Rheumatic immune diseases, also known as “rheumatism” or “rheumatism”, are now known as “rheumatism” in the medical community because recent medical research has found that these diseases are caused by abnormalities in the body’s immune system. immune diseases”. These diseases are systemic in nature and can involve many organs and systems throughout the body, with the skin being one of the most commonly affected organs.
The rashes of rheumatic immune diseases are complex, as the same disease and the same patient can present with different rashes, and the same rash can appear in different rheumatic immune diseases. Therefore, it is important to correctly identify rashes associated with rheumatologic diseases and to consult a rheumatologist early for early diagnosis of rheumatologic diseases. To help you understand what kind of rash to suspect to rheumatic immune disease, some common rashes are introduced.
Butterfly-shaped erythema: This kind of erythema often appears on the cheeks, manifesting as bright red or purplish red edematous erythema slightly above the skin surface, which may be accompanied by desquamation and blistering, etc. It is mainly seen in lupus erythematosus. It is mainly seen in lupus erythematosus, as shown in Figure 1.
Figure 1 Butterfly-shaped erythema
Discoid lupus erythematosus rash: The limited rash involves only the head and face. Disseminated discoid lupus also involves the hands, feet, extremities and trunk, and a few may develop into systemic lupus erythematosus. The rash starts as a small papule and gradually expands into dark red patches with adherent scales. The rash is most commonly seen on the cheeks of the face and the back of the nose, followed by the auricle, lateral neck, scalp, mouth and lips, and the back of the hands and chest, often with bilateral but asymmetric involvement. As shown in Figure 2.
Figure 2 Discoid lupus erythematosus
Subacute cutaneous lupus erythematosus rash: The rash is mostly distributed on the face, ears, upper chest, back, shoulders and back of the hands, etc. The main manifestations are papulosquamous and annular erythematous type. As shown in Figure 3.
Figure 3: Subacute cutaneous lupus erythematosus
Erythema nodosum rash: It is an inflammatory disease that occurs in the subcutaneous fat. The rash is usually found on the anterior tibia and is often a symmetrical painful nodule with a red elevation on the skin surface, 1 cm in diameter, with pressure pain, does not break down, can fade on its own, and can recur (Figure 4).
Figure 4 Erythema nodosum
Raynaud’s phenomenon: spasm of small finger (toe) arteries that occurs suddenly under the stimulation of cold or emotional stress. Typical symptoms are white and purple coloring of the fingers or toes after cold or emotional stress, which may be accompanied by local numbness or tingling. Raynaud’s phenomenon is often associated with connective tissue diseases and can be seen in more than 90% of scleroderma and mixed connective tissue diseases and more than 20% of lupus erythematosus. As shown in Figure 5.
Figure 5 Raynaud’s phenomenon
Psoriasis: In rheumatic immune diseases, the rash is mainly seen in patients with psoriatic arthritis, with lesions on the scalp and extremities, especially at the elbows and knees, in a scattered or generalized distribution, paying special attention to rashes in hidden areas such as hair, perineum, buttocks, umbilicus, etc., manifesting as papules or plaques, garden or irregular in shape, with abundant silvery-white scales on the surface, shiny films after removing the scales, and shiny films after removing the films. Punctate hemorrhage (Auspitz sign) can be seen, and this feature has diagnostic significance for psoriasis. As shown in Figure 6.
Figure 6 Psoriasis
Reticulocutaneous cyanosis: it is a reticulocutaneous cyanosis, which is aggravated by cold and can disappear after warmth. As shown in Figure 7
Figure 7: Reticulocutaneous cyanosis
Gottron’s sign: The rash is located on the joint extensions, mostly at the elbow, metacarpophalangeal and proximal interphalangeal joints, but also at the knee and inner ankle skin, and appears as erythematous plaques with scales, which may be accompanied by skin atrophy and hypopigmentation, and is valuable for the diagnosis of dermatomyositis. As shown in Figure 8
Figure 8 Gottron rash
Gottron’s rash: periorbital edematous dark purplish-red rash, seen in 60% to 80% of patients, characteristic rash for dermatomyositis. Figure 9.
Figure 9 Gottron’s rash
Purpura, urticaria-like rash, alopecia, cutaneous vasculitis, ulcers, skin pigmentation or hypopigmentation, photosensitive rash, purulent cutaneous keratosis, annular erythema, etc. can also be seen in rheumatic immune diseases, but lack specificity.