When you’re living with lupus, you might expect rashes or skin discoloration to crop up, but some skin symptoms might still take you by surprise. One MyLupusTeam member shared, “I looked at my upper arm one day and there was a bright orange spot there. At first I thought it was a marker or pen, so I tried scrubbing it off, but it’s definitely skin.”

Lupus could be responsible for a surprising new skin symptom for several reasons, which we discuss below. But remember, anytime you experience new or worsening symptoms, talk to your health care professional.

Malar Rash

Lupus tends to be associated with the malar rash, or “butterfly rash,” which usually spreads across both cheeks and meets in the middle at the nose. This facial rash can look bright red on fair skin and purplish or brown on darker skin tones. A malar rash may appear after sun exposure or arise spontaneously and affects about 50 percent of people with lupus.

Photosensitivity

Half of people diagnosed with lupus are sensitive to ultraviolet radiation, including some indoor lights, according to Johns Hopkins Lupus Center. Photosensitivity can cause a sunburnlike reaction, even when the skin hasn’t been burned. These patches can be deeply colored and appear on any part of the body exposed to the sun. Always wear sunscreen with an SPF of at least 50, and take other measures to avoid exposure, such as wearing sun-protective clothing or carrying an umbrella on sunny days.

Subacute Cutaneous Lupus

Sometimes, you might experience an even more intense response to the sun. Patches of skin might become not just bright red (on fair skin) or purple (on darker skin) but also scaly, or you might develop round sores with a hole in the middle. This is called subacute cutaneous lupus, a type of lupus of the skin, and some people experience it even without sun exposure.

Hives

The raised, itchy patches of hives can appear in one place or all over the body. On dark skin, hives may blend in with your normal color or appear a shade or two lighter or darker. Hives can be bright red or pink on paler skin tones.

Lupus itself can cause hives, but people who have the condition can also get them from an allergic reaction. Hives that don’t disappear after 24 hours are likely related to lupus, and you should talk to your health care provider about how to treat them.

Purpura, Petechiae, and Ecchymosis

People living with lupus sometimes develop discolored spots that form when a small blood vessel under the skin breaks and leaks blood into surrounding tissues. This under-the-skin bleeding can cause tiny spots (petechiae), larger flat discolored areas (purpurpa), or very large bruised areas (ecchymosis). In terms of color, they can appear red, pink, or purple on light skin and deep purple or brown on darker skin.

These skin symptoms may be a result of lupus, but they can also be a side effect of some medications or indicate another condition.

Livedo Reticularis

Livedo reticularis, a netlike or lacy pattern beneath the skin, can be pink, red, purple, or brown. The discoloration usually shows up on the legs when veins are swollen and worsens in the cold. Livedo reticularis is associated with Raynaud’s phenomenon, which causes blood circulation problems in the fingers and toes. Lupus is a risk factor for developing Raynaud’s phenomenon, which may be triggered if you get chilled.

Discoid Lesions

Discoid lupus is a type of cutaneous lupus erythematosus. Most people with discoid lupus develop scaly patches or lesions on their head or face, though the symptoms can extend to the rest of the body. The lesions may appear bright red, orange, purple, or brown on different skin tones.

Discoid lesions that persist for years may develop into skin cancer. You and your rheumatology team should monitor the lesions to stay on top of any changes to your skin.

Other Skin Conditions

A wide variety of skin conditions, like eczema and psoriasis, can cause intensely colored spots and rashes. You and your dermatology expert can determine whether your skin symptoms are caused by lupus or by something else. Your doctor may need to run some tests to determine a diagnosis. Once they pinpoint the cause of your skin discoloration, they can advise you on the best strategies to address the symptom.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Are you living with discolored skin due to lupus? Have you discussed this symptom with your health care provider? Share your experience in the comments below, or start a conversation by posting on your Activities page.