The main types of lupus are categorized by the primary signs and symptoms in each case. In lupus, the immune system produces proteins called autoantibodies that can attack any type of tissue or organ, causing a wide variety of symptoms. Since each person experiences the disease a little differently, it is possible to have lupus that does not fit neatly into one type or another. It is also common for lupus symptoms to change over time, which may result in a change in type.
Most doctors agree on four main types of lupus. Several have subtypes that describe more specific symptoms.
Systemic lupus erythematosus (SLE)
SLE is the most common form of lupus, accounting for 70 percent of cases. Systemic disease is widespread throughout the body, attacking different types of tissue. In severe cases, SLE can attack the kidneys, heart, brain, nerves, and blood vessels.
Kidney damage caused by lupus is referred to as lupus nephritis. Approximately 60 percent of people with lupus eventually develop kidney problems. Kidney damage is usually not noticeable until it becomes severe. Regular blood and urine tests can detect kidney problems earlier.
People whose lupus primarily affects the brain and nerves can be said to have CNS lupus. CNS lupus can cause seizures, strokes, cognitive dysfunction (problems thinking or remembering), peripheral neuropathy (numbness or tingling in the extremities), and psychotic episodes.
People diagnosed with SLE are less likely to have skin involvement. However, it is not uncommon for people with systemic lupus to have the malar rash characteristic of lupus on their faces.
Cutaneous lupus erythematosus (CLE)
Cutaneous disease is mostly limited to the skin. People with cutaneous forms of lupus are less likely to have systemic lupus. About 10 percent of those with skin lupus will eventually go on to develop systemic disease. Since lupus can cause silent damage in other tissues of the body, people with cutaneous lupus may still be monitored for systemic disease.
The most common form of cutaneous lupus is chronic cutaneous lupus (CCLE) or discoid lupus (DLE), which causes round or oval lesions of thick, scaly, red skin. In cases where DLE is limited to the head and neck, systemic lupus is less likely to develop.
In subacute cutaneous lupus (SCLE), scaly red patches and ring-shaped lesions develop on the chest, back, and neck. They may also appear on the face and arms. People with SCLE do not usually develop severe systemic disease, but joint symptoms are common.
The malar or butterfly rash is typical of acute cutaneous lupus (ACLE). In ACLE, which is also common in people with systemic lupus, there are red patches on the cheeks and across the nose that form the shape of a butterfly. Red patches can also occur on other parts of the body. These patches are photosensitive (sensitive to sunlight and tanning beds).
Drug-induced lupus erythematosus
Certain medications can cause the immune system to overreact and develop a lupus-like condition called drug-induced lupus. Some of the most common drugs that can cause this reaction are the blood pressure drug Hydralazine, anti-arrhythmia drug Procainamide, and Isoniazid, taken to treat tuberculosis. Some anti-seizure medications and tumor necrosis factor (TNF) alpha inhibitors taken for autoimmune conditions can also trigger drug-induced lupus.
Drug-induced lupus may develop after taking the medication for three to six months. Symptoms can include any lupus symptoms such as rash, joint pain, photosensitivity, and inflammation in the lungs, heart, or kidney. Symptoms usually stop within days or weeks of stopping the medication responsible.
Neonatal lupus (also called congenital lupus) is not an infant form of lupus, but a rare condition caused by an autoimmune reaction in the mother. When a woman with lupus or another autoimmune condition is pregnant, autoantibodies in her blood can attack the tissues of the fetus, causing a lupus-like rash and other – mostly temporary – symptoms. Besides the rash, a baby born with neonatal lupus may have low blood cell counts or liver problems that usually clear up within the first few months of life. In serious cases, babies with neonatal lupus may have a heart defect that requires surgery to repair.
Childhood lupus is not considered a separate diagnosis. However, childhood lupus is distinct from other types of lupus in several ways. Boys are more at risk for lupus than men. Childhood cases of lupus tend to be more aggressive and are twice as likely to involve kidney damage.