What is butterfly rash? It turns out this is the culprit!

Systemic systemic disease systemic lupus erythematosus is a very common disease nowadays. It is also a systemic disease. Patients with lupus erythematosus will have large and small erythema all over their body. In addition to the erythema, butterfly-shaped erythema will also form. The butterfly-shaped erythema will be symmetrical on both sides of the patient's cheeks. The shape of the erythema is like the wings of a butterfly. Many people think it is beautiful, but it will have a great impact on our appearance, because lupus erythematosus is a highly specific skin injury, which will cause large areas of skin damage and even cause unbearable itching symptoms. Severe cases will cause the keratin of hair follicles and pores to expand. The erythema disappears without leaving any traces. As long as you do not scratch excessively and do not allow the skin to be damaged or infected, you can prevent lupus erythematosus from affecting the skin surface after recovery.

summary

Butterfly rash is a facial erythema that occurs symmetrically on both cheeks of patients with systemic lupus erythematosus. The rash is connected by the bridge of the nose and is light red or bright red in color, like a butterfly covering it. Hence the name butterfly rash. It is a type of skin lesion with a high specificity in systemic lupus erythematosus. Butterfly rash is an edematous erythema that is higher than the skin, with clear or blurred edges. It is bright red or purple at first and may turn dark red later. The surface is mostly smooth. In severe cases, it may be accompanied by blisters and crusts, followed by scales, follicular keratin plugs and capillary dilation. After the erythema disappears, there is generally no trace left, but there may be brown pigmentation. Skin atrophy is less common and should be differentiated from pregnancy spots and freckles.

Causes

The cause of systemic lupus erythematosus (SLE) is still unclear and may be related to multiple factors. Including genetic factors, infection, hormone levels, environmental factors, drugs, etc.

There have been many studies on the pathogenesis of SLE, and the following results all confirm that the disease is an autoimmune disease caused by immune dysfunction in the body.

1. SLE patients may be found to have a variety of autoantibodies such as antinuclear antibodies, anti-single-chain and double-chain DNa antibodies, anti-histone antibodies, anti-RNP antibodies, anti-Sm antibodies, etc. All of the above are antibodies against nuclear material (antigens). Others include anti-cytoplasmic antigen antibodies, such as anti-ribosomal antibodies, anti-blood cell surface antigen antibodies, such as anti-lymphocyte toxic antibodies, anti-red blood cell antibodies, anti-platelet antibodies, etc.

2. SLE is primarily an immune complex disease, which is the main mechanism of tissue damage. Immune complex deposits can be found in the skin in 70% of patients with or without rash. Multiple organ damage is also often caused by the deposition of immune complexes on the blood vessel walls. Immune complexes can be found in pleural effusion, pericardial effusion, synovial fluid, cerebrospinal fluid and blood.

3. Immune regulation disorders are prominent in SLE, with the production of large amounts of autoantibodies and elevated immunoglobulin G, indicating that B cells are highly proliferative and active. Although the absolute amount of T lymphocytes decreases, the percentage of T helper cells often decreases, while the percentage of T suppressor cells increases, resulting in an imbalance in the T4+/T8+ ratio. SLE is a heterogeneous disease, and the immune abnormalities may vary from patient to patient.

Diagnosis

The presence of butterfly rash on the face does not necessarily mean systemic lupus erythematosus, because in addition to systemic lupus erythematosus, there are some other diseases that can also cause butterfly rash on the face, such as dermatomyositis, rosacea, rosacea, seborrheic dermatitis, facial mite disease and other diseases can all cause butterfly rash on the face. However, these skin erythemas have their own characteristics: patients with dermatomyositis have characteristic edematous purple-red spots on their faces, characterized by involvement of the eyelids, and the skin on the cheeks, forehead and top of the head may also be affected; rosacea has papules or pus-like lesions; seborrheic dermatitis may also have red and yellow greasy scales attached to the skin, which are more common between the eyebrows and on the sides of the nose.

Clinical examination methods include:

1. General examinations often show anemia, leukopenia and thrombocytopenia, or pancytopenia and abnormally increased erythrocyte sedimentation rate.

2. Immunological examination is characterized by the presence of multiple autoantibodies in the blood. Antinuclear antibodies (ANA) are almost 100% positive when the disease is active. When the result is negative, changing the examination method may result in a positive result. When antinuclear antibodies are negative, the disease cannot be completely ruled out and a comprehensive analysis based on clinical and other laboratory examination data is required.

3. Immunopathological examination Immunofluorescence study of renal biopsy tissue sections showed that immunoglobulins, mainly IgG and IgM accompanied by complement, were deposited in the kidneys of SLE nephritis.

4. Complement and protein determination.

5. Other examinations show that about 20-50% of SLE patients are positive for rheumatoid factor.

Treatment and care

Treatment mainly focuses on relieving symptoms and inhibiting the pathological process. Due to the large individual differences in the disease, it should be tailored to each patient's condition.

1. General treatment

During the acute active phase, you should rest in bed. Those in the chronic stage or whose condition has stabilized can return to work appropriately. Mental and psychological treatment is very important. Patients should have regular follow-up visits, avoid triggering factors and irritants, and avoid direct skin exposure to sunlight. Women of childbearing age should strictly practice contraception.

2. Drug treatment

Nonsteroidal anti-inflammatory drugs, antimalarial drugs, glucocorticoids, immunosuppressants, plasma exchange therapy, treatment of SLE with neuropsychiatric disorders,

3. Precautions when taking medication

The treatment plan and dosage must be determined according to the specific circumstances of the disease. Comprehensive treatment should be strengthened, such as controlling blood pressure, blood sugar, and calcium supplementation. Patients should keep in touch with their doctors and take medication under the doctor's guidance, and generally have a check-up every 1 to 3 months. When the condition changes, the treatment plan should be adjusted in time to avoid missing the treatment opportunity.