This document summarizes a talk on managing lupus through skin care, weight control, and feeling good. It discusses how lupus can affect the skin, common skin manifestations, and tips for skin care including managing acne and sun exposure. It covers how lupus and steroids can impact weight and provides dietary and exercise recommendations. Finally, it addresses elements of feeling good such as managing fatigue and sleep.

1. Skin Care, Weight Control and
Feeling Good with Lupus
S.L.E. Lupus Foundation
New York City Hospital Tour 2013
Harlem Hospital
May 7th
, 2013
Amanda M. Sammut, MD and Sharon Isaac, MS, CDN

2. Outline of Talk
• Introduction
– What is Lupus?
• Skin
– Lupus effects on the skin
– Skin issues and concerns with steroid use
– Skin care tips – acne care, sunscreen use, and smoking cessation
• Weight Control
– The effects of Lupus on weight
– The effects of steroids on weight
– Diet and exercise
• Feeling Good
– Key elements of feeling good with Lupus
– Fighting fatigue
– Sleep hygiene
• Summary

3. What is Lupus?
• Lupus is an inflammatory, autoimmune
disease
• Lupus affects many different organ systems in
the body
• Lupus can range from mild to severe in terms
of its manifestations
• It has a variable course and variable prognosis

4. Outline of Talk
• Introduction
– What is Lupus?
• Skin
– Lupus effects on the skin
– Skin issues and concerns with steroid use
– Skin care tips – acne care, sunscreen use, and smoking cessation
• Weight Control
– The effects of Lupus on weight
– The effects of steroids on weight
– Diet and exercise
• Feeling Good
– Key elements of feeling good with Lupus
– Fighting fatigue
– Sleep hygiene
• Summary

5. Lupus and The Skin
• The skin is often affected by lupus
• Lupus may affect only the skin, without
affecting other organs, this is known as:
“Cutaneous Lupus”
• Lupus may affect the whole body, this is
known as: “Systemic Lupus Erythematosus”
• Treatments for lupus may affect the skin

6. Common Skin Manifestations of Lupus
• Butterfly/malar rash/acute cutaneous lupus
erythematosus
• Discoid lesions
• Loss of hair – generalized or localized
• There are many more skin manifestations of
lupus that are less common (and not
mentioned in this talk)

7. Common Skin Manifestations of Lupus

8. Common Skin Manifestations of Lupus
Butterfly/malar rash/acute cutaneous lupus erythematosus

9. Common Skin Manifestations of Lupus
Discoid lesions

10. Common Skin Manifestations of Lupus
Loss of hair –
generalized or
localized

11. Skin and Steroid Use
• Acne
• Stretch marks/Striae
• Skin Thinning
• Bruising

12. Acne
• Acne is the medical
term for pimples
• Pimples occur when
pores get clogged
with dead skin and
oil, and bacteria
build up
• The skin gets
inflamed and can
turn red or swell

13. Acne: Home skin care recommendations
Instructions on skin
cleansing:
•Apply a gentle cleanser with
fingers
•Do not scrub aggressively,
massage skin gently with
fingertips
•Rinse with warm water
twice daily

14. Choosing Products
• Water-based lotions, cosmetics,
and hair products are less
comedogenic (pimple-forming)
than oil-based products
• Seek out “non-comedogenic”
skin care and cosmetic products
• Do not pick acne lesions, as this
may worsen scarring
• A number of treatments for acne
are contraindicated in
pregnancy, see a dermatologist
for further care

15. Tip:
Avoid Minocycline!!!
Minocycline is an oral antibiotic used
in the treatment of acne.
It is generally recommended that
patients with lupus avoid
minocycline as minocycline
may activate lupus or
cause drug-induced lupus.

16. Stretch Marks/Striae
• Seen in ~ 90% of
pregnant women, 70%
of adolescent females,
and 40% of adolescent
males
• Striae from prolonged
steroid use are usually
larger and wider, and
involve widespread
areas, occasionally
including the face

17. Stretch Marks/Striae
• Purple striae occur as the
fragile skin stretches due
to the enlarging trunk,
breasts, and abdomen
• The striae appear as wide,
reddish-purple streaks
because the increasingly
thin skin does not hide the
color of venous blood in
the underlying deep skin

18. Stretch Marks/Striae
• Avoid striae by avoiding rapid weight gain or weight loss
• Striae are most likely to respond to treatment at an early
stage
• Once they become white, only few treatments exist and they
become quite difficult to treat
• Intensive moisturization of the stretch marks has been
advocated for the early treatment of striae
• Tretinoins applied to the skin may improve the appearance of
early striae (note: tretinoins can not be used in pregnant or
breastfeeding women; tretinoins increase photosensitivity)
Tretinoins are prescribed by dermatologists

19. Sun Exposure
• Increases risk of skin cancer
• Cosmetic issues: wrinkles, freckles, sun spots
• In patients with Lupus, sun exposure
increases the risk of Lupus activity or a Lupus
flare

