1. “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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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
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.

10. 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.

11. 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.

12. 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

13. Thank you!