Lupus Erythematosus: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate lupus erythematosus:

Systemic lupus erythematosus (SLE)

Leading symptoms – skin manifestations.

  • Skin lesions (75% of patients with SLE have skin lesions, which are even symptomatic in 25% of cases):
    • Acute cutaneous lupus erythematosus (ACLE).
      • Butterfly-shaped erythema (butterfly erythema; erythema (areal redness of the skin)) on the face (starting from the bridge of the nose symmetrically onto the zygomatic and cheek regions); occurs in up to 80% of affected individuals; which is exacerbated by sunlight (photosensitivity)
      • Maculo-papular exanthema (patchy nodular rash), generalized or mainly on the chest and back.
    • Especially on the fingers blotchy, reddened skin lesions.
    • Nail symptoms (frequency of nail involvement: 20%):
      • Koilonychia (spoon nails) – nail change with trough-shaped depression and increased brittleness of the nail plate.
      • Red lunula (red nail moon)
      • Teleangiectasias (dilation of skin vessels) and hemorrhages (hemorrhages) at the nail fold (splinter hemorrhages of the nails, i.e. small streaky brown. Discolorations)
    • Erythema (areal skin redness; Here: bright red), erosions (superficial substance defects confined to the epidermis, without scarring), ulcers (ulcers) on the oral mucosa.
  • Raynaud’s symptomatology – vasoconstriction occurring mainly in the fingers and toes with temporary reduced blood flow.
  • Diffuse hair loss

Skin symptoms in systemic lupus erythematosus can be very diverse.The musculoskeletal system is affected in about 90% of patients with SLE. General symptoms

  • General feeling of illness (possibly also fatigue/fatigue).
  • Fever
  • Unwanted weight loss
  • Nausea (nausea), diarrhea (diarrhea).
  • Generalized lymphadenopathy (lymph node enlargement).
  • Arthralgia (joint pain), often in the small joints.
  • Arthritides (inflammation of the joints)
  • Myalgia (muscle pain)
  • Cephalgia (headache)
  • Epileptiform seizures
  • Psychotic states
  • Cognitive disorders
  • Acute confusion
  • Movement disorders
  • Peripheral neuropathies (diseases of the peripheral nervous system).
  • Pleurisy (inflammation of the pleura)
  • Endocarditis (inflammation of the inner lining of the heart)
  • Pericarditis (inflammation of the pericardium)
  • Glomerulonephritis (inflammation of the renal corpuscles) [predictor of outcome of SLE].
  • Sjögren’s syndrome (group of sicca syndromes) – autoimmune disease from the group of collagenoses leading to chronic inflammatory disease of the exocrine glands, most commonly the salivary and lacrimal glands; typical sequelae or complications of sicca syndrome are:
    • Keratoconjunctivitis sicca (dry eye syndrome) due to lack of wetting of the cornea and conjunctiva with tear fluid.
    • Increased susceptibility to caries due to xerostomia (dry mouth) due to reduced salivary secretion.
    • Rhinitis sicca (dry nasal mucous membranes), hoarseness and chronic cough irritation and impaired sexual function due to disruption of mucous gland production of the respiratory tract and genital organs.
  • Blood count changes such as anemia (anemia), leukocytopenia (decreased number of leukocytes/white blood cells compared to the norm), lymphopenia (decreased number of lymphocytes/white blood cells compared to the norm), thrombocytopenia (decreased number of platelets/platelets compared to the norm).
  • Splenomegaly (spleen enlargement).

Discoid lupus erythematosus (DLE)

Discoid lupus erythematosus (DLE) usually shows a chronic course – therefore it is called chronic discoid lupus erythematosus (CDLE). Leading symptoms – skin manifestations

  • Disc-shaped, sharply demarcated erythema with firmly adherent scales with the tapestry nail phenomenon (= erythematous plaques with follicular hyperkeratoses); occurring mainly on the light-exposed areas such as forehead, cheeks, shoulders, neck, etc.; heal with scarring.
  • Dimpled scars
  • Teleangiectasia – dilation of skin vessels.
  • Patchy hypo/hyperpigmentation
  • Narrow alopecia (irreversible alopecia; hairlessness; pseudopelade).
  • Erythema, erosions on the oral mucosa.

The skin symptoms show increased sensitivity to touch. No general symptoms are present. Approximately 5% of patients with DLE, initially without systemic organ involvement, develop SLE during the course of the disease.

Subacute cutaneous lupus erythematosus (SCLE)

Leading symptoms – skin manifestations

  • Disc-shaped, sharply demarcated erythema with firmly adherent scales with the tapestry nail phenomenon; occurring mainly on light-exposed areas such as the forehead, cheeks, shoulders, neck, etc.; scarless healing.
  • Teleangiectasia – expansion of skin vessels.
  • Patchy hypo/hyperpigmentation
  • Erythema (redness of the skin), erosions (superficial substance defects confined to the epidermis, without scarring) on the oral mucosa

Skin manifestations show increased sensitivity to touch. General symptoms – compared to systemic lupus erythematosus much milder pronounced.

  • Arthralgia (joint pain), often in the small joints.
  • General feeling of illness
  • Fever
  • Myalgia (muscle pain)

Lupus erythematosus profundus

Leading symptoms – skin manifestations

  • Painful nodularity localized to the face, upper arms/thighs, and buttocks; livid surface; may ulcerate and heal with scarring

Juvenile systemic lupus erythematosus

Only differences in symptomatology and course are listed below:

  • Fever, skin symptoms, and organ involvement (hemolytic anemia, encephalopathy (brain disease), renal insufficiency (kidney weakness to failure) (more common than in adults)
  • Pneumonia / pneumonia (cause of death in about 50% of cases).
  • Cutaneous involvement (vasculitis), nephropathy (kidney disease) or seizures are (rare at the onset of the disease).
  • Joint manifestations, photosensitivity (increased sensitivity of the skin to light), sicca symptomatology (symptomatology of dry eyes and/or a dry mouth), discoid lupus (rare at onset and later in the course of the disease)