Autoimmune Skin Conditions: What Causes Them and How to Treat Them

The skin is the largest organ in your body, and it can tell you a lot about your health. Many different autoimmune diseases can affect your skin, and these skin changes may be the first — or only — symptoms you see. Here, we’ll review why autoimmune disorders affect the skin, what those skin changes look like, and how you can treat them.

Why do some autoimmune disorders affect the skin?

You may be surprised to know that your skin is an important part of your immune system. It has many different cells that identify and target foreign invaders (like certain bacteria) and it’s constantly communicating with other cells in your body. 

So, it’s not a surprise that your skin can be affected by autoimmune diseases, which happen when your immune system mistakenly attacks normal parts of your body. Some autoimmune conditions only affect the skin. Others can affect the skin and other parts of the body. And because your skin is so visible, it may be the first sign of an autoimmune disease.

What does an autoimmune rash look like?

Different autoimmune diseases can cause different skin changes. Some symptoms are general while others are pretty specific for a specific condition. Some common skin changes are:

• Pink or red rashes

• Scaly patches

• Itchy skin

• Open sores

• Blisters in the skin (with clear or milky fluid)

Seeing a dermatologist or healthcare provider with skin expertise may be needed to get the right diagnosis. This may require a skin biopsy, a procedure done in your provider’s office that removes a small piece of tissue. Below, we’ll discuss common skin changes seen in certain autoimmune diseases.

Rashes on the face

Two autoimmune diseases — lupus and dermatomyositis — have rashes that can affect the face in different ways. 

Lupus

Lupus is a chronic autoimmune disease that most commonly affects women age 15 to 44. There are different types of lupus. Some forms mainly affect the skin, like cutaneous lupus. Others can affect many parts of your body in addition to your skin, like your: 

• Kidneys

• Joints

• Heart

• Blood vessels (systemic lupus)

If you have lupus involving your skin, your provider may do more tests, like blood work, to see if other organs are involved.

The first sign of systemic lupus may show up on your face as a butterfly rash. This pink-red rash gets its name from its butterfly shape across your cheeks and the bridge of your nose. In some people, it can itch or hurt, and it’s often mistaken for sunburn.

In cutaneous lupus, the rash can have different patterns:

• Red, scaly, round patches mainly on skin that’s exposed to the sun (called subacute cutaneous lupus)

• Thick, discolored, scaly patches on the face, scalp, or ears that can be associated with hair loss (called discoid lupus)

Dermatomyositis

Dermatomyositis is a rare autoimmune disease that causes muscle weakness, skin changes, and sometimes difficulty breathing or a cough. It usually affects children between the ages of 5 and 15 and adults between the ages of 40 and 60.

The first sign of dermatomyositis can also affect the face: a reddish-purple rash on the eyelids (called a heliotrope rash). Other skin changes include:

• Red or purple bumps on the outer joints of the hand, knees, or elbows

• Red or discolored skin on the shoulders, neck, and upper back

There is no cure for lupus or dermatomyositis, but different medications that lower the immune response can help manage symptoms.

Blisters in the skin

There are many autoimmune diseases that can cause blisters in the skin. Blisters can look different depending on what part of the skin is involved. Some are large, firm, and filled with clear fluid. Others are small and form yellow crusts. Below, we’ll review some of the more common autoimmune conditions with blisters. 

Dermatitis herpetiformis

Dermatitis herpetiformis is a chronic autoimmune skin condition that happens as a reaction to eating gluten, which is a protein found in many foods like wheat and rye. Dermatitis herpetiformis is related to Celiac disease, an autoimmune disease that damages part of the intestine when gluten is in the diet. Between 10% and 15% of people with Celiac disease will have skin symptoms.

Dermatitis herpetiformis usually starts in people between the ages of 30 and 40 as extremely itchy blisters and red bumps on the: 

• Elbows

• Knees

• Buttocks

• Scalp

Many people will also experience: 

• Stomach pain

• Cramping

• Diarrhea

• Constipation

In some people, the symptoms will come and go, which can make diagnosing it harder.

Treatment includes removing all gluten from the diet. Some medications can also help (read on to learn about treatments).

Pemphigoid

Pemphigoid is a group of rare autoimmune diseases that form blisters in the skin. The most common one is called bullous pemphigoid, which usually affects people over the age of 70. Bullous pemphigoid causes itchy, firm blisters on any part of the skin, including the mouth or the genitals. Some people will just have a few spots while others can have large parts of their bodies covered. Neurologic diseases — like dementia and Parkinson’s disease — are more common in people with bullous pemphigoid.

There are different medications that can help treat pemphigoid (more on treatments below). For many people, the rash will go away on its own after a few years.

Pemphigus

Pemphigus is another group of rare autoimmune diseases that form blisters in the skin, but it’s very different from pemphigoid. Pemphigus vulgaris is the most common one, and it usually affects adults who are middle-aged or older.

Most people will get small blisters that don’t itch and break easily. This causes ulcers that can join together and be quite painful. It’s common for the blisters to start in the mouth and then spread to any part of the skin. Some people will have fewer blisters. Others will have large areas of skin involved. People with pemphigus may also get skin infections where the blisters are. In some people, pemphigus vulgaris can become life-threatening if it’s not treated.

There is no cure for pemphigus, but there are good treatments that can control symptoms (see treatments section, below).

