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Approximately two out of every three people with systemic lupus erythematosus (SLE) develop skin lupus. SLE is the most common type of lupus, and it affects multiple organs. Not all people with skin lupus — called cutaneous lupus erythematosus — have SLE, however. Nevertheless, people living with either type (or both) can develop skin rashes, including rashes on the legs, among other skin symptoms.
Learn more about the types of leg rashes related to lupus, their causes, and how to manage them.
Skin rashes are a common lupus symptom among MyLupusTeam members, but not everyone with lupus will have leg rashes. Not all leg rashes caused by lupus look the same either. One MyLupusTeam member described their skin symptoms as “little things that look like blood blisters that then break open and start bleeding. When they heal, they leave scars and look horrible.”
Other lupus leg rashes look like faint, interlocking networks of red circles. For example, one MyLupusTeam member reported, “I get a rash with red lacy circles on my legs. It kind of looks like a snake pattern. It seems to show up when I’m having a flare and my hip joints and thighs hurt a lot.”
There’s as much variety in how lupus leg rashes feel as in their appearance. As one MyLupusTeam member observed, “There are so many different kinds of skin issues with this thug of a disease. We’re all so different but also alike.”
People commonly report a painful burning, crawling, or pin-pricking sensation with their lupus leg rashes. Some people describe it as feeling like a sunburn. Other MyLupusTeam members report increased sensitivity to either very hot or cold temperatures, which causes itchy or painful hives, chilblains, blisters, or pimplelike bumps. Some people describe experiencing visible skin changes, while others experience itching or pain without any rashes or changes in color.
Some lupus-related rashes are intensely itchy. Another MyLupusTeam member wrote, “By the end of the day, my skin feels like I have an army of ants under it, and I am scratching it till it bleeds.”
Chronic itching can disrupt sleep, increase irritability, and lead to scratching and scarring. A MyLupusTeam member commented, “I also get lesions on my lower legs that are so itchy, my scratching breaks the skin or causes bruising.”
Lupus is an autoimmune condition, which means the symptoms of the disease result from a person’s own immune system attacking their tissues. This can include the skin, resulting in rashes.
The main triggers for lupus-related leg rashes are:
If your rash has round, coin- or disk-shaped red patches that are thick and scaly but not itchy or painful, you might have discoid cutaneous lupus (DCL). There are several reasons to see a dermatologist — a type of specialized skin doctor — for skin conditions such as DCL. DCL can lead to scarring, especially if you scratch it. Exposing a DCL rash to sunlight can also cause permanent skin scarring or discoloration (skin turns lighter or darker).
Another reason to see a dermatologist for regular checkups is that DCL lesions can develop into skin cancer. If you do not already have a dermatologist, you can ask your primary health care provider for a referral. The dermatologist may perform a biopsy to get the diagnosis. A biopsy entails removing a small sample of tissue or cells for examination. The doctor may also order bloodwork to check for autoimmune disease.
Subacute cutaneous lupus erythematosus (SCLE) can sometimes be the cause of circular red leg rashes, which don’t itch and aren’t painful. The red circles of SCLE have red-ringed borders and can be scaly. Sunlight and taking certain medications can trigger SCLE. Doctors use the word “subacute” to describe this rash because it appears quickly and doesn’t last as long as other lupus rashes. SCLE doesn’t cause scarring like DCL but can cause permanent skin lightening or darkening.
Lupus leg rashes can be unpredictable. Symptoms can come and go, varying with the time of day, seasonal temperatures, or stress levels. Without treatment, flares may persist for months or longer. As one MyLupusTeam member shared, “I thought I was crazy!! Intense itching sometimes, no rash! I wake up with no visible or inflamed rash, but by the time afternoon/evening comes around, my legs are inflamed and itchy.”
The chronic and unpredictable nature of itchiness from lupus leg rashes can increase people’s risk for depression and anxiety.
MyLupusTeam members discuss their frustrations of trying to avoid any possible rash triggers. Many people living with skin lupus have sensitivities to ingredients found in some cleaning and beauty products. People with the condition also commonly have other allergies, including skin allergies that can cause contact dermatitis.
