Types of Lupus

Lupus is a systemic autoimmune disease that causes inflammation in the body. The body’s immune system protects the body from infection by attacking invaders, such as viruses and infections. Lupus causes the immune system to mistakenly attack the body’s tissues and organs, causing inflammation, swelling, pain and damage to the body.

Various organs and tissues can be affected by lupus-related inflammation including, but not limited to, the brain, lungs, heart, kidneys, skin, joints and blood cells. Although most individuals with lupus develop a mild case, it can be severe or life-threatening.

Individuals with lupus undergo specific medical tests to determine the type and severity. Lupus is categorized into four types:

Systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is the most common form of lupus and ranges from mild to severe. SLE can affect various organs. Inflammation can occur in the joints, kidneys and skin. The nervous system and cardiovascular system can also be affected. Symptoms of SLE may improve or worsen over time.

Cutaneous lupus

Cutaneous lupus is generally limited to the skin. The main symptom is a rash that may result in severe scarring. Cutaneous lupus usually appears on the face, neck and scalp; however, it may present on or in the ears or upper torso. Scaly areas expand slowly and then heal, leaving discolored skin and/or sunken scars. This type of lupus is more prominent in smokers and African-Americans.

Cutaneous lupus is categorized into three subtypes:

• Acute cutaneous lupus erythematosus (ACLE) is the most common form of cutaneous lupus associated with SLE. ACLE presents with the typical ‘butterfly rash” associated with lupus. Acute cutaneous lupus can predict the recurrence of systemic disease or prognosis of the disease.
• Subacute cutaneous lupus erythematosus (SCLE) is non-scarring and typically develops in sun-exposed areas.
• Chronic cutaneous lupus erythematosus, or discoid lupus erythematosus (DLE), is a form of skin lupus that causes scarring. DLE on the scalp may result in permanent hair loss.

A skin biopsy is often necessary to determine the type of cutaneous lupus as each has its own characteristic pattern.

Drug-induced lupus erythematosus

Drug-induced lupus erythematosus (DILE) is caused by the long-term use of certain medications. Typically, DILE does not affect major organs; however, it mimics the symptoms of systemic lupus, including joint pain and inflammation around the lungs. Medications most commonly associated with DILE include hydralazine, procainamide, isoniazid, minocycline and anti-tumour necrosis factor (TNF).

Neonatal lupus

Neonatal lupus is extremely rare and affects infants whose mothers have lupus. A newborn may have a skin rash, liver problems or low blood cell count. Antibodies from the mother can act on the baby’s heart conduction system. Most symptoms subside after several months; however, it may result in a heart defect.