Hardened or firm skin

Scleroderma is an autoimmune disease that causes your body to make too much collagen, a protein found in your skin and other tissues. Anyone can get scleroderma, but it usually affects people between the ages of 30 and 50. There are two main types:

• Localized scleroderma (called morphea) affects the skin and underlying tissue.

• Systemic scleroderma (called systemic sclerosis) can affect the skin and other organs, like your heart, lungs, kidneys, and blood vessels. This is the more serious type.

In both forms, scleroderma causes patches of hardened, thick skin that feel firm to the touch. The patches are usually darker than normal skin. They can be round and oval, or they form lines that run down your arm or leg, or appear on your forehead.

There is no cure for scleroderma, but treatments can help manage the different symptoms. Some people with localized scleroderma may not need treatment since the skin changes may go away on their own. 

Sores in the mouth or genitals

Mouth ulcers, like canker sores, are common and usually go away on their own. If mouth ulcers keep coming back, or if you also have them on the genitals, it could be a sign of a rare autoimmune disorder called Behçet disease.

Behçet disease can happen at any age, but it usually affects people in their 20s and 30s. We don’t know the exact cause, but many symptoms are caused by inflammation of blood vessels. The condition can be different in each person, and it’s common for symptoms to come and go. Some other symptoms include:

• Skin rashes (acne-like spots, or painful, firm bumps)

• Eye problems (like blurred vision, pain, or light-sensitivity)

• Pain in the joints

• Diarrhea

• Headaches

There is no cure for Behçet disease, but symptoms can usually be controlled with different medications. In some people, the symptoms will go away for a period (called a remission), and treatment may not be needed for a while.

It’s important to note that other autoimmune diseases can also cause sores in the mouth or genitals, including lupus and pemphigus. It’s a good idea to be checked out by your provider to determine what the underlying cause is. 

Thick skin with scales

Psoriasis is a common autoimmune disease that affects about 3% of adults in the U.S. It’s a chronic condition that causes patches of skin to grow too quickly. There are different types of psoriasis, and the most common one is called plaque psoriasis. This causes red patches with thick white scales to form, usually on the: 

• Elbows

• Knees

• Lower back

• Scalp

Psoriasis doesn’t just affect the skin. People with psoriasis are can also have other conditions, like:

• Psoriatic arthritis, which causes painful, swollen joints

• Heart disease

• Diabetes

• Depression

Psoriasis is usually a life-long condition, and treatment depends on how severe the symptoms are. This usually includes medicated creams and pills or shots that can help lower the immune system. 

Are skin changes permanent?

The good news is that most autoimmune skin changes are not permanent. But there are some exceptions. When skin inflammation is deep enough, it can cause scarring or discoloration. Some examples include:

• Discoid lupus erythematosus usually causes permanent scars, discoloration, or hair loss

• Certain types of bullous pemphigoid can also leave permanent scars on the skin or mucous membranes (like the mouth, eyes, and throat).

Some conditions — like morphea, psoriasis, and pemphigus — can leave discolored skin even after the rash has improved. These changes are usually not permanent and fade over time. 

Treatment for skin symptoms in autoimmune diseases

The most important way to treat the skin in autoimmune disease is to treat the underlying cause. Most medications work by lowering inflammation and the immune response. When just small amounts of skin are affected, it may be possible to just use medicated creams or lotions. When larger areas of skin or other organs are involved, usually pills or shots are used.

Here are some common medications used in autoimmune diseases:

• Corticosteroids help block inflammation and can be used to treat most autoimmune diseases. They come in medicated creams, as injections, or as pills.

• Methotrexate (Rheumatrex) is a pill that helps to lower the immune system. It is used to treat many autoimmune diseases, including lupus, dermatomyositis, psoriasis, pemphigus, and pemphigoid.

• Hydroxychloroquine (Plaquenil) is a pill that is usually used to treat an infection called malaria, but it also works well to treat lupus.

• Dapsone (Aczone) is a pill that is usually used to treat certain infections, but it works well to treat dermatitis herpetiformis.

• Biologics are newer medications that block specific molecules in the immune system. Most are given as shots. Some examples include: Etanercept (Enbrel) is used to treat psoriasis or psoriatic arthritis. Rituximab (Rituxan) is used to treat pemphigus vulgaris. Belimumab (Benlysta) is used to treat systemic lupus.

Do any over-the-counter treatments work? 

It depends. Some over-the-counter products can help, but they may not be strong enough to use as the first treatment. Products with these ingredients may help in certain situations:

• Hydrocortisone is a low-strength steroid cream that may help with some mild rashes seen in autoimmune disease.

• Salicylic acid, urea, or coal tar can help treat psoriasis.

• Calamine or menthol can help soothe some rashes that itch.

What if I don’t treat the skin symptoms?

Not treating skin symptoms can lead to more discomfort, including more severe itch and pain. In some conditions, like discoid lupus erythematosus, it can also lead to worse scarring.

Sun protection if you have an autoimmune condition

Sun protection is an important part of treatment for many autoimmune conditions, especially lupus and dermatomyositis. Even a small amount of sun exposure can cause skin symptoms to worsen, so it’s important to wear sunscreen of at least SPF 30 every day.

Psoriasis is one autoimmune condition where ultraviolet light (called phototherapy) is used as a treatment. While natural sunlight may help with symptoms, it’s not always recommended. Talk to your provider about what’s right for you if you have psoriasis.

Keep in mind that some medications used to treat autoimmune diseases can also make you more sensitive to the sun.