“Making Nice to Your Skin” Lupus and Your Skin Beth McLellan, MD Director of Dermatology Jacobi Medical Center Assistant Professor Albert Einstein College of Medicine

Background Skin is our largest organ It is our first defense against infection It also keeps the good things inside

How is Skin Lupus Diagnosed? Thorough skin exam by a dermatologist Often a sample of the skin will be taken by a biopsy Blood tests help us tell if there is involvement in other places

Lupus and the Skin Sometimes lupus is only in the skin Sometimes lupus can also affect other organs Skin changes from lupus can be permanent If lupus is limited to the skin it can be treated in many ways: Creams, ointments, solutions Injections into the skin Stronger medications taken internally We try to stop lupus early so we can prevent scars, discoloration, and permanent hair loss

Tips About Topical Medications Topical steroids come in many forms – ointment, cream, lotion, oil, liquid If you don’t like the version you are using, ask your doctor if there is another option It may depend on where you are applying – entire body, scalp, face, etc. Always apply medications before other moisturizers Make sure you follow the instructions closely for where and how often to apply your medications – ask for written instructions if you need them Let your doctor know if your medications are too expensive – prices of topical medications change quickly and we don’t always know what will be covered when we prescribe it but there is usually an alternative

Tips About Injections A small amount of steroid medication can be injected directly into your skin disease This sometimes works better than creams because it gets deeper in the skin Side effects can include discoloration of your skin (lighter color) or a depression in the skin There is some pain associated

General Skin Care Tips Keep showers not too hot or too long Use a gentle fragrance-free soap and limit to areas that need it Directly after showering while the skin is still damp: Apply medications to areas directed by your doctor Apply a moisturizer all over Thicker, heavier, greasier moisturizers tend to work best Covering moisturizers and medicines helps them to soak in Socks/gloves for hands/feet

Lupus and the Sun UV radiation can trigger lupus flares Patients with lupus may be more sensitive to other types of reactions from the sun No matter what type of lupus you have, protecting your skin from UV radiation is VERY important! Could get itchy and other rashes that come from the sun that are not lupus.

Types of Sun Protection Sunscreen SPF – at least SPF 30 Look for the words “BROAD SPECTRUM” Re-apply every 2 hours or after swimming/sweating Physical blockers vs chemical blockers Look for zinc oxide, titanium dioxide 50-60-90-100 should be used for people with lupus with skin sensitivity. Doctors have objected to just labeling 50+ because of diseases like lupus. Broad spectrum means there’s UVA protection. Could use moisturizers that have SPF 50 in them. In people with sensitive skin, or have a rash – chemical blockers can irritate skin. Zinc are ones that have physical blockers. A shot glass of sun screen is needed to cover your body.

Types of Sun Protection Clothing Invest in a good wide-brim hat All different types of clothing available – shirts, tights, pants, hats, scarves, blankets, sleeves, etc. Coolibar.com, Sundayafternoon.com Limits how much sunscreen you have to put on. Hat protects your face, head, ears, neck. Can find everywhere – Amazon. Best kind are longer in the neck so ears are covered. May invest in these if you’re outside a lot.

Types of Sun Protection Seek Shade Remember that some types of UV radiation from the sun can penetrate through window glass Some types of UV radiation can reach your skin indirectly even when you are in the shade Avoid peak times of sun exposure – 10am – 2pm Choose the shady side even of the sidewalk. You go outside even just walking short distances. You get it through glass, lights. Must have sun protection and seek shade.

Conclusions Lupus can commonly affect the skin in many different ways Sometimes a skin biopsy is needed to see if your skin problem is due to lupus Lupus in the skin can be treated many different ways, a dermatologist can help you come up with a tailored treatment plan It is very important to protect your skin from the sun when you have lupus Many common to have manifestations in the skin. If you have new manifestation, show your doctor. Topical and injections can help. Sun protection is extremely important. Find the way that works best for you

Thank you!