Many people living with lupus experience skin sensitivity. This can include sensitivity to sunlight (known as photosensitivity), along with skin rashes or ulcers (lesions or sores) — especially around the nose, mouth, or other sun-exposed areas. Skin symptoms can also be a sign of cutaneous lupus, a type of lupus that primarily affects the skin.

Sensitive skin, rashes, and flushing can be uncomfortable and frustrating. As one MyLupusTeam member wrote, “I am in the middle of skin flares. I can’t be in the sun at all without problems. Itching and burning all over my body. My hands are red and sore and itchy.”

Here’s what you need to know about skin sensitivity and lupus, including what causes it and how it can be treated. If you’re experiencing this symptom, talk to your rheumatologist or a dermatologist.

How Do People With Lupus Experience Skin Sensitivity?

Many MyLupusTeam members have shared their experiences dealing with skin sensitivity. Some have felt like they’ve been bruised — even if it’s not visible — particularly if someone touches them. Other members say they deal with lupus flushing, rashes, and sensitivity, sometimes caused by a lupus symptom known as a malar rash (also called a lupus rash or butterfly rash).

Butterfly rashes typically spread across the face — but not always. “My nose is about the only place that doesn’t usually get the rash,” one member of MyLupusTeam said.

Not everyone with lupus experiences itchiness along with a rash. “I get a butterfly rash, but it doesn’t bother me,” one member wrote. “In a flare-up, I get a rash on my back, legs, arms, lips, and chest. It starts to tingle until little blisters appear.”

Some people find that their rashes and facial flushing tend to come and go. One member explained, “I used to get butterfly rashes, but then it stopped.”

“If I get hot, it pops out, like hot showers or baths or when I get out in the sun,” reported another member.

Like many others with lupus, this member shared that they also experience mouth sores with their rashes: “It feels like a burn, and the skin peels off. Sometimes it’s red knots that have a white spot on top inside of my lips, and also the red bumps on my tongue that are very painful at the time.”

Note that skin discoloration may look different depending on your underlying skin tone.

Another member said that although they didn’t get many rashes, “I get mouth sores all the time.”

For some people, rashes are the first sign of lupus. This symptom alone can make diagnosis difficult, as it did for one member: “When my butterfly rash appeared 35 years ago, no one made the lupus connection.”

What Causes Skin Sensitivity in Lupus?

In some cases, skin sensitivity and rashes are caused by cutaneous lupus. However, systemic lupus erythematosus (SLE) — the most common form of lupus — may also cause skin problems, such as a malar rash. Both conditions can cause a person’s skin to become sensitive to light, leading to irritation or rashes.

Cutaneous Lupus Erythematosus

Cutaneous lupus erythematosus refers to a form of lupus that affects only the skin. This condition is different from SLE, which affects the skin as well as other parts of the body. It’s possible to have both types of lupus (CLE progressing over time to SLE) or to have CLE but not SLE.

There are several types of cutaneous lupus, and many cause rashes. These rashes can look and feel different — some may itch, burn, or hurt, while others don’t. Some rashes may be permanent, but many improve or clear up after several days or weeks, while some leave scars.

How Do You Know if You Have Cutaneous Lupus?

The best way to find out if you have cutaneous lupus is to see a dermatology expert. If they suspect cutaneous lupus, they’ll take a sample of your skin called a biopsy. If they suspect your skin symptoms are part of systemic lupus, they may do blood tests to see if you qualify for that diagnosis instead.

Photosensitivity

According to the Johns Hopkins Lupus Center, half of the people living with lupus are sensitive to light. This can include both sunlight and artificial lighting that emits ultraviolet (UV) radiation. People who experience this symptom may develop rashes, flushing, or reactions resembling sunburns when exposed to sunlight.

“Every time I get a little Florida sunshine,” explained one member, “I have red flushing on my face, and my nose gets red-hot, literally.”

There are three main forms of cutaneous lupus: acute, subacute, and chronic. Several forms of cutaneous lupus — including subacute CLE, discoid lupus (a subtype of chronic CLE), and lupus erythematosus tumidus (another subtype of chronic CLE) — can cause photosensitivity, including flushing or rashes.

SLE can also cause photosensitivity. Subacute cutaneous lupus, in particular, can cause photosensitivity that may be triggered by both sunlight and fluorescent light bulbs. Sun exposure can also lead to lupus flare-ups across other parts of the body in people with SLE.

Butterfly Rash

Malar rash is considered a common symptom of lupus. The name “butterfly rash” refers to the rash’s appearance. It often covers the center of the face across the cheeks and bridge of the nose. Butterfly rashes may be scaly, flushed, or raised. For some, butterfly rashes signal the start of a lupus flare. For others, the rash develops on its own.

