Autoimmune skin disorders are conditions in which the immune system acts against the body’s own tissue and the skin shows it. They include cutaneous lupus, morphea, blistering diseases, vitiligo and alopecia areata, and are diagnosed and treated at Coastal Dermatology + Aesthetics in San Luis Obispo.
When the immune system shows up on the skin
Lupus is a group of diseases that can cause inflammation in different parts of the body, and when lupus affects the skin it is called cutaneous lupus. [1] Some types stay in the skin. Others are a sign the disease reaches further. That distinction is most of what an appointment is for.
Discoid lupus is the most common type of cutaneous lupus. It causes a rash of disc-shaped patches that are raised, thick and scaly. [1] It affects only the skin. [3] Subacute cutaneous lupus produces a rash that usually develops on the upper back, upper chest or arms, and strong sun protection helps prevent it. [2] Acute cutaneous lupus often causes the butterfly-shaped rash across the nose and cheeks, and a butterfly rash can be a sign that lupus affects more than the skin. [1] Less common types include lupus tumidus, lupus panniculitis and chilblain lupus. [1]
Morphea is the most common type of scleroderma, and scleroderma is a condition in which the body makes too much collagen. [6] [7] People see one or a few patches of thickened skin, usually red or purple, and the patches may not feel especially hard. [6] [7] Where it affects the skin and sometimes the tissue underneath, it is called localized scleroderma; where it affects an internal organ, it is systemic sclerosis. [6] Morphea is the skin-only version, and that is the reassuring part of the name.
Blistering diseases are rarer and are treatable. Bullous pemphigoid is a rare autoimmune disease that can cause large blisters on the skin, and it often begins after 60 years of age. [10] Pemphigus is a group of rare diseases that cause blisters, with several distinct types. [11] Neither is contagious, and treatment reduces itching, rash and the number of new blisters. [10]
Several conditions on this site are autoimmune and have their own pages, including vitiligo, which is an autoimmune disease in which the immune system attacks the cells that give skin its color, [12] and alopecia areata, which occurs when the immune system attacks hair follicles. [13] Psoriasis, thyroid disease and vitiligo are all linked to alopecia areata, and having one of them raises the likelihood of another. [13]
How long hardened skin in scleroderma often takes to clear on its own. [8] It can also cause changes that do not reverse, which is why treatment is about limiting what happens in the meantime.
What sets it off, and what keeps it going
The immune system turns inward
In each of these conditions something in the immune system goes wrong and the body’s own tissue becomes the target: pigment cells in vitiligo, [12] hair follicles in alopecia areata, [13] and in scleroderma an immune fault that drives the body to make too much collagen. [9] None of it is caused by anything a person did.
Ultraviolet light, including light indoors
Sunlight, tanning beds and fluorescent light bulbs all expose skin to ultraviolet light, [3] and lupus can make skin extremely sensitive to sunlight and to other types of light. [2] The self-care guidance goes as far as replacing fluorescent, compact fluorescent and halogen bulbs, because those emit some UV. [5] Sun protection can prevent new flare-ups and keep lupus from worsening. [4]
Smoking, which is the one people are not told
Smoking can worsen cutaneous lupus, and research suggests it can prevent an antimalarial medication from working as well as it can. [4] [5] The other half of that finding is the useful half: when patients quit smoking, medication that had failed to clear their rashes and other skin problems starts to work. [5]
Fluorescent, compact fluorescent and halogen bulbs emit some ultraviolet light, and replacing them is part of standard self-care guidance for lupus. [5] Very few people are told this.
Which one is it, and what does it do?
This is a category page, and the useful thing a category page can do is help someone work out which conversation they are about to have.
