Autoimmune Diseases
Understanding Dermatological Disorders
Autoimmune diseases are conditions in which the immune system inadvertently targets and attacks the body's own tissues, treating them as foreign invaders. This results in inflammation and damage to various organs and systems.
Alopecia Areata
Alopecia areata is an incurable autoimmune disease that causes round patches of hair loss and can lead to total hair loss.
This is the result of when the immune system, which normally helps protect the body from infection and disease, attacks the hair follicles. In most cases, the hair falls out in small, round patches about the size of a quarter, leaving a few bare spots. Hair loss can be more widespread in some than others. In rarer cases, the disease can cause total loss of hair on the head (alopecia areata totalis) or on the entire body (alopecia areata universalis).
Signs & symptoms
Alopecia areata is not painful and does not cause illness
- Hair loss pattern - Hair loss in small, round patches about the size of a quarter.
- Extensive hair loss - In some, there is a more sizeable amount of hair loss.
- Rare forms - In rare instances, it can lead to total hair loss on the head (alopecia areata totalis) or complete loss of all body hair (alopecia areata universalis)
Who gets it?
Genes and environment work together to determine who will have the condition
- Alopecia areata affects nearly 2% of Americans, regardless of sex, age, & race. It often begins in childhood.
- You are slightly at higher risk if a close family member has the disease, and even greater if they lost their first patch of hair before age 30.
- Often occurs in people whose family members have other autoimmune diseases (such as type 1 diabetes, rheumatoid arthritis, thyroid disease, systemic lupus erythematosus, pernicious anemia, or Addison's disease).
- People who have the condition do not usually have any other autoimmune diseases, but more likely to have thyroid disease, atopic eczema (long-term disease causing dry, itchy, skin), nasal allergies, & asthma.
Systemic Lupus Erythematosus (SLE)
Lupus
Systemic lupus erythematosus (lupus) is a chronic autoimmune disease that can affect many parts of the body.
It occurs when the immune system attacks its own tissues, leading to inflammation and, in some cases, permanent tissue damage. People who have lupus may experience periods of illness, known as flares, as well as periods of wellness, called remission. Flares can vary in severity and may not follow a predictable pattern. However, with appropriate treatment, many people with lupus are able to effectively manage the disease.
Symptoms & warning signs of flares
- Arthritis - Causing painful, swollen joints & morning stiffness
- Fevers
- Feeling tired - fatigue, often
- Rashes
- Sores - Are usually painless, in nose & mouth
- Change of color in fingers & toes - Blue-purplish, white, or red from cold &/or stress
(Raynaud's phenomenon) - Swollen glands
- Swelling - Legs or around eyes
- Pain when breathing - Deeply or lying down
- Headaches, dizziness, depression, confusion, or seizrures
- Stomach pain
Body parts affected
- Skin
- Joints
- Heart
- Lungs
- Kidneys
- Brain
In some lupus cases, inflammation may lead to other health problems with the kidneys, heart, or lungs.
Cutaneous Lupus Erythematosus (CLE)
Skin Lupus
Cutaneous lupus erythematosus (skin lupus), often called skin lupus, is a form of lupus that primarily impacts the skin rather than internal organs. It is one of the subsets of lupus, distinct from systemic lupus erythematosus (SLE), which can involve multiple organ systems like the kidneys, heart, and lungs.
Skin lupus is a form of lupus that primarily affects the skin, causing symptoms such as rashes, lesions, or sensitivity to sunlight. Unlike systemic lupus erythematosus (SLE), which can affect multiple organs and systems in the body, cutaneous lupus is typically limited to skin involvement. While it shares a connection with SLE, many people with cutaneous lupus do not experience the broader systemic symptoms of lupus. Accurate diagnosis and specialized care are essential to managing this condition effectively.
Subtypes of skin lupus
- Discoid Lupus Erythematosus (DLE) - Characterized by round, scaly lesions that can cause scarring.
- Subacute Cutaneous Lupus Erythematosus (SCLE) - Manifests as red, scaly, or ring-shaped lesions, often triggered by sun exposure.
- Acute Cutaneous Lupus Erythematosus (ACLE) - Associated with the classic "butterfly rash" on the cheeks and nose, often linked to systemic lupus erythematosus (SLE).
Signs & Symptoms
- Skin Symptoms - CLE manifests as rashes, lesions, or discolorations that often appear on sun-exposed areas like the face, neck, scalp, or arms.
- Photosensitivity - Many with CLE experience heightened sensitivity to sunlight, which can trigger or worsen symptoms.
- Scarring - Some forms, like discoid lupus, may lead to permanent scarring or hair loss if untreated.
Psoriasis
Psoriasis is a chronic, noncommunicable skin disorder that causes red, scaly patches on the limbs, trunks, scalp, and other parts of the body.
The rash goes through cycles of improving and worsening (flares). At times the condition can be disfiguring, uncomfortable, and even painful.
Types of Psoriasis
- Plaque psoriasis - Skin lesions red at base & covered by silvery scales. *This is the most common type of psoriasis*.
- Guttate psoriasis - Small, drop-shaped lesions appear on trunk, limbs, & scalp. Most often triggered by upper respiratory infections (sore throat caused by streptococcal bacterial).