Ulcers

Approximately 25 percent of people with lupus develop ulcers in or around their nose or mouth. These ulcers may resemble canker sores when they affect the inside of the mouth. Several factors may cause you to develop mouth or nose sores. These include lupus flare-ups, other autoimmune diseases, and the side effects of medications for lupus, such as corticosteroid medications.

Another wrote that they noticed tenderness inside their mouth. “I felt bumps inside my jaw and red bumps on my tongue. I also get sores in the corners of my mouth,” they shared.

One member described the feeling as “burning mouth syndrome.” “It’s so painful to eat anything because it’s on the roof of my mouth and back of my throat,” they said.

This lupus skin burning sensation may make it hard to get enough calories.

Skin Soreness Without Injury

Some people with lupus find that their skin is so sensitive that they feel as if they’ve been injured, even when they know they haven’t. Some lupus medication such as corticosteroids can lead to more fragile blood vessels that can lead to more frequent bruising.

There’s not much research on this symptom, even though people report it. “Does anyone else have spots that feel bruised and sore, but there isn’t a bruise?” one MyLupusTeam member asked.

“I do, and I know for sure I have not run into anything,” someone replied.

“Yes, I know what you mean,” agreed another member. “I get a feeling like my bones are bruised in my hands and wrists. It comes and goes, and there is never a reason for it. It’s frustrating because there is nothing you can do to prevent it — it just appears randomly.”

Feeling as if you’ve been bruised isn’t considered a typical symptom of lupus, but it’s important to mention it to your rheumatology provider. Your care team can help you figure out how best to manage these sensations.

Hives

Roughly 10 percent of people with lupus develop urticaria (hives). Hives can cause very itchy bumps or raised patches of skin to form, either individually or in groups. Although hives are most commonly the result of allergic reactions, cases that last longer than 24 hours are usually caused by lupus.

Cutaneous Vasculitis

Cutaneous vasculitis is a condition in which the blood vessels close to the skin’s surface become inflamed, limiting the flow of blood. This can cause bumpy, sometimes itchy skin lesions that may resemble hives. Cutaneous vasculitis can result in serious complications if left untreated, so let your doctor know as soon as you develop any new or worsened skin symptoms.

Treating and Managing Skin Sensitivity With Lupus

If you develop flushing, rashes, a feeling of bruising, or other types of sensitive, itchy skin conditions, talk to your rheumatologist or another healthcare provider. They may refer you to a dermatologist, who can rule out other potential skin conditions and find the right treatment for you.

Make sure to discuss these issues with your doctor right away, as certain conditions, including cutaneous vasculitis, may cause serious complications. Because of this, treating the underlying problem and taking additional steps to protect your skin from the sun are important parts of dealing with skin sensitivity with lupus.

Treating Your Lupus

If SLE or CLE is responsible for your skin problems, treating the underlying condition is the first step toward improving the symptoms. Your doctor may prescribe one or several treatments for lupus, including oral immunosuppressants like hydroxychloroquine (Plaquenil) and methotrexate.

Treating Butterfly Rash

If you develop a butterfly rash, your doctor may prescribe medications to help reduce inflammation. These include topical medications like corticosteroid creams and steroid injections into the affected area.

Managing Photosensitivity

Sun protection is an important part of managing photosensitivity with lupus. “I try to avoid the sun and heat in general as much as possible,” wrote one MyLupusTeam member.

You can take several steps to help protect your skin from the sun and UV light:

• Avoid sun exposure when you can, particularly when the sun’s rays are strongest (between 10 a.m. and 4 p.m.).
• Wear a broad-spectrum sunscreen. Make sure your sunscreen blocks both UVA and UVB light of at least 30 SPF (preferably 50 SPF) and reapply frequently.
• Wear protective clothing, including wide-brimmed hats, long-sleeved shirts, and long pants made with sun-protectant fabrics.

If you experience skin irritation, sensitivity, or flushing from the sun while indoors, use sun-blocking shades or drapes around windows. If you’re sensitive to fluorescent light bulbs, you can cover them with light shields or purchase low-UV lights, like LED lights.

Treating and Managing Ulcers

Your doctor may provide prescription mouthwash or toothpaste to help heal mouth ulcers and may recommend steroid nasal sprays for nose ulcers.

“My doc prescribed me something they call a magic mouthwash. I use it before I eat, and it works. When I first got it, I couldn’t eat for three days because the ulcers were so painful,” one member said.

Some members also find that avoiding certain foods or ingredients helps prevent irritating existing mouth ulcers, sharing comments like these:

• “I noticed gluten brings on more mouth ulcers for me, so I try to eat mostly gluten free.”
• “Salty foods, citrus, and tomatoes can make it worse.”
• “Lysine helps me keep them away. Salt water helps me heal them.”

Join the Conversation

On MyLupusTeam, people share their experiences with lupus, get advice, and find support from others who understand.

How do you manage skin sensitivity related to lupus? Let others know in the comments below.