| Condition | What shows on the skin | What it does |
|---|---|---|
| Discoid lupus | Disc-shaped patches that are raised, thick and scaly [1] | Affects only the skin. Can leave scarring, and scarring on the scalp is permanent [2] [3] |
| Subacute cutaneous lupus | A rash on the upper back, upper chest or arms [2] | Can be a sign lupus reaches beyond the skin. Strong sun protection helps prevent the rash [1] [2] |
| Acute cutaneous lupus | A butterfly-shaped rash across the nose and cheeks [1] | A butterfly rash can be a sign that lupus affects more than the skin [1] |
| Morphea, or localized scleroderma | One or a few patches of thickened skin, usually red or purple [6] [7] | Stays in the skin and the tissue beneath. Hardened skin often clears in 3 to 5 years [6] [8] |
| Bullous pemphigoid | Large blisters, most often beginning after age 60 [10] | Rare, not contagious, and treatment reduces itching, rash and new blisters [10] |
| Pemphigus | Blisters, in several distinct forms [11] | A group of rare diseases. Treatment is what keeps it controlled [11] |
| Dermatomyositis | A violet or dusky red rash on the face and eyelids, and small bumps on the hands near the knuckles [14] [15] | Also affects muscle, and it comes with a cancer-screening conversation in adults [14] |
| Vitiligo | Patches that lose pigment | Autoimmune. Has its own page on this site [12] |
| Alopecia areata | Round patches of hair loss | Autoimmune. Has its own page on this site [13] |
The line that matters most in that table is in the discoid row. With discoid lupus, hair loss can be permanent because scarring develops, and hair does not grow back where a scar has formed on the scalp. [2] Treating the condition early can prevent cutaneous lupus from progressing and causing damage. [4] That is the whole argument for not waiting a year on a scalp rash.
Dermatomyositis carries one specific piece of advice worth repeating. Alongside the rash, it involves weakness in the muscles closest to the center of the body: hips, thighs, shoulders, upper arms and neck. [14] In adults it has been linked to a higher risk of certain cancers, and the guidance is to ask what cancer screenings apply to you. [14] That is a question for your physician, and it belongs on this page because the rash is often what brings someone in first.
The two things that change how well treatment works
Light, including the light in your house
Lupus can make skin extremely sensitive to sunlight and other types of light. [2] The standard guidance is more specific than most people expect:
- Apply broad-spectrum sunscreen, SPF 30 or higher, water resistant, to all skin that clothing will not cover [5]
- Apply it 15 minutes before going outdoors, and reapply every two hours and after swimming or sweating [5]
- Wear sun-protective clothing: long sleeves, pants, a wide-brimmed hat and sunglasses where possible [5]
- Replace fluorescent, compact fluorescent and halogen bulbs, which emit some UV light [5]
- Sun protection can prevent new flare-ups and keep lupus from worsening [4]
- Ask about a vitamin D supplement, since bodies need vitamin D for healthy bones and a blood test will show whether you are getting enough [5]
Smoking, and what happens when it stops
Smoking can worsen cutaneous lupus. [5] Research suggests that smoking cigarettes can prevent an antimalarial from working as well as it can, [4] and studies have shown that when patients quit smoking, medication that had failed to clear their rashes and other skin problems starts to work. [5]
Those two paragraphs are the highest-yield things on this page for anyone already diagnosed. They cost nothing, they are within a person’s control, and they change what the medication is able to do.
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The Coastal difference
Naming it is the hard part, and it happens here
Most people with one of these conditions arrive having been treated for something else first. A scaly patch gets treated as eczema. A thickened patch gets watched. A rash that appears every summer gets attributed to the sun in a general way rather than a specific one. Board-certified dermatologists are experts in treating cutaneous lupus, [1] and the reason that matters is that the diagnosis is made from the skin.
If lupus could be the cause of a rash, sores or another skin problem, the examination covers skin, hair and nails. [4] Where a diagnosis needs confirming, a small sample examined under a microscope gives the answer, and in scleroderma a blood test for elevated antinuclear antibodies is part of the picture. [8] Cutaneous lupus often responds quickly to a corticosteroid, applied to the skin or taken as a pill. [4] For scleroderma, narrowband UVB and UVA-1 phototherapy can help, and methotrexate and other systemic options are used where they are warranted. [8]
There is no cure for scleroderma, and treatment reduces the effects of the disease. [6] That pattern holds across most of this page, and it is a better sentence than it reads: these are conditions that respond well to being named early, and the naming is the part that keeps getting postponed.
