The butterfly rash on the face: Let's learn about Acute Cutaneous Lupus (ACLE) in simple terms

Have you ever had a rash that looks like a butterfly's wings, or a red rash, across your cheeks and nose? Many people think it's just a sunburn or an allergy. But sometimes it can be a sign of something more serious. Today we're talking about 'Acute Cutaneous Lupus', a type of lupus that affects the skin and has exactly these symptoms.

First, let's see, what is Lupus?

Simply put, lupus is an autoimmune disease. Dad, does that sound a bit complicated? Okay, let me explain. Imagine that our body has a defense system. We call it the immune system. Their job is to recognize and attack enemies like germs, viruses, and bacteria that enter the body from outside, and protect us from disease.

But, in a person with an autoimmune disease like lupus, something goes wrong. That defense system makes a mistake and can't tell the difference between foreign invaders and our own healthy cells and tissues. So, they start attacking our own healthy cells. This can cause swelling, pain, and damage in various parts of the body.

The most common and most common type of lupus is Systemic Lupus Erythematosus (SLE) . In this condition, the autoimmune attack is not limited to the skin. It can also affect internal organs such as the kidneys, heart, lungs, and joints. About three out of every four people with lupus have this condition.

So what is cutaneous lupus?

The word 'cutaneous' means "related to the skin." Cutaneous Lupus Erythematosus (CLE) is a condition in which lupus primarily affects the skin. This is when the immune system directly attacks the skin cells. This causes various types of spots, lesions, and sores on the skin.

Acute Cutaneous Lupus (ACLE) is a type of skin lupus. 'Acute' means "suddenly occurring." So what happens in this case is that the symptoms, especially the butterfly rash, appear suddenly. Most of the time, this happens after exposure to the sun.

What are the types of cutaneous lupus?

There are three main types of lupus that affect the skin. Each type has a different rash. To understand this more clearly, see the table below.

Who is more likely to develop this ACLE condition?

The exact cause of lupus has not yet been discovered, but some people have been found to be at higher risk.

• Hereditary causes: If someone in your family has lupus or other autoimmune diseases, you may also be at risk.
• Gender: Surprisingly, this disease is more common among women.
• Age: Usually common among women between the ages of 20 and 50.
• Race: This disease is more common among certain ethnic groups, for example, people of African and Asian descent.

About two-thirds of people with SLE develop skin symptoms, including ACLE. Some people are first diagnosed with lupus after this butterfly rash appears.

What are the symptoms of ACLE?

The main and most obvious symptom is the butterfly rash we talked about. This is medically called a 'malar rash'. 'Malar' means cheek. Although it looks like a sunburn, it is usually not painful. However, it can sometimes be a little itchy.

The good thing about this rash is that it doesn't leave scars over time. However, after the rash heals, the skin color in those areas may be slightly lighter or darker than it was before.

In addition to the butterfly rash, other symptoms may occur.

• Rashes on the hands and feet after sun exposure.
• Painful sores inside the mouth (Canker sores).
• Painful raised blisters on the skin (hives).
• Temporary hair loss.

What is this "flare-up"?

A person with ACLE does not have symptoms all the time. There is a cycle of symptoms that appear, subside for a while, and then reappear. This sudden increase in symptoms is what we call a "flare-up."

There are specific causes, or 'triggers', that cause these flare-ups.

• Sunlight (UV rays): This is the main trigger. That's why the rash gets worse when you go out in the sun.
• Stress: Things like excessive pressure and anxiety can worsen the disease.
• Some infectious conditions.
• Not getting enough sleep.

How to diagnose this disease?

If you have these symptoms, the first thing you should do is see your family doctor. He or she will refer you to a dermatologist or a rheumatologist, as needed.

Your doctor will examine your skin. Sometimes , a skin biopsy may be needed to make a definitive diagnosis . This involves taking a small piece of skin from the area where the rash is located and examining it under a microscope. This can help determine whether the rash is caused by ACLE or another skin condition.

What are the treatments?

ACLE is not a completely curable disease. However, symptoms and flare-ups can be very well controlled with proper treatment. Your doctor will prescribe the right treatment for you depending on the severity of your symptoms.

• Topical steroid ointments: These are medications that are applied to the skin where the rash is located. For example, fluocinolone acetonide or hydrocortisone butyrate. These reduce swelling and redness.
• Anti-inflammatory drugs: Drugs such as dapsone or low-dose methotrexate can reduce pain and swelling.
• Antimalarial drugs: Drugs like `hydroxychloroquine` (Plaquenil®) are very effective in treating malaria. They reduce fatigue, rash, and joint pain.
• Immune-controlling drugs (Calcineurin inhibitors): Drugs such as tacrolimus or pimecrolimus control the activity of the immune system to some extent, reducing its attack on the skin.

How to prevent flare-ups?

Just as important as taking medication is avoiding triggers that can cause flare-ups. Between 40% and 70% of people with lupus experience flare-ups after exposure to UV light, so sun protection should be number one.

• Use sunscreen every day when you go out in the sun. Choose a broad-spectrum sunscreen with at least SPF 30 or higher that protects against both UVA and UVB rays.
• Avoid the sun's hottest hours. Avoid going out in the sun as much as possible between 10 am and 4 pm.
• Wear clothing that covers you well. Use things like long sleeves, wide-brimmed hats, and sunglasses.
• Avoid artificial UV light sources like tanning beds completely.
• Some fluorescent lights used indoors can also emit small amounts of UV rays. Therefore, minimize prolonged exposure to them as well.

What else can you do besides protecting yourself from the sun?

• Eat a nutritious diet. Include more fruits, vegetables, legumes, and whole grains in your diet.
• Exercise. Do non-strenuous exercise, such as walking or yoga, every day.
• Manage stress. Relax your mind in a way that suits you, such as meditation or listening to music.
• Sleep well. Get at least 7-8 hours of sleep a day.
• If you smoke, stop immediately. Smoking can worsen the skin rash and reduce the effectiveness of the treatment medications.

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