Jennie Clarke, MD focuses on a few points from her lecture "Cutaneous Lupus: How I Do It" on Saturday, November 11, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA.

In this video

Speaking with dermatology PA Lisa Weiss, Dr. Clarke explains that while lupus can affect the skin in many ways, nearly all types are characterized by photosensitivity — rashes that worsen in the sun and sit in a photo-distributed area while sparing covered skin. She notes that the classic butterfly (malar) rash is actually the least common lupus rash seen in dermatology, and that discoid lupus is the most common skin manifestation, appearing as scaly, often atrophic plaques that cause scarring alopecia. Her pearl: look in the ears — discoid lupus likes to show up in the conchal bowl, which isn't a photo-distributed area.

On workup, Dr. Clarke separates what she orders at diagnosis from what she follows longitudinally. At diagnosis she checks an ANA (positive in nearly all patients), CBC for cytopenias, kidney function, urinalysis, and additional serologies including anti-Smith, double-stranded DNA, a lupus anticoagulant and anti-cardiolipin panel, and complement levels. Over time she doesn't repeat all the antibodies — she follows urinalysis, CBC, and kidney function about once a year, watching for kidney disease and cytopenias. For systemic screening, she leans on a thorough head-to-toe review of systems more than imaging, keying in on serositis, neurologic symptoms like psychosis and seizures, thrombotic events, and kidney involvement.

  • Nearly all types of lupus are characterized by photosensitivity — look for rashes that worsen in the sun and sit in photo-distributed areas while sparing covered skin.
  • The classic malar butterfly rash is actually the least common lupus rash; discoid lupus is the most common skin manifestation.
  • Look in the ears — discoid lupus often shows up in the conchal bowl, an area that isn't sun-exposed.
  • At diagnosis, order a broad panel: ANA, CBC, kidney function, urinalysis, anti-Smith, double-stranded DNA, lupus anticoagulant/anti-cardiolipin, and complement levels.
  • Longitudinally, follow urinalysis, CBC, and kidney function about once a year to catch emerging kidney disease or cytopenias — and rely on a good head-to-toe review of systems to screen for systemic disease.