What a dermatologist examines when lupus could be behind a rash. [4] A biopsy confirms it, and a blood test for antinuclear antibodies is part of the picture in scleroderma. [8]
When to see a dermatologist
Book an appointment if:
- You have a rash across the nose and cheeks, or one that appears or worsens after time outdoors [1] [2]
- You have disc-shaped patches that are raised, thick and scaly, particularly on the scalp, face or ears [1]
- A patch of skin has become thickened, tight, red or purple [6] [7]
- You have developed blisters, particularly larger ones, or blisters that keep returning [10] [11]
- You have a violet or dusky rash on the eyelids or face, or small bumps on the hands near the knuckles [14] [15]
- You have been diagnosed with an autoimmune disease elsewhere in the body and something has changed on your skin
- You have patchy hair loss with scarring, redness or scaling on the scalp [2]
Treating the condition early can prevent cutaneous lupus from progressing and causing damage to the skin. [4] For a scalp rash that scars, that timing is the difference between hair that regrows and hair that does not. [2]
Living with an autoimmune skin condition
Sun and light
- Broad-spectrum sunscreen, SPF 30 or higher, water resistant, on all skin clothing will not cover, 15 minutes before going out and reapplied every two hours [5]
- Sun-protective clothing, a wide-brimmed hat and sunglasses [5]
- Replace fluorescent, compact fluorescent and halogen bulbs [5]
- Ask your dermatologist about vitamin D, since heavy sun avoidance affects it and a blood test will show where you are [5]
Medication and habits
- Give a treatment its full run before judging it. Cutaneous lupus often responds quickly to a corticosteroid, and other treatments take longer [4]
- If you smoke, this is the single change with the clearest published payoff for skin lupus [4] [5]
- Keep a photograph record of a rash or patch in consistent light. Flares are easier to describe with pictures than with memory
Worth knowing
- No type of lupus is contagious, and neither are the other conditions here [1]
- Discoid lupus affects only the skin [3] and is most common in Black people [3]
- With a darker skin tone and discoid lupus, dark, blue-black nails can develop [2]
- In scleroderma the hardened skin often clears on its own in 3 to 5 years, and some changes do not reverse [8]
- Linear scleroderma in a child can interfere with bone growth, which is why pediatric cases are followed closely [7]
- Having one autoimmune disease raises the likelihood of another, which is part of why follow-up matters [13]
Treatments we offer
Diagnosis, including the tests that name the condition, and treatment of the skin disease itself. Pick a treatment to see how it works.
What treatment costs
Diagnosis and treatment of autoimmune skin conditions are medical care rather than a cosmetic service, and are handled differently from the aesthetic treatments on this site. Our office will go through what applies to you when you book.
Where a skin sample or blood work is sent for examination, laboratory fees are billed separately by the laboratory, and we will tell you at the time that anything is being sent.
The one dermatologists see most
Cutaneous lupus, meaning lupus that affects the skin. Discoid is its most common form [1]
What light does
Lupus can make skin extremely sensitive to sunlight and to other kinds of light, including some indoor bulbs [2] [3]
What smoking does
It can stop an antimalarial medication working as well as it can, and quitting can restart a treatment that had stalled [4] [5]
Whether any of it is contagious
No type of lupus is contagious, and neither are the other conditions on this page [1]
Autoimmune skin disorder frequently asked questions
Studies have shown that when patients quit smoking, medication that had failed to clear their skin lupus starts to work. [5] Few things in dermatology have a clearer payoff.
