Lupus Pics from the Lupus Encyclopedia: Includes color images
Due to publishing restrictions, the photos from The Lupus Encyclopedia edition 1 were published in black and white. This page includes those photos in color. In addition, photographs that will be included in the second edition will also be placed here.
Includes photographs of cutaneous lupus affecting skin of color
Photographs of people of color are included. We need more photographs of cutaneous lupus (lupus affecting the skin) in people of color that are easy to find on the internet. Rashes in people of color are underrepresented in books and on the internet. It is important that they be published because it can be more difficult to notice redness (erythema) and pink colored rashes on darker skin. I hope more healthcare providers publish their photographs of cutaneous lupus in people of color.
Why are most lupus pics done of white skin? It is because rashes are much easier to see. Unfortunately, this trend of making things easy left out the largest population of lupus patients. Lupus occurs much more often in people of African, Asian, Hispanic and indigenous ancestry.
LUPUS PICS FROM CHAPTER 1
Figure 1.1 Saint Martin and Saint Brice healing the Bishop of Liege of his lupus,
“le loup,” in Tours, France at the Shrine of Saint Martin. Image copyright Donald Thomas, MD
Saint Martin and Saint Brice Healing Éracle, the Bishop of Liège of lupus
The above beautiful wood cutting comes from a French book dated 1496, “Le vie et miracles de Monsigneur Saint Martin, translatee de latin en francoys.” I believe that this is the oldest depiction of someone with a disease called lupus. It comes from a 15th Century book, and it depicts Eraclus (Éracle), the Bishop of Liège, dying of lupus in the 10th Century. Above him are standing Saint Martin (whose tomb is depicted on the left) and Saint Brice (who was buried close by).
The page before this page with the wood cutting states that the Bishop had a disease commonly called “le loup” (French for lupus). Therefore, we know that “lupus” was used as the name of a disease as early as the 10th Century. The Bishop wrote that his body was full of open sores that looked like the bites of a wolf (lupus in Latin).
The Bishop of Liège, Belgium travelled to the Shrine of Saint Martin in Tours, France. He prayed inside Saint Martin’s shrine for seven days and seven nights to be healed of his lupus, since he was close to dying from it. On the seventh night the saints appeared. When he awoke in the morning, all his open sores were gone, and he was healed.
He then went back to Liège and built a church dedicated to Saint Martin. Today, you can go to Liège and see St. Martin’s Basilica (la basilique Saint-Martin de Liège or Basilica of Saint Martin).
Outside of St. Martin’s Basilica in Liege, Belgium. A church built to thank God and Saint Martin for healing Éracle, the Bishop of Liege, of his lupus in the 11th Century. Note, this is not the original building. It burned and the building was rebuilt. Image copyright Donald Thomas, MD
Inside St. Martin’s Basilica you can see this replication of the sarcophagus of Éracle (Eraclus), Bishop of Liege. The first person written down in history as having lupus. He was cured of lupus by Saint Martin in the 10th Century. Image copyright and photograph Gary O’Connor, JD
You can watch the 3 videos of my visit to St. Martin’s Basilica on YouTube. I’ll take you outside and inside the historic basilica. This is Part 1 of 3 videos
lupus pics from chapter 7
Most SLE patients with arthritis and tendinitis will not develop deformities. Unfortunately some will develop a problem where the tendons will be damaged from inflammation and slip over the joints, causing the above appearance. This is called Jaccoud’s (pronounced yah-KOOZ’) arthropathy. SLE is the most common cause of Jaccoud’s.
The photo above and below will appear in the 2nd edition of The Lupus Encyclopedia
lupus pics from chapter 8
Malar (butterfly) rash: a type of acute cutaneous lupus erythematosus
Lupus profundus (lupus panniculitis)
Lupus profundus is a type of chronic cutaneous lupus. It is due to inflammation of fat (panniculitis) under the skin. It can be quite painful to the patient. If not treated quickly, it can leave permanent loss of tissue under the skin, causing a large indentation. We usually call it lupus “profundus” rather than just panniculitis when there is involvement of the superficial skin by discoid lupus (like this patient has).
Lupus profundus is a type of chronic cutaneous lupus erythematosus (CLE). Discoid lupus erythematosus (DLE) is the most common type of CLE.
Discoid lupus erythematosus
Discoid lupus erythematosus (DLE) is the most common type of chronic cutaneous lupus erythematosus. If not treated quickly and brought into remission, it leaves permanent skin damage and scarring. DLE starts off as small inflamed red or pink areas. Untreated, they grow wider. They are oval or round. This is why they called “discoid.” They are disc shaped.
Note how the border is red. It is actively inflamed and will continue to grow wider if not brought under control.
Note how the inside is a light color without the redness. This is permanently scarred, damaged skin. It can be very disturbing for the patient due to the cosmetic appearance changes. It is especially devastating when it occurs in people with skin of color.
Her discoid lupus was brought under control when her SLE went into remission on treatment. She was left with scarred areas of skin that was lighter in color, but the areas did not enlarge.
Discoid lupus on skin of color
Lupus rashes can look quite different on skin of color compared to white skin. Notice the differences between the discoid lupus affecting the cheek and ear of this black man cared for in the dermatology clinic at Howard University by Dr. Okoye.
It is imperative that we treat these aggressively as soon as they are first noticed. Hydroxychloroquine (Plaquenil) should be used in most patients. Cortisone creams and injections also help.
Scarring alopecia due to discoid lupus erythematosus
When DLE affects the scalp and destroys the hair follicles, hair loss (alopecia) occurs. These lost hair follicles can never come back, so the person is left with areas of permanent hair loss (scarring alopecia).
It is important that the person with DLE be treated quickly and aggressively to prevent permanent, cosmetic changes from occurring. People suffering from DLE have high levels of poor self esteem and subsequent poor quality of life related to these changes and needs to be taken seriously.
Lupus tumidus (tumid lupus)
Lupus tumidus is classified as a type of chronic cutaneous lupus by most lupus skin experts. However, some think that it is a separate disease. The vast majority of tumid lupus patients do not have systemic lupus. In addition, the biopsy appears very different under the microscope compared to other types of cutaneous lupus.
It appears as purple/blue color areas of raised skin, similar in appearance to welts or hives (urticaria). With successful treatment, they tend to resolve.
Erythromelalgia is a rare complication of SLE. The appearance above itself is actually common in SLE patients, due to palmar erythema or cutaneous vasculitis.
However, erythromelalgia is painful (distinguishing it from common palmar erythema and cutaneous vasculitis). This patient would keep putting her hands under the cold water in the exam room. Erythromelalgia feels better in cold and worse with warmth (the opposite of Raynaud’s which is worse in cold). After treatment with aspirin and immunosuppressant therapy, this resolved.
lupus pics from chapter 14
Tongue in Sjögren’s with Thrush
Mouth dryness in Sjögren’s can cause the tongue to develop deep furrows. Think of when your skin gets wrinkly from dryness; it is a similar process. Decreased saliva leads to the loss of beneficial bacteria and bad organisms can take over such as the yeast Candida albicans. This is called thrush.
When there is some moisture, a white coating can form as in this patient. This is called “pseudomembranous candidiasis.”
However, in severely dry mouths, the yeast is unable to grow as much on the surface. Instead, it infects the tissues, causing a red colored tongue with a loss of papillae (the tiny bumps on the tongue surface) that is usually tender and sore. This is called “atrophic candidiasis.”
The image above will appear in the 2nd edition of the book.