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loujords, hi & welcome. I'm glad you found us. Here are some things I've learned about lupus rashes & how they fit into the overall picture. But since I'm just a dumb patient, please read in that light, OK?

Only two rashes (malar and discoid) "make" the list of diagnostic criteria for systemic lupus. What isn't stated is that there are ADDITIONAL lupus-specific rashes. e.g., SCLE annular, SCLE psoriasiform or papulosquamous, tumid, bullous, etc.

You can have a lupus rash but not have "systemic" lupus. That's because lupus has varying degrees. If you meet 4 or more of the 11 criteria for SLE, you are deemed to have systemic disease; if less than 4, not systemic. In SLE (systemic), certain blood tests will be positive (e.g., ANA, anti-ds-DNA, anti-Ro, anti-La, etc.) In cutanous lupus, such tests will be negative.

Here are very short (dumb-patient) takes on some (not all) lupus rashes.

Malar = facial butterfly.

Discoid tend to scar &/or depigment. About 5% or so progress to systemic disease.

SCLE annular has red papules that expand into target-like circles, while SCLE psoriasiform looks like psoriasis but isn't. Neither tend to scar or depigment. Both favor upper torso but can be anywhere. Anti-Ro very often positive. ANA positive roughly 2/3, negative roughly 1/3. While SCLE is thought to be a "bridge" between cutaneous & systemic lupus, some people with SCLE rashes do get more severe systemic disease, incl. kidney involvement (etc.).

Tumid looks (to me, anyway) like a deep-hued penetrating sunburn. Think it favors the V-neck area (neck & upper chest). There are people here who've posted on it, so you could try searching the board.

Where blood tests are unrevealing, best diagnostic tool is probably deep-punch biopsy coupled with immunofluorescent stain tests (I believe this is called "lupus band test"). Punch is examined microscopically for cellular changes typical of lupus, but the real kicker is part 2, the stain tests, which can reveal linear "bands" considered diagnostic of lupus. (The stains light up "immune junk" deposited between dermal/epidermal layers, something seen only in lupus.)

I had a terrible time getting my SCLE annular rash diagnosed. Local specialists didn't recognize it as a lupus rash, despite two deep-punch biopsies (stain tests omitted, alas). I took myself to a teaching hospital rheumatologist, who re-did labs & sent me to a dermatopathologist (that's a dermatologist + pathologist, does his own labwork), for one last deep-punch. Dx was subacute systemic lupus. Plaquenil has helped a lot.

Before your appt., you could read more about lupus rashes & about systemic lupus diagnostic criteria. Have you seen the "sticky posts" (permanent info posts) at the top of the thread list? They're a good place to start. I hope this helps a little & that you post more soon. Best wishes, sincerely, Vee

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