Offered at
Have a rash nobody has named? Request an appointment
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Sources and medical review
1. American Academy of Dermatology Association. “Lupus: Overview.” States that “lupus is a group of diseases that can cause inflammation in different parts of your body,” that “when lupus affects the skin, it’s called cutaneous (skin) lupus,” and that “no. In fact, no type of lupus is contagious.” Describes discoid lupus as “the most common type of cutaneous lupus,” which “causes a rash of disc-shaped patches that are raised, thick, and scaly”; describes acute cutaneous lupus as a type that “often causes a butterfly-shaped rash across the nose and cheeks,” and states that “if you develop a butterfly rash, it can be a sign that lupus affects more than your skin”; describes subacute cutaneous lupus with the note that “without strong sun protection, this type of lupus can quickly cause a rash.” Also names lupus erythematosus tumidus, lupus panniculitis and chilblain lupus. States that “board-certified dermatologists are experts in treating cutaneous lupus.” https://www.aad.org/public/diseases/a-z/lupus-overview · Medical Organization
2. American Academy of Dermatology Association. “Lupus: Signs and symptoms.” States that “lupus can make your skin extremely sensitive to sunlight and other types of light,” that the subacute rash “usually develops on the upper back, upper chest, or arms” and that “effective sun-protection helps to prevent this rash,” that “if you have discoid lupus, hair loss can be permanent because scarring develops,” that “when scars develop on the scalp, hair cannot grow where there are scars,” and that “if you have discoid lupus and a darker skin tone, you may develop dark, blue-black nails.” https://www.aad.org/public/diseases/a-z/lupus-symptoms · Medical Organization
3. American Academy of Dermatology Association. “Lupus: Causes.” Lists ultraviolet light among triggers, stating that “sunlight, tanning beds, and fluorescent light bulbs expose you to UV light.” States that “discoid lupus erythematosus (DLE): Affecting only the skin, DLE is most common in Black people,” and that “people of all races and ages can get lupus and develop rashes, sores, and other signs of lupus on their skin.” https://www.aad.org/public/diseases/a-z/lupus-causes · Medical Organization
4. American Academy of Dermatology Association. “Lupus: Diagnosis and treatment.” States that “if lupus could be the cause of a rash, sores, or other skin problem, your dermatologist will closely examine your skin, hair, and nails,” that “cutaneous (skin) lupus often responds quickly to a corticosteroid. You may apply this medication to your skin or take it as a pill,” that “sun protection can prevent new flare-ups and stop lupus from worsening,” that “research suggests that smoking cigarettes can prevent an antimalarial from working as well as it can,” and that “treating the condition early can prevent cutaneous (skin) lupus from progressing and causing damage.” https://www.aad.org/public/diseases/a-z/lupus-treatment · Medical Organization
5. American Academy of Dermatology Association. “Lupus: Self-care.” Advises to “apply sunscreen to all skin that clothing won’t cover, using a sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance,” to “be sure to apply it 15 minutes before going outdoors. While outdoors, reapply your sunscreen every two hours and after swimming or sweating,” to “wear sun-protective clothing like pants, long sleeves, a wide-brimmed hat, and sunglasses when possible,” and to “replace fluorescent, compact fluorescent, and halogen light bulbs. These light bulbs emit some UV light.” States that “findings from research studies suggest that smoking can worsen cutaneous (skin) lupus,” and that “studies have also shown that when patients quit smoking, medication that failed to clear their rashes and other skin problems starts to work.” Advises asking about a vitamin D supplement, noting “our bodies need vitamin D for healthy bones” and that “a blood test can tell your dermatologist whether you’re getting enough vitamin D.” https://www.aad.org/public/diseases/a-z/lupus-self-care · Medical Organization
6. American Academy of Dermatology Association. “Scleroderma: Overview.” States that “when a person has scleroderma, the body makes too much collagen,” that “when scleroderma affects the skin and sometimes the underlying tissue, a person has localized scleroderma. When scleroderma affects an internal organ, the person has a type of scleroderma called systemic sclerosis,” that “morphea: People see 1 or a few patches of thickened skin, which are usually red or purple,” and that “there is no cure for scleroderma, but treatment can help reduce the effects of this disease.” https://www.aad.org/public/diseases/a-z/scleroderma-overview · Medical Organization
7. American Academy of Dermatology Association. “Scleroderma: Signs and symptoms.” States that “if you have morphea (more-fee-uh), the most common type of scleroderma, the patches may not feel too hard,” that “some people develop 1 or 2 patches of hard, thick skin. Others have widespread patches on their body,” that “some types of scleroderma affect the skin and internal organs like the lungs and kidneys,” and that “when a child gets some types of scleroderma, such as linear scleroderma or en coup de sabre, the scleroderma can interfere with bone growth.” https://www.aad.org/public/diseases/a-z/scleroderma-symptoms · Medical Organization