- Pustular psoriasis - Blisters of noninfectious pus appear on skin. It can be triggered by medications, infections, stress, or exposure to certain chemicals.
- Inverse psoriasis - Smooth, red patches in folds of skin near genitals, under breasts, or in armpits. Friction & sweat may worsen symptoms.
- Erythrodermic psoriasis - Widespread reddening & scaling of skin. Reaction to severe sunburn, corticosteroids (cortisone), or medications. May also result from increased activity of poorly controlled psoriasis. Can be very serious & requires immediate medical attention.
Most people have just one type of psoriasis at a time, but it is possible to have two types simultaneously. A person with one type of psoriasis (typically plaque) may later develop a different type. Some parts of the body are particularly challenging to treat, including the scalp, face, hands, feet, and nails.
Flare triggers
- Stress (Major life changes, financial stress, relationship issues, health concerns, etc)
- Infections (Strep throat, staphylococcus)
- Medications (lithium, beta blockers, anti-malarial drugs)
- Skin injury (Bruises, chafing from tight clothing, shaving, tattoos, vaccinations, sunburn)
- Other skin condtions (Scabies, blisters, boils, dermatitis)
- Weather that drys out skin (Cold winter days, indoor heating or cooling)
- Hormones (The surges that occur after puberty & during pregnancy)
- Smoking & excessive drinking
Recommended treatment for psoriasis depends on several factors:
type, location, and severity.
Psoriasis severity may be measured by amount of skin affected.
- Mild: affects less than 3% of body
- Moderate: affects 3-10% of body
- Severe: affects more than 10% of body
Psoriasis severity is also influenced by the type, the impact the illness has on a person's quality of life, and a person's susceptibility to side effects from the treatment.
Psoriatic Arthritis
Psoriatic arthritis is a progressive inflammatory condition of the joints and the places where tendons and ligaments attach to the bones (entheses).
It happens when the immune system, for unknown reasons, becomes overactive and creates inflammation, leading to pain and swelling. Most people who develop the condition already have psoriasis when diagnosed, but a small fraction have joint pain before the skin rash. Although there is no cure for psoriatic arthritis, treatment can slow its progression, lower pain, and protect joints.
Psoriatic arthritis can affect anyone but is most common in adults usually developing 7-10 years after the onset of psoriasis. Risk factors include obesity, severe psoriasis, and potentially stressful events, joint trauma, or certain infections.
Symptoms
Symptoms vary from person to person and appear in different patterns in each—this can make the disease extremely hard to diagnose.
- Scaly, inflamed patches of skin, a characteristic of psoriasis (often on the scalp, elbows, or knees)
- Stiffness, pain & swelling of 1 or more joints, worse in morning or after resting (the joints of the spine can be affected too, leading to stiffness in neck, lower back, & hips)
- Fatigue, feeling tired often (having a lack of energy)
- Tenderness in entheses, areas where tendons or ligaments attach to bone (back of heel & sole of foot are commonly affected spots)
- Painful swelling of whole finger or toe (sausage-like)
- Nail changes such as pitting (tiny dents) or crumbling, nails can separate from nail bed
- Eye inflammation, especially uveitis (inflammation of the middle layer of the eye), can cause eye pain, redness, & blurry vision (must be treated promptly to avoid vision loss)
- Inflammatory bowel disease, which causes inflammation in digestive tract (occurs in some people)
*Psoriatic arthritis is a complex condition that requires a proper diagnosis by a rheumatologist, a specialist trained to evaluate and treat diseases affecting the joints.
Vitiligo
Vitiligo is a chronic autoimmune disorder that causes patches/areas of skin to lose pigment (color).
This happens when melanocytes (skin cells that make pigment) are attacked and destroyed, causing the skin to turn a milky-white color. The white patches of vitiligo typically appear symmetrically on both sides of the body, such as on both hands or knees. In some cases, there may be rapid pigment loss affecting larger areas of skin. The segmental subtype of vitiligo is less common and characterized by white patches confined to one side or segment of the body, such as one leg, arm, or side of the face. This form often will start early in life.
People with the condition have a higher likelihood of developing other autoimmune disorders and sometimes other family members will have it too. Although there is no cure, treatments can be effective in halting the progression and reversing effects, plus improving and evening-out skin tone.
Anyone can get vitiligo, and it develops at any age (for many people, the white patches begin appearing before age 20, or early childhood).Vitiligo seems to be more common in people who have a family history of it, or have certain autoimmune diseases such as:
- Addison's disease
- Pernicious amnesia
- Psoriasis
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Thyroid disease
- Type 1 diabetes
Signs & symptoms
The main sign of vitiligo is loss of natural color or pigment (depigmentation). The depigmentation patches can appear anywhere on the body and can affect:
- Skin - Milky-white patches on the skin often appear on the hands, feet, arms, and face, but can occur anywhere on the body.
- Hair - Areas or patches of hair on the scalp, eyebrow, eyelash, beard, or body can turn white where the skin is losing pigment.
- Mucous membranes On the inside of your mouth or nose.
- Uveitis - Inflammation or swelling in the ear may happen.
- Inflammation - In the ear, inflammation may occur.
Sometimes an event—such as a sunburn, emotional distress, or exposure to a chemical—can trigger vitiligo or make it worse.
