Rashes are not uncommon; in fact, they are quite common. One gets them easily after coming in contact with an allergen or irritant, but what if the rash is associated with rheumatic diseases like lupus, rheumatoid arthritis, or scleroderma?.

While arthritis describes joint inflammation caused by a range of joint-related issues, rheumatic disease caters to a diverse range of medical conditions that joints, soft tissues, and organs. More than 100 types of rheumatic diseases exist.

Though each type produces distinct symptoms, skin rash can occur with many of them.

The Link Between Rash and Rheumatic Diseases

Noticing a rash is always a red flag. It can be the only clue to a specific illness, event, condition, or reaction.

Rash is defined as a change in the skin’s texture, color, or appearance, but rash can occur differently in patients with rheumatic diseases like lupus and scleroderma. Skin rashes associated with rheumatic disease can range from mild to severe, asymptomatic to symptomatic.

Most rashes that occur due to rheumatic diseases are fixed, maculopapular, and erythematous. They tend to be symmetrical and are located in the sun-exposed areas of the body like the face, neck, and upper extremities.

Lacy, reticular, and atypical patterns can indicate underlying and uncommon autoimmune diseases.

Rashes Associated with Lupus

Lupus is an autoimmune disease that causes inflammation in different organs. Its symptoms vary widely from mild to severe and from patient to patient. Skin rashes are a prominent clinical feature in lupus, affecting more than half of the patients.

It is important to recognize that not every rash in lupus patients is due to lupus, and not every lupus patient will have a rash.

The most common rashes associated with lupus include the following:.

Malar Rash

Malar rash looks like a butterfly-shaped rash on the cheeks and the bridge of the nose. It is named after the Latin word, “mala,” which means cheek. When a patient has this rash, he or she appears as if wearing a mask.

This rash is one of the classic features of lupus and persists throughout the disease.

Discoid Rash

Discoid rash is a scaly, circular, and raised rash that appears on the scalp, face, and neck. It is a chronic, relapsing rash that often appears when patients develop systemic lupus erythematosus.

Unlike malar rash, discoid rash produces scarring and depigmentation of the skin.

Photosensitivity Skin Rash

Photosensitivity in lupus refers to an increased sensitivity to sunlight, artificial light, and ultraviolet radiation. When the skin is exposed to sunlight after photosensitization with medications, a skin rash occurs.

The rash is red and scaly and can affect the face, scalp, chest, arms, and legs.

Rashes Associated with Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder that affects the joints, muscles, and sometimes other organ systems. The outbreaks of skin rashes in rheumatoid arthritis are usually non-specific and temporary.

The most common rashes associated with rheumatoid arthritis are the following:.

Rheumatoid Nodules

Rheumatoid nodules are noncancerous bumps that appear beneath the skin. The nodules are usually painless and are often found in areas that receive pressure, like the elbow and the back of the heel.

These bumps are often associated with seropositive rheumatoid arthritis.

Palpable Purpura

Palpable purpura is a purplish-red rash that appears due to inflammation in the blood vessels. The rash can be felt by touching the skin, may be itchy or painful, and often looks like bruises.

Palpable purpura is a rare but possible symptom of rheumatoid arthritis.

Rashes Associated with Scleroderma

Scleroderma is a rare autoimmune disorder characterized by hardening and tightening of the skin, blood vessels, and internal organs. Patients with scleroderma may develop skin rashes in the early or the late stages of the disease.

The most common types of rashes associated with scleroderma are the following:.

Morphea

Morphea is a patchy, irregular, and discolored rash that develops on the trunk or on the face. The rash is non-contagious and appears early in the progression of scleroderma. It can be painful, itchy, and affects circulation near the rash.

Calcinosis

Calcinosis is a rare and severe symptom of scleroderma. It occurs when calcium deposits form inside the skin. The deposits can cause skin infections, ulcers, and other problems. Calcinosis does not typically develop in early scleroderma.

When to Seek Medical Advice

As it has been reiterated, the occurrence of a rash is always a red flag. If you ever notice a rash that occurs with joint pain, stiffness, or swelling, seek medical help from a rheumatologist as soon as possible.

Early diagnosis and treatment of rheumatic diseases can prevent or delay the progression of the disease and its complications.

Remember, the symptoms of rheumatic diseases are nonspecific and can overlap with other medical conditions. Therefore, a thorough clinical evaluation, laboratory tests, and imaging studies are required to establish a diagnosis of rheumatic diseases.

Conclusion

Rheumatic diseases are complex and often challenging medical conditions that cause significant morbidity and mortality. Skin rashes may occur in almost any rheumatic disease.

Many of these rashes are symptomatic or a sign of progression of the underlying disease. As such, the diagnosis and treatment of these rashes and the underlying disease requires a multidisciplinary approach.