Lupus - The butterfly effect

Dr Rodgers Moeng - Dr Neo Sekgoma | Tuesday March 22, 2022 06:00

It predominantly affects the joints, skin, brain, lungs, kidneys, and blood vessels. The causes of Lupus are unknown, but are believed to be linked to environmental, genetic, and hormonal factors. Lupus can affect people of all ages, including children. However, women of childbearing ages - 15-44 years - are at greatest risk.

What are some of the symptoms one may experience?

As Dr Moeng, a specialist internal medicine physician and fellow in infectious disease at the Harvard Medical School explains, people with Lupus may experience a variety of symptoms that include fatigue, skin rashes, fevers, pain, swelling or arthritis in the joints. Some adults experience periods of Lupus symptoms - called flares, which may happen every so often, sometimes even years apart, and go away (remission). However, other adults may experience Lupus flares more frequently throughout their life. Other internal organ symptoms include, lung problems, kidney disease, seizures, heart problems, psychosis, and blood cell and immunological abnormalities.

Dr Sekgoma, a specialist dermatologist, elucidates that according to the Systemic Lupus erythematosus International Collaborating Clinics Criteria (SLICC), skin signs and symptoms play a critical role in making a diagnosis of this autoimmune disease. Lupus commonly affects the skin, mucous membranes and hair of affected patients. The skin presentations are varied and can be quite debilitating, says Dr Sekgoma. Cutaneous (skin) presentations include an increased sensitivity to the sun (photosensitivity), a butterfly (malar)rash on the face, blisters and rashes that affect the fat layer of the skin (lupus panniculitis). Discoid lupus erythematosus (DLE) lesions are deep scaring skin lesions that have textural changes, pigmentary alterations and affect the scalp, ears and face. However, the DLE lesions can be more generalised and affect all areas of the body. Hair loss also known as alopecia is a common manifestation, which results in diffuse thinning, patchiness or fragility of the hair. Other commonly affected areas include the inner aspects of the mouth, the tongue and nose, typically presenting with ulceration.

Is there a cure for Lupus?

Treating SLE often requires a multidisciplinary team approach with collaborations from a Rheumatologists, Internal Medicine Physicians, Dermatologists, Nephrologists, Hematologists and Psychiatrists are necessary because of the number of organs that can be affected. Dr Moeng and Dr Sekgoma highlight that even though there is no cure for Lupus, there are some treatments available. Lupus treatment consists primarily of immunosuppressive drugs that inhibit the activity of the immune system such as antimalarials (e.g. Hydroxychloroquine & Chloroquine), and oral and topical corticosteroids for both the internal organ and skin manifestations.

The FDA approved belimumab in 2011, the first new drug for SLE in more than 50 years that has shown to have promising outcomes for affected patients. Lupus also may occur with other autoimmune conditions that require additional treatments, like Sjogren’s syndrome, antiphospholipid syndrome, thyroiditis, hemolytic anemia, and idiopathic thrombocytopenia purpura. In light of the fact that the skin is tremendously affected, Dr Sekgoma gives the following recommendations to lessen the risk of long-term skin problems: • Sun avoidance (use of umbrellas, broad brim hats, and long sleeve clothing) • Use broad spectrum sunscreen (sunscreen that has a sun protective factor (SPF) of 30 or higher, and protects against ultraviolet rays specifically UVA and UVB • Compliance to the topical prescription creams, ointments and injections given by a Dermatologist and oral medication given by the Rheumatologist/Physician • Avoid touching the patches and rashes • Stop smoking • Avoiding triggers • Joining a support group for people living with Lupus • If you notice any skin changes, inform your Dermatologist

Are there any long-term effects of Lupus? Lupus can have both short and long-term effects on a person’s life. Early diagnosis and effective treatments can help reduce the damaging effects of SLE and improve the chance to have better function and quality of life. Poor access to care, late diagnosis, less effective treatments, and poor adherence to therapeutic regimens may increase the damaging effects of SLE, causing more complications and an increased risk of death.

What home remedies if any, can one use?

Some people with Lupus try over the counter creams, ointments, fish oil, supplements and homeopathic remedies. In spite of some patients reporting some relief on home remedies, research studies have not shown any benefits to these types of treatments. Talk to your doctor before trying any alternative medicine. To all the Lupus warriors, “Always remember you are braver than you believe, stronger than you seem, smarter than you think and twice as beautiful as you’ve ever imagined.” - Dr. Seuss

*By Dr Neo Sekgoma and Dr Rodgers Moeng