
  • fatigue
  • anemia
  • fever
  • flu-like symptoms
  • chest pain when breathing deeply
  • unexplained hair loss, particularly on the scalp
  • Raynaud’s disease, where toes or fingers change color, such as turning paler or purple, due to cold or stress
  • rash or feeling sick after sun exposure

In some people with lupus, inflammation may affect the blood and organs, which could lead to:

Lupus nephritis

If a person has a kidney issue due to lupus, doctors may refer to it as lupus nephritis. With this condition, people may experience:

Lupus can also increase the risk of cardiovascular disease. If people with lupus experience unexplained chest pain, they should seek immediate medical help.

People of all genders, races, and ethnicities can develop lupus. According to the Lupus Foundation of America:

  • lupus is more common in females than males: 9 out of 10 people with the condition are female
  • African American females are three times more likely to develop lupus than white females
  • African American females are more likely to develop more severe cases of lupus, and at a younger age
  • lupus affects 1 in 250 African American females in the United States

The main form of lupus, systemic lupus erythematosus, is more common among people of African heritage.

There is currently no clear reason why lupus commonly affects people of African descent. Researchers believe it may have a link to:

  • genetics
  • hormones
  • environmental factors

Other racial and ethnic groups are also at higher risk for developing lupus. These include:

  • Asian American
  • Hispanic
  • Latinx
  • Native American
  • Pacific Islander

Race and ethnicity can also affect complications of lupus. African Americans, Hispanics, Latinos, and Asian Americans are at higher risk of developing lupus nephritis than white people.

As well as race, ethnicity, and gender, risk factors for lupus may include a history of lupus in the family, or another autoimmune condition.

There is no known cause for lupus. However, possible causes may include genetics, environmental factors, and immune system factors. Stress, certain medications, and sunlight can also trigger lupus symptoms, known as flares. However, lupus is not contagious.

There are four different types of lupus:

  • Systemic lupus erythematosus: This is the most common type of lupus.
  • Cutaneous lupus: This type of lupus only affects the skin. The most common type to affect black skin is discoid lupus, which presents as a rash, usually on the face, neck, and scalp.
  • Drug-induced lupus: This occurs when certain medications cause symptoms similar to lupus.
  • Neonatal lupus: A rare condition that affects infants.

Diagnosing lupus can be difficult, as there is no specific test for the disease, while many of its symptoms overlap with other conditions. A doctor will use a combination of laboratory tests and symptom assessments to diagnose the condition.

These tests may include:

  • Blood and urine tests: Antinuclear antibody tests can indicate if a person’s immune system is likely to make autoantibodies of lupus. Roughly 97% of people with lupus show positive test results for these autoantibodies.
  • Tissue biopsy: A doctor may take a sample of skin or kidney tissue to check for signs of autoimmune disease.
  • Physical exam: To check for rashes or other physical symptoms of lupus.
  • Medical and family history: To keep track of any symptoms and investigate any family history of autoimmune disease.

There is a set criteria list of 11 symptoms and test results for diagnosing lupus. If people meet four or more out of the 11, they may have the condition.

As different lupus symptoms can develop over time, it can be beneficial to keep track of any health issues that people experience over the years. It is also important to know if any relatives have had lupus or autoimmune disease.

There is currently no cure for lupus, although people can work with their healthcare team to develop a treatment plan to help manage the condition.

Treatments can help keep symptoms in check, prevent the immune system from attacking healthy tissue, and protect against organ damage.

These strategies may be a combination of medications, lifestyle and dietary changes, and alternative therapies.

Medications

Medications for lupus can include:

  • Anti-inflammatory drugs: These include ibuprofen to reduce pain, inflammation, and swelling in joints and muscles.
  • Corticosteroids: These may help reduce swelling, tenderness, and pain. They could also calm the immune system.
  • Antimalarials drugs: These drugs may help treat:
    • joint pain
    • skin rashes
    • fatigue
    • lung inflammation
  • Immunosuppressants: In severe cases, doctors may suggest these to help manage inflammation and an overactive immune system.
  • Anticoagulants: Many people with lupus may be at risk for blood clots. Therefore, doctors may recommend these drugs to prevent a stroke or heart attack.

People can discuss the potential side effects of any medication with their doctor. Healthcare professionals will carefully monitor a person taking lupus medication to check for any serious adverse effects.

Lifestyle and diet changes

Lifestyle and dietary changes may include:

  • Protection from sun exposure: People with lupus should try to wear sunscreen all year round, cover up, and stay out of the sun at peak times. Lupus can cause the skin to become more sensitive to the sun and trigger flare-ups.
  • Eating a healthy, balanced diet: Eating plenty of vegetables, fruits, and foods low in salt, sugar, and fat may help manage symptoms.
  • Regular exercise: Moderate, low-impact exercise can help maintain strength and energy levels.
  • Rest: Excessive activity may trigger a lupus flare, so alternate active periods with rest and get quality sleep.
  • Avoiding smoking and second-hand smoke: Cigarette smoke chemicals can worsen lupus symptoms.

People can contact their doctor if they have a temperature above 99.6°F (37.5°C). A high temperature could indicate a lupus flare or infection.

Lupus can also cause depression, so it is important that people reach out to a healthcare professional if they are experiencing mental health issues. Connecting with a support network may help people manage their condition and positively affect health.

Alternative therapies

Alternative therapies, such as acupuncture, tai chi, and massage therapy, may help alongside other treatments to relieve pain and ease stress. However, more research is necessary to confirm their effectiveness.

If people are pregnant or planning to become pregnant, they can talk with their doctor. Healthcare professionals consider lupus pregnancies as high risk, and people will need to follow a plan to ensure they and their baby stay safe.

Lupus is an autoimmune condition that causes the immune system to attack healthy tissue. This can result in a range of mild to severe symptoms, which can include skin rashes.

Gender, race, and ethnicity may play a role in who is more likely to have lupus. The condition more commonly affects females and people of African heritage. Possible reasons for this include genetics, hormones, and environmental factors.

Although there is currently no cure for lupus, a combination of treatments can help control symptoms and improve quality of life. People can see their doctor for diagnosis and a treatment plan to help manage the condition.

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