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What Is The Cause And Treatment For Malar Rash When Suffering From Lupus?

Posted on Fri, 13 Feb 2015

Question: Hi i am writing because i was wondering if you could provide me with your opinion on my condition. Awhile back, i was told i had a high sed rate which indicates an autoimmune condition, around the same time, i developed a horrible raised rash over my entire body, it went away as they treated me with tons of benadryl and steroids. It took over a week to disppear, now from time to time i get a rash on my face which i believe is similar to the butterfly rash of lupus, the specific test for lupus was negative but i feel i may have it, bc along w the rash i have all the other symptoms that lupus brings, and what scares me the most is that i also have something wrong w my heart and i read that lupus can cause heart issues, i had ekg indicate that i had at one time a heart attack and actually wrote you guys on this matter... I still am following up w a dr on this but they dont seem to help je and blame a lot on my weight which to me is unfair since i was in perfect shape prior ro being sick and i am yes a little overweight now but i have recently lost 40 pds. And lately i cant eat and am always either throwing up or having the runs as they say lol so i havent been gaining any new weight and close to being under 200 pds. I was around 170 before the sickness which for my height i looked very good, but a decade later i am falling apart and no one seems to help me, can u offer any advice. I am attaching some photos. Ty

Answered by Dr. Naval Mendiratta (37 minutes later)

Brief Answer:
?/is it lupus

Detailed Answer:
Good evening.

Thank you for writing on health care magic

I have gone through your history and the pictures

Firstly I want to say not to get stressed. I understand the situation you are in. But we will try to sort it out together

As for the rashes I have seen, the ones on your face looks like malar rash. The one seen in lupus. You may have photosensitivity to it. While the rest of the rashes on the abdomen and legs are urticarial rashes. It can be an independent problem or it can be a part of lupus.

To diagnose lupus we need to have more symptoms like oral ulcers, hair fall, joint pains, abdominal pains or cough or difficulty in breathing along with the blood results. The routine blood tests like complete blood count, ESR, crp, liver and renal function tests, urine routine along with ANA ena and complement levels.

A combination of this gives us a diagnosis of lupus.

I would like you to let me know these queries.because the management will depend on the organs involved. As for the heart involvement it can happen in lupus but it is still rare. If ECG is fine you need not worry.

Await your reply

Regards
Dr naval

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Naval Mendiratta (5 hours later)

Thank you for your response, i provided u with bloodwork and some more photos to perhaps help you make your diagnosis as much as you can without seeing me... I have these scars and liasions over my body. They start out as if i get a cut or bugbite and they run like a sore then dont heal for months. As you can see, my hands are so swollen and from the xray i had at mayo apparently a bit deformed although i dont have that paperwork. Along with my hands being swollen, so are my knees and ankles. I am constantly carrying extra water weight from it and it hurts very badly, i have a hard time typing, moving around, and accomplishing every day activites, along w this, i get headaches, heart palpitations, i feel like i lose my breath often, and do have asthma, i have joint pain so severe i cry, my life has been turned upside down and i just want some answers. I also am always sick to my stomach and having digestive issues. If there is anything else you specifically need, i can try my best to answer you, i appreciate your time and realize that you cant fully diagnose me as i am not there and you dont know all my history. I just want to know if it could be lupus despite some bloodwork not indicating that. Thank you again :) XXXXXXX

Answered by Dr. Naval Mendiratta (13 hours later)

Brief Answer:
Is it LUPUS?

Detailed Answer:
Good evening XXXXXXX

Well I have gone through your photos. Sorry, I could not find the blood reports attached. If you could check into it, that would be great.

But you do have puffy fingers and swollen hands. I wonder, how can anyone ignore that especially in your age. All these symptoms do point towards a connective tissue disease. Since you have swelling in your ankles and knees as well, I would like to look into serum Albumin and considering a possibility of lupus, I would like to see if you are losing it out in urine.

But yes, I feel you need to be started on medications for the connective tissue disease. At least a moderate to low dose of steroids along with hydroxychloroquine would help in your case

If you get check into blood reports once, it would be helpful

Await your reply
Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Naval Mendiratta (3 hours later)

Dear Dr Naval, thank you again for your reply and your suggestions thus far. This is really helpful to me! Any insight into what is happening to me is quite useful and the regime you suggested i will speak to my family dr about immediately. I am thinking there may be a cap to the photos i can send you as i do see the bloodwork next to the photos i had originally submitted but i am attempting now to resend, my sed rate was 30. I do have low vitamin D, b12 i am taking supplements for these.. I also have underactive thyroid which i take synthroid for. My Hgb hct were low. The b-type natriuretic wb/plasma was high, the aptt was low, my gloucouse was 91. The rheumo factor was negative and so was the ana which i think is directly associated w lupus.and my rdw was a little high, potassium a little low i been trying to eat bananas lol... I will try and reattach everything and hope it works! If the ana factor and rheumo factor is negative, what could that mean? It was a 10 so under the 14. The ana doesnt show any number just says negative but these tests were done in septemberand now i am experiencing even more pronunced symptoms esp the rash on my face which is basically there everyday now where as before it was intermittent. But do these have to be positive for a lupus diagnosis? U did mention hair i am not losing a lot but my hair a yr ago to today, there is a definite difference. Its less full, its damaged, its limp. Etc,
Thats all i can think of again my thanks and fingers crossed the documents come thru !
Sincerely XXXXXXX

Answered by Dr. Naval Mendiratta (24 hours later)

Brief Answer:
?Is it lupus.

Detailed Answer:
Good evening XXXXXXX

Really sorry for the late reply. Just had a bad day going on. Finally getting it together.

I have gone through your pictures again. ANA is negative but the rashes you have are urticarial one. It can be either an independent thing known as urticarial vasculitis(if it is lasting more than 24 hours) or it can be a part of lupus. ANA negative does make the possibility of lupus less likely, but I would suggest you to repeat your levels once more and make sure it is done by Immunofluroscence Assay(IFA) since the accompanying symptoms you are having can be a part of connective tissue disease. If possible get ENA profile also done. So, if both are negative, at least we are sure that connective tissue disease is less of a possibility. Also just check if CPK levels have been done.

I still feel low dose steroids and Anti allergics will help your rashes and the overall disease. But yes your physician needs to be more convinced.

Do let me know for more queries.
I will be on time for sure :)

Regards
Dr Naval

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari