Is it lupus or something else? Skin conditions that look alarmingly similar

Lupus or systemic lupus erythematosus (SLE) is an autoimmune disorder that can involve a few or all organs. That includes the skin as well. Most common and most severe is that of the butterfly rash, which is red and flat or slightly elevated like a bump on the cheeks or the bridge of the nose. But two other skin presentations are closely mimetic to this eponymous sign, and these will be a cause of confusion and potential misdiagnosis.

It is a disease that occurs in the body after the immune system becomes deranged and starts destroying tissues found in the body, leading to extensive damage and inflammation. Patients who have lupus are at risk for malar rashes, photosensitivity, etc. The skin manifestation will be provoked or worsened by the sun and will be the same in different patients.

Conditions that can mimic lupus rashes

• Rosacea: A long-standing illness that usually affects the face, producing long-standing redness, easily seen blood vessels, and, in some cases, acne-like papules. Rosacea is an imitation of the butterfly rash but without the accompanying systemic findings of weakness, arthralgic-type joint pain, or organ failure as in lupus.
• Seborrheic Dermatitis: Red scaling lesions on scalp, nose, eyebrows. Seborrheic dermatitis is a carbon copy of lupus.
• Dermatomyositis is an autoimmune disorder that also produces muscle weakness with associated rashes on the skin. Although it comes about in much the same way that lupus does, one of the major distinctions involves the inflammation of muscles.
• Psoriasis: Psoriasis involves thick scaly patches over the elbows, knees, and scalp. But its rashes on the skin even mimic lupus rashes on sun-exposed skin at times.
• Solar Urticaria: Uncommon sun sensitivity that produces hives and red, stinging welts on skin exposed to the sun. It is falsely identical in appearance to lupus photosensitivity, so it's difficult to diagnose.

Why getting the diagnosis right matters
The correct diagnosis must be made to treat appropriately. Inappropriate treatment with immunosuppression of a lupus simulator for actual lupus will fail or be toxic in seborrheic dermatitis or rosacea. Organ toxicity will be the result of uncontrolled secondary systemic inflammation due to failure to make a correct diagnosis of actual lupus.

Diagnosis of lupus is performed with a thorough clinical evaluation, laboratory tests like the antinuclear antibody (ANA) test, and even skin biopsy in certain instances. Doctors must keep in mind all the symptoms available, like arthralgias, weakness, and organ failure, and even cutaneous manifestations, in trying to diagnose properly.

Even as lupus comes hand in hand with common manifestations of skin illnesses whose diagnosis is ordinary for any circumstance, professional medical evaluation for conditions that will come close to mirroring lupus is valid since there exist several skin disorders such as rosacea, seborrheic dermatitis, dermatomyositis, psoriasis, and solar urticaria. All these and many more ailments simulate lupus.

If one has discovered an acute or chronic change in their skin, or if it is one of the attendant symptoms of weakness or arthralgia, visit a physician. Prompt diagnosis on the part of appropriate medical testing will be invaluable to therapy and prognosis.

Dr Asmita Dhekne Chebbi, MBBS, MD Dermatology, at Apollo Spectra Hospital, Bangalore