20. A Few Words on Tanning Salons…
Tanning Salons are NOT recommended
They emit UVA rays, which still
contributes to activating Lupus (as well
as to increasing skin cancer risk)

21. Tips on Sunscreen Use
• SPF 30 or higher
• Look for “Protection
against both UVA and UVB
rays”
• Apply before makeup or
before moisturizer
• Apply at least 10minutes
prior to sun exposure
• Re-apply every two hours
if continued sun exposure

22. Tips on Sunscreen Use
• Invest in sun-protective
clothing and wide-brimmed
hats
• Certain medications may
increase risk of
photosensitivity, for
instance: antibiotics,
diuretics, anti-inflammatory
drugs and birth control pills
and many more

23. Cosmetically…
• Camouflage makeup, can often conceal skin
discoloration and scarring
• Skin scars – filler and laser technology may
improve scarring and skin discoloration –
Buyer Beware!
– Disease should be in full remission if this is to be
performed
– See a dermatologist if you want more information
on filler and laser treatments
– Shop around – get recommendations

24. Smoking Cessation
• Smokers have more active lupus
• Smoking increases rates of lupus flares
• Hydroxychloroquine is less effective in
patients who smoke
• Other reasons to stop smoking:
• Smoking is associated with higher rates of cancer
and of heart disease
• Financial considerations
• Cosmetic considerations

25. Skin Care Tips - Summary
• For skin lesions caused by Lupus: control Lupus
activity, sun exposure avoidance, smoking cessation
• For acne: wash face with gentle cleanser twice daily,
see a dermatologist for medications, avoid
minocycline
• For stretch marks: In the early stage, keep them moist
and see a dermatologist if you want to consider
medications that can be applied to the skin
• Sunscreen Use and Protection from UVA and UVB rays
• Smoking Cessation

26. Outline of Talk
• Introduction
– What is Lupus?
• Skin
– Lupus effects on the skin
– Skin issues and concerns with steroid use
– Skin care tips – acne care, sunscreen use, and smoking cessation
• Weight Control
– The effects of Lupus on weight
– The effects of steroids on weight
– Diet and exercise
• Feeling Good
– Key elements of feeling good with Lupus
– Fighting fatigue
– Sleep hygiene
• Summary

27. Lupus Activity and Weight
• When Lupus is active, patients may have
active inflammation and fevers and may lose
weight from the body’s increased energy
consumption
• People with active Lupus may feel fatigue and
lose stamina, resulting in inactivity, which
results in rapid muscle loss

28. Steroids and Weight
• Steroids enhance appetite
• This may result in significant weight gain
• Some patients may lose weight on steroids
but the majority gain weight

29. Tips to Battle Weight Gain
Associated With Steroids
• Keep mainly healthy food in your house
• Grab healthy food when feeling hungry
(cucumbers, baby carrots, etc.)
• Have a bowl of fresh fruits and vegetables
available
• Keep a food diary
• Keep hydrated with plenty of water

30. Diet
• Limited informative research on the effect of
dietary modification in Lupus
• Balanced diet of carbohydrates, proteins and
fats is generally recommended
• Diet should be modified based on disease
activity and response to therapy

31. Healthy ways to add fruits and
vegetables to your diet
• Eat fruits and vegetables throughout the day
• Add vegetables to your soups, sandwiches,
and salads
• Use fruits to make smoothies
• Use fruit to your cereal and yogurt, also in
salads, like asian salad
• Choose fruits, or vegetables that are fresh, or
frozen

32. • Fill ½ of your plate
with fruits/veggies
• Fill ¼ of your plate
with whole grains
(i.e. brown rice or
whole-wheat
pasta)
• Fill ¼ of your plate
with a protein (i.e.
lean meat or fish)
Dietary
Recommendation

33. Special Dietary Considerations
• For patients on steroids: a low-fat and low salt
diet is recommended (because steroids can
increase blood pressure and cholesterol)
• For patients with kidney disease: a low-fat and
low sodium diet is recommended (because
kidney disease can increase fluid retention and
increase cholesterol)

34. Special Dietary Considerations
• Patients who are dieting or not able to obtain
an adequate diet should take a daily
multivitamin
• Patients with hypertension or nephritis should
restrict salt intake
• All dietary modifications should be discussed
with your physician

35. Watch out for…
• Herbal remedies – these are of unproven
benefit, may be harmful, may interact with
medications
• “Natural” does not equal “safe”

36. Exercise
• Walking, swimming, bicycling, low-impact
aerobics, Pilates, stretching, or using an
elliptical exercise machine
– Strengthens bones and tones muscles without
aggravating inflamed joints
– Helps to lower the risk of developing osteoporosis
• Avoidance of high-impact activity, ex. jogging,
especially if joints are inflamed
• Vary the exercises, so that different muscle
groups all get a regular workout

37. Exercise
• Pace yourself, especially if you tire easily
• Don’t give up
• Exercise should not be painful
• Muscles that are not used may quickly
become weak

38. Exercise
• Regular exercise and even simple low-impact
movement will:
– reduce or minimize stress
– help to keep your heart healthy
– increase muscle strength and your range of
motion
– help prevent osteoporosis
– improve muscle stiffness