People living with lupus who don’t have any allergies may still experience burning, stinging, and irritation from chemicals in many household products if they have open sores or scratched areas of skin. This can make going to new places or trying out new products intimidating, as you may inadvertently come away with a painful or disfiguring rash.
The unpredictability of lupus leg rashes can impact your social life, travel, and ability to live your life the way you want: “We are planning our trip for this summer, and I’m terrified to go,” a MyLupusTeam member commented. “I’m scared I will overdo it and get sick with a horrible rash again. I don’t want to hold my family back from having a good vacation.”
Experiencing changes to your physical appearance caused by skin lupus can take an emotional toll — as can other people’s reactions to your skin issues. As one MyLupusTeam member wrote, “Because of the skin lesions, people stare at you. Some people have actually asked me if I was a meth addict because of the sores and scarring. People stare in disgust and back away as if I may infect them. It not only takes a toll on your self-esteem, but it’s so painful as well.”
Living with lupus can be stressful. Stress can make people feel overwhelmed and isolated. Seeking help from a therapist, counselor, or behavioral health provider helps those living with lupus leg rashes to cope better with the social and emotional struggles chronic skin problems cause. You can also benefit from learning how to manage stress through techniques like meditation, which may decrease how often you get rashes or how bad they are.
Because there are different kinds of lupus leg rashes, it is important to see a dermatologist to help you find the right treatment plan for your rash. Before starting treatment, the dermatologist may do a test called a biopsy to find out what type of skin lupus you have.
The main types of treatments for lupus rashes on the legs are:
For itching, some MyLupusTeam team members recommend trying an over-the-counter antihistamine. One recommended Benadryl, a formulation of diphenhydramine. “I use Benadryl. The downside is that it can make you tired,” one member shared. “But, it does make the rash and itching go away.” This medication can be taken as a pill or as a cream for rashes.
Some MyLupusTeam members take the children’s dosage during the day to feel less sleepy and switch to an adult dose to help them sleep through itching at night. Antihistamines that are less sedating are good options for daytime use. These include such as loratadine (sold under brand names including Claritin and Alavert) or cetirizine (including Zyrtec).
Steroids (such as cortisone and prednisone) are prescription medications that can be taken by mouth, applied to your skin where you have the itching or painful rash, or given as an injection directly into the skin lesions. Steroids help to reduce inflammation and clear your skin. They can also help prevent scarring. Talk with your doctor about the risks and benefits of taking steroids because they can cause other health problems when taken for a long time.
Immunomodulators or immunosuppressive medications help to block your immune system from attacking your skin and reduce inflammation. Your doctor must prescribe them. This class of medications can be taken in pill form or used as a cream on your skin. Examples include tacrolimus ointment (Protopic) or methotrexate (Rheumatrex).
Doctors also prescribe antimalarial medications to treat lupus leg rashes. Antimalarial pills such as hydroxychloroquine (Plaquenil) also stop your immune system from attacking your skin and are very effective in treating discoid lupus and subacute cutaneous lupus. Antimalarials also help prevent UV rays from triggering rashes.
MyLupusTeam members also recommend cool (not cold) baths, sometimes with oatmeal or tea tree oil, to help soothe their itchy or painful rashes. Baths can also offer a relaxing way to prepare for a better night’s sleep if your leg rashes keep you awake.
While you can’t prevent skin lupus, you may be able to prevent rashes with some lifestyle changes. Exposure to sunlight often triggers rashes and sores and makes breakouts worse. As such, avoiding sun exposure can be key. Learning what triggers rashes and how to avoid these triggers can help you enjoy less pain, itching, or self-consciousness about your leg rashes.
Here are some tips for avoiding triggers and protecting your skin:
Finally, seek mental health support if you experience anxiety, depression, social isolation, or insomnia (difficulty falling asleep or staying asleep) related to your leg rashes.
MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 215,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus and the leg rashes it can cause.
Are you living with lupus-related leg rashes? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Amy Harris, MS, RN, CNM is a certified nurse midwife and trained health literacy specialist.. Learn more about her here.
