The first clinical manifestations of lupus erythematosus are not always small red bumps. Lupus erythematosus is an autoimmune disease with systemic multi-organ involvement. Early symptoms vary from person to person, and skin lesions can occur in the vast majority of patients, but some patients do not necessarily develop skin lesions throughout the course of the disease. The skin lesions of lupus erythematosus, known clinically as pemphigus, papules or maculopapular rash, can be seen in most patients. However, there are still some patients whose clinical skin manifestations do not start with the appearance of macular rash or papule-like bumps, but are mostly seen in other clinical manifestations, such as skin breakdown, photosensitivity, and the formation of macules. Moreover, SLE has more clinical manifestations, and the clinical symptoms are often atypical at the earliest beginning, with systemic manifestations such as low to moderate fever commonly accompanied by clinical symptoms such as fatigue, weakness, lack of appetite, muscle pain, and weight loss. In addition, some patients may have joint and muscle manifestations as the first symptoms, and may experience swelling and pain in the joints and muscle pain. Or the first symptom is the involvement of other systems. When the first symptom is the involvement of kidney, there may be elevated blood pressure, swelling of lower limbs, and increased foam in urine; when the first symptom is the nervous system, it may manifest as numbness of hands and feet, epilepsy, cerebrovascular disease, etc. Some patients may also have the symptom of dry mouth and eyes, which varies greatly among individuals. Therefore, for patients with lupus erythematosus, the first clinical symptoms are various and not always small red bumps. If patients have other multi-organ involvement in addition to the clinical manifestations of small red bumps, they should go to the hospital for diagnosis as soon as possible to clarify whether it is lupus erythematosus and then use the corresponding treatment.