39. Outline of Talk
• Introduction
– What is Lupus?
• Skin
– Lupus effects on the skin
– Skin issues and concerns with steroid use
– Skin care tips – acne care, sunscreen use, and smoking cessation
• Weight Control
– The effects of Lupus on weight
– The effects of steroids on weight
– Diet and exercise
• Feeling Good
– Key elements of feeling good with Lupus
– Fighting fatigue
– Sleep hygiene
• Summary

41. Key Elements of Feeling Good With
Lupus
• Control Lupus
• Exercise and Diet
• Fight fatigue
• Rest and Good Sleep Hygiene
• Support System – Don’t be afraid to ask for
help
• Managing stress, anxiety and depression
• Smoking Cessation

42. Controlling Lupus
• Ongoing patient-doctor communication
• Compliance with medications and follow up
• Alleviate symptoms
• Prevent and treat relapses
• Lessen side effects related to drug therapy
• Coordinate care with your primary care
physician

43. Fatigue
• Up to 80 percent of people with
lupus experience fatigue
• Fatigue may be the main
symptom and can be debilitating
• Contributing Factors:
– Disease activity, pain, age, and
medications
– Poor physical and mental health
– Lack of good social support
– Smoking

44. Fatigue
• Other medical conditions may contribute to
fatigue
• A few examples include:
– Anemia
– kidney failure
– Hypothyroidism
– Depression

45. Tips to Help Manage Fatigue
• Alternate activities with periods of rest
throughout the day
• Establish good sleep patterns
• Plan ahead; for example, shop for gifts
throughout the year
• Prepare meals in advance
• Eat a healthy diet and exercise regularly
• Stop smoking if you smoke

46. Rest
• Especially important during periods of disease
activity
• Inflamed or damaged muscles require rest to heal
• Too little or too much sleep isn’t healthy
• Napping during the day may be helpful during
periods of lupus activity
• Try to allow extra time in your daily schedule for
rest

47. • Keep the same bedtime and wake
time every day.
• Limit liquids, heavy meals, tobacco
and alcohol within 3 hours of bedtime.
• Limit caffeine at least 6 hours before
bedtime.
• Exercise regularly, but not within 3
hours of bedtime.

48. • Wind down for at least 1 hour before
bed in dim lights. Engage in
something quiet, calm and relaxing.
• Keep the bedroom quiet, cool and
dark.
• Take a hot shower or bath 1.5-2
hours before bedtime, not right before
bed.
• Limit any screen time (TV, tablets,
phone, computer) within an hour of
bedtime and during the nighttime
hours.
• Limit time in bed to 7½ to 8 hours at

49. Outline of Talk
• Introduction
– What is Lupus?
• Skin
– Lupus effects on the skin
– Skin issues and concerns with steroid use
– Skin care tips – acne care, sunscreen use, and smoking cessation
• Weight Control
– The effects of Lupus on weight
– The effects of steroids on weight
– Diet and exercise
• Feeling Good
– Key elements of feeling good with Lupus
– Fighting fatigue
– Sleep hygiene
• Summary

50. Summary
• Lupus is a complex autoimmune disease
characterized by symptom diversity and periods of
disease activity and remission
• Important principles of skin care, weight control
and feeling good include:
– Controlling Lupus – patients and physicians, together
– Battling side effects of steroids
– Protection against UVA and UVB rays
– Smoking Cessation
– Diet, Exercise, Rest, Sleep Hygiene
– Recognizing need to seek help

51. Thank You
• S.L.E. Lupus Foundation
• Eric Mariuma, MD
• Michelle Coombs
• Harlem Hospital

52. References
• Subramanyan K, Johnson AW. Role of mild cleansing in the management of
sensitive skin. Poster presented at the American Academy of Dermatology 61st
Annual Meeting, San Francisco, CA, March 21 to 26, 2004.
• Draelos ZD. Cosmetics and cosmeceuticals. In: Dermatology, 2nd ed, Bolognia JL,
Jorizzo JL, Rapini RP, et al (Eds), Elsevier, 2008. p.2301.
• Images, if not otherwise mentioned, from google image
• Acne treatment algorithm image from: www.uptodate.com
• Draelos ZD. Cosmetic therapy. In: Comprehensive Dermatologic Drug Therapy, 2nd
ed, Wolverton SE (Ed), Elsevier Inc, 2007. p.761.
• Management of acne: a report from a Global Alliance to Improve Outcomes in
Acne. Gollnick H, et. Al. J Am Acad Dermatol. 2003;49(1 Suppl):S1.
• E-medicine article “Striae Distensae Treatment & Management” Author: Samer
Alaiti, MD, RVT, RPVI, FACP; Chief Editor: William D James, MD
• “Lupus Intangibles” slide borrowed from the Lupus Initiative
• Fatigue, Rest and Exercise information from a variety of sources including patient
information websites from the Lupus Foundation of America
• Sleep Hygiene slides from Eric Mariuma, MD

53. The End