University of Iowa Health Science Relations and
Richard D. Sontheimer, MD
Professor of Dermatology
First Published: November 2000
Last Revised: September 2003
Peer Review Status: Internally Peer Reviewed
According to the Lupus Foundation of America, an estimated 16,000
Americans develop erythematosus ("lupus") every year and 500,000 to
1.5 million Americans have been diagnosed with the disease.
Lupus is a chronic inflammatory disease that can affect various
parts of the body, especially skin, joints, blood, and kidneys.
Although lupus can affect any part of the body, most people with the
disease experience only a few symptoms. Some of the most common are
achy joints, skin rashes, fatigue, loss of hair, sores in the mouth,
inflammation of the lining of the lungs, and decreased kidney
The causes of the disease are relatively unknown, but environment
and genetic factors are involved. Richard Sontheimer, MD, professor
and head of dermatology at the University of Iowa, said that although
the disease is mainly hereditary, environmental factors may induce
"Sunlight exposure can really bring out lupus in someone who
hasn't been yet diagnosed with the disease," Sontheimer said. "UV
(ultraviolet) rays really aggravate lupus, especially for those
people in which the disease affects the skin."
According to Dr. Sontheimer: Lupus is an illness that can cause
problems in the body in many different ways. However, there are
several general patterns of illness into which most lupus patients
fall. In one pattern, patients experience only lupus skin disease
("cutaneous lupus"). An example would be patients who have only
discoid LE skin lesions.
In another pattern, patients experience problems from the way that
lupus can attack one or more of the vital organs inside the body.
Examples would include lupus kidney disease and lupus brain disease.
This pattern of lupus is called systemic lupus or SLE (systemic lupus
erythematosus) for short.
A third pattern is where lupus patients experience problems both
in their skin and in their internal vital organs at the same time.
Such patients can be referred to as having systemic lupus with lupus
skin lesions. Examples would include systemic lupus patients who also
have discoid LE skin lesions or other types of lupus skin lesions
such as subacute cutaneous lupus erythematosus or acute cutaneous
lupus erythematosus (butterfly rash).
In some patients, lupus skin disease or lupus internal organ
disease can be triggered by reactions to certain drugs.
Hydrochlorothiazide and diltiazem (for high blood pressure) as well
as terbinafine (for skin fungus infections), can trigger the
appearance of certain types of lupus skin disease such as subacute
cutaneous lupus erythematosus. Other drugs such as hydralazine (for
high blood pressure) and procainamide (for heart rhythm
irregularities) can trigger the appearance of some symptoms of
internal lupus (fever, loss of energy, joint pain, chest pain). In
such "durg-induced" lupus patients, simply stopping the offending
drug can result in complete resolution of the lupus skin and internal
symptoms without further treatment.
It is estimated that there is one lupus patient for every 3,000
U.S. citizens. Each year, approximately one in 20,000 U.S. citizens
will be newly diagnosed with lupus. Lupus is often called a women's
disease, affecting females eight times more frequently than males.
The disease can occur at any age and seems to target
African-American females living in the United States most often. "In
fact, approximately one in 7,500 African-Americans will develop the
disease each year in the U.S.," Sontheimer said.
Treatment and medications often depend on the organs involved and
the severity of the symptoms. "Treatment depends on the type of
lupus, the stage of the disease and the individual patient,"
Sontheimer said. "Treatment really needs to be individualized."
Treatment approaches are based on the specific needs and symptoms
of each person. For most people diagnosed with lupus, effective
treatment only minimizes symptoms, reduces inflammation, and
maintains normal body functions.
"Treatments for lupus are directed at trying to settle down the
overactive immune system that is seen in lupus patients," Sontheimer
said. "The most common form of treatment today for severe cases
continues to be systemic immuno-suppresive drugs, such as
corticosteroids (cortisone), used in high doses."
Other classes of drugs, such as antimalarials, can also be used to
minimize the amount of corticosteroids a lupus patient must take
(there can be many side effects associated with taking high doses of
corticosteroids internally for prolonged periods of time). Sontheimer
also said that people at risk for lupus, such as those who have a
family member with the disease, should try to stay out of the sun or
use sunscreen whenever possible.
Preventive measures have been focused on the environmental effects
that trigger lupus.
"We try to prevent or minimize the onset of symptoms of lupus by
telling people to decrease exposure to sunlight and artificial forms
of ultraviolet light, use sunscreens, use corticosteroid creams for
skin rashes and practice stress management," Sontheimer said.
"Psychological and physical stress can aggravate both internal and
skin forms of lupus."
Although there is no cure, lupus is generally not a fatal disease.
In fact, the prognosis for the disease is better than ever. Ninety
percent of people with lupus live 10 years after their diagnosis.