8. American Academy of Dermatology Association. “Scleroderma: Diagnosis and treatment.” States that “while the hardened skin often clears on its own in 3 to 5 years, scleroderma can cause irreversible changes,” that “your dermatologist will remove a bit of affected skin so that it can be examined under a microscope,” that “a blood test can tell your doctor whether you have something in your blood called ‘elevated antinuclear antibodies,'” that “a type of light treatment called narrowband UVB treatment can be helpful,” and that “UVA-1 phototherapy may be prescribed. UVA-1 produces long wavelengths that can deeply penetrate the skin to reduce hardness.” Also lists methotrexate, oral corticosteroids and calcipotriene with a strong corticosteroid. https://www.aad.org/public/diseases/a-z/scleroderma-treatment · Medical Organization
9. American Academy of Dermatology Association. “Scleroderma: Who gets and causes.” States that “women are more likely than men to get most types of scleroderma,” that “one type, linear morphea, tends to develop before 18 years of age,” that “the other types are most likely to begin between the ages of 30 and 50,” and that “something in the person’s immune system goes wrong, causing the body to make too much collagen.” https://www.aad.org/public/diseases/a-z/scleroderma-causes · Medical Organization
10. American Academy of Dermatology Association. “Bullous pemphigoid: Overview.” States that “this is a rare autoimmune disease that can cause large blisters on the skin,” that “it often begins after 60 years of age,” that it is not contagious, and that “treatment can prevent (or reduce) itching, rash, and how many new blisters you get.” https://www.aad.org/public/diseases/a-z/bullous-pemphigoid-overview · Medical Organization
11. American Academy of Dermatology Association. “Pemphigus: Overview.” States that “pemphigus is a group of rare diseases that causes blisters,” and lists types including pemphigus vulgaris, pemphigus foliaceus, drug-induced pemphigus, fogo selvagem and paraneoplastic pemphigus. https://www.aad.org/public/diseases/a-z/pemphigus-overview · Medical Organization
12. American Academy of Dermatology Association. “Vitiligo: Causes.” States that “vitiligo is an autoimmune disease,” in which the immune system attacks and destroys “pigment-producing cells called melanocytes,” and that a dermatologist can watch for signs of another health condition developing, “such as another autoimmune disease like thyroid disease, some hearing loss, or a problem with your eyesight.” https://www.aad.org/public/diseases/a-z/vitiligo-causes · Medical Organization
13. American Academy of Dermatology Association. “Alopecia areata: Causes.” States that “alopecia areata is an autoimmune disease that occurs when your immune system mistakenly attacks hair follicles,” that “psoriasis, thyroid disease, or vitiligo: These are autoimmune diseases linked to alopecia areata,” and that “having one of these autoimmune diseases may increase your risk of developing alopecia areata, which is another autoimmune disease.” https://www.aad.org/public/diseases/hair-loss/types/alopecia/causes · Medical Organization
14. Mayo Clinic. “Dermatomyositis.” States that “dermatomyositis is a condition in which swelling and irritation, called inflammation, attacks the body’s tissues,” that “a violet-colored or dusky red rash appears, most often on the face and eyelids and on the knuckles, elbows, knees, chest and back,” that “there also may be small bumps on the hands, mainly near the knuckles,” that “muscle weakness involves the muscles closest to the center of the body, called the trunk. This includes the muscles in the hips, thighs, shoulders, upper arms and neck,” and that “dermatomyositis in adults has been linked to a higher risk of getting certain types of cancer. Ask your healthcare professional what cancer screenings you may need.” https://www.mayoclinic.org/diseases-conditions/dermatomyositis/symptoms-causes/syc-20353188 · Medical Organization
15. Cleveland Clinic. “Dermatomyositis.” States that “dermatomyositis is a rare disease that causes muscle weakness and rashes on your skin,” and names “discoloration and bumps (sometimes referred to as Gottron papules) on your hands, especially near your knuckles.” Describes muscle weakness that “might make it hard for you to do common motions,” including sitting upright, getting up from a seated position and climbing stairs. https://my.clevelandclinic.org/health/diseases/15701-dermatomyositis · Medical Organization
Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. The conditions described here overlap in appearance and are distinguished by examination, laboratory testing and sometimes a skin biopsy rather than by description. Several of them can involve organs beyond the skin and are managed alongside a rheumatologist or other specialist. Medications used for these conditions, including corticosteroids, antimalarials, methotrexate and phototherapy, carry their own risks and monitoring requirements, which are discussed before treatment. Individual results may vary.