Is your skin problem actually an autoimmune condition?
The skin may offer the earliest clues to autoimmune disease — if you know what to look for.
- Reviewed by Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
An unusual rash cropped up several weeks ago, but despite your gentle measures — including applying cortisone cream and moisturizing daily — it’s hanging on.
Many people treat skin changes like this as purely cosmetic. Such symptoms do often come from common skin diseases such as eczema, or an allergic reaction. But when the immune system attacks the body’s own cells and tissues — a process that’s at the root of all autoimmune conditions — the first warning signs often show up where you can see them: on your skin.
Autoimmune diseases affect an estimated 8% of Americans, 80% of whom are women, according to the National Institutes of Health. An array of them can trigger inflammation that becomes visible on the skin well before internal symptoms show up.
“People often discount skin issues as just a cosmetic problem or an annoyance rather than a systemic disease,” says Dr. Robert Shmerling, senior faculty editor with Harvard Health Publishing and the former clinical chief of the Division of Rheumatology at Harvard-affiliated Beth Israel Deaconess Medical Center. “Most of the time, they’re right, but an autoimmune condition could be the cause.”
More than skin deep?
A diverse group of autoimmune disorders include — or are dominated by — surface-level symptoms such as rashes, blisters, scaling, dryness, thickening, pigment changes, painful lesions, and more. Here’s an overview:
Psoriasis. Thick, red, scaly patches appear when skin cells multiply too quickly. But about 10% of people with psoriasis develop psoriatic arthritis, which produces joint pain, swelling, and stiffness.
Lupus. Inflamed skin may lead to a butterfly-shaped rash on the nose and cheeks, which is often triggered by sunlight. A form of the disease called cutaneous lupus affects just the skin, but a version called systemic lupus erythematosus also attacks organs — particularly the kidneys, heart, and brain — and can be life-threatening.
Scleroderma. Skin can tighten and harden when the body overproduces the protein collagen, but scleroderma can also scar internal organs.
Dermatomyositis. One key sign is a purplish-red rash, particularly on the eyelids. But dermatomyositis can also trigger muscle weakness and soreness, often in the shoulders, hip, neck, and upper arms.
Vitiligo. The skin loses pigment-producing cells, leading to milky white patches, commonly on the hands and face. Even the eyes can be affected, leaving the colored part of the eye lighter than normal.
Bullous pemphigoid. Large, fluid-filled blisters are a classic symptom of this disease, which occurs when the immune system attacks proteins that helps skin layers stick together.
Alopecia areata. In this disorder, the immune system targets hair follicles, causing patchy — or even total — hair loss on the scalp or body.
Lichen planus. Purplish, flat, itchy bumps on the skin typically appear, but lichen planus can also affect the mucous membranes (especially the mouth), nails, and hair follicles.
Autoimmune thyroid disease. Depending on whether the thyroid is producing too little thyroid hormone (hypothyroidism), most often due to Hashimoto’s disease, or too much thyroid hormone (hyperthyroidism), such as in Graves’ disease, symptoms can vary widely and include weight gain or loss, constipation, or bulging eyes. But skin symptoms may also be prominent, including dry, rough, pale, or swollen areas.
Celiac disease. Its defining symptoms are digestive, including nausea, abdominal pain, and diarrhea. But a small proportion of people with celiac disease — which occurs when the immune system reacts to gluten, a protein found in wheat, barley, and rye — develop itchy bumps, blisters, or sores on the skin.
Rheumatoid arthritis (RA). Joint pain, swelling, and stiffness are classic RA symptoms, but a fraction of patients develop firm, raised nodules under the skin.
Sarcoidosis. Clusters of immune cells called granulomas can show up on the skin — resulting in reddish-purple bumps or discolored patches — but may also form in the lungs, liver, or other organs.
Connecting the dotsSkin changes can appear months or years before an autoimmune disease diagnosis, says Dr. Robert Shmerling, former clinical chief of the Division of Rheumatology at Beth Israel Deaconess Medical Center. And they’re easy to miss, since they’re often mistaken for eczema, allergies, or simple dryness. Look for these clues that your skin problem is related to an autoimmune disorder:
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Image: © kinga krzeminska/Getty Images
About the Author
Maureen Salamon, Executive Editor, Harvard Women's Health Watch
About the Reviewer
Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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