The skin is the body’s largest organ, and it is the first line of defense we have against external aggressors in our environment like allergens and irritants. It can also be the first part of the body to show warning signs of internal concerns like autoimmune diseases. According to Dr. Paul Curtiss of U.S. Dermatology Partners Carrollton, “Autoimmune diseases occur when the body’s immune system mistakenly identifies healthy cells as threats and begins attacking them. These immune system malfunctions can impact nearly every part of our body, including the skin. Malfunctioning immune systems cause rashes, itching, hair loss, skin discoloration—among other skin health concerns.” In this blog, Dr. Curtiss explores the link between autoimmune disease and skin conditions, as well as highlighting common symptoms and making recommendations for managing autoimmune conditions and their impact on skin.
How Autoimmune Diseases Impact Skin
The immune system is designed to protect us from damage caused by infections, diseases, cancers, and environmental aggressors. Its secondary purpose is to recognize healthy cells, as friendly. For those who struggle with autoimmune disease, Dr. Curtiss says, “The immune system is either overactive or it turns on itself, damaging healthy tissues. This malfunction leads to inflammation, pain, as well as symptoms inside the body. Many autoimmune diseases first manifest in the skin, in which the immune system normally plays an important protective role against the outside world.”
Some skin changes are early warning signs of a poorly or incorrectly functioning immune system. Early skin symptoms may seem benign, but they are often indicative of something more serious. That’s why dermatologists play a vital role in early detection for autoimmune disease. While symptoms vary between individuals and specific autoimmune diseases, some common skin-related symptoms of immune dysfunction include:
- Inflammation – this may look like skin swelling, redness, or warmth. It may also lead to stiffness or limited mobility in joints.
- Autoimmune disease skin rashes – long-lasting or chronic skin irritation, itching that may look like red or dry skin or cause small, itchy bumps.
- Highly sensitive/reactive skin – sensitive skin that reacts when exposed to the sun or environmental allergens and irritants, including clothes detergents, soaps, and perfumes.
- Dry or scaly skin – abnormally dry, scaly-feeling skin, especially if the dryness is irregular or develops in seemingly inexplicable locations.
- Hardening or thickening skin – loss of skin elasticity and abnormal rigidity in skin that can occur when the immune system slows collagen and elastin production or damages collagen and elastin in skin.
- Hair loss – shedding caused by immune attacks on hair follicles can lead to bald patches or more extensive hair loss.
- Pigment changes – this may look like hyperpigmentation (extra pigment/darkening) or hypopigmentation (lost pigment/lightening).
Common Autoimmune Skin Conditions and Their Symptoms
Dr. Curtiss says, “Autoimmune skin conditions are relatively common. Their symptoms and triggers vary widely, but it’s important to recognize the common warning signs of these conditions and inform your dermatologist or general care provider about concerns as soon as possible to ensure early diagnosis and effective treatment planning.” Below, Dr. Curtiss goes through some of the most common autoimmune conditions and how they impact skin health:
Psoriasis
What it looks like: Thick, red patches of skin covered with silvery-white scales. These plaques often appear on the elbows, knees, lower back, and scalp.
Cause: Psoriasis is caused by overactive immune response that speeds up skin cell production. Typically, skin cells renew every 28-30 days. In psoriasis, this process happens in just 3-4 days, causing a buildup of skin cells and thickened patches of skin on the surface.
Triggers: Stress, infections, cold weather, and certain medications can exacerbate symptoms.
Lupus (Cutaneous Lupus Erythematosus)
What it looks like: A butterfly-shaped rash across the cheeks and nose is one of the most common indicators of lupus, but it can also include scaly, disk-shaped lesions, sun sensitivity, and potential scarring.
Cause: Lupus is a systemic autoimmune condition, but cutaneous lupus is a sub-type that specifically affects the skin. It often coincides with or precedes systemic symptoms of lupus like fatigue, joint pain, and fever.
Triggers: Sun exposure is a major trigger. Hormonal shifts and infections can also play a role.
Vitiligo
What it looks like: Lighter patches of skin where pigment-producing cells (melanocytes) have been destroyed by an overactive immune system.
Cause: For those with vitiligo, the immune system attacks melanocytes, leading to depigmentation. It often starts on the face, hands, and areas around body openings.
Why diagnosis matters: Early diagnosis is key to preventing progression and guiding treatments, including topical medications, light therapy, or surgical options for pigment restoration.
Scleroderma
What it looks like: Tightening and thickening of skin, especially on the hands and face. Scleroderma may also lead to a skin that appears shiny or areas of skin with visible small blood vessels (telangiectasias).
Cause: Scleroderma is caused by an excessive production of collagen proteins, leading to hardening of skin and connective tissues. It can be localized to one specific area or systemic. When Scleroderma is systemic, it can even impact the internal organs.
Triggers: Infections, certain medications, or environmental exposures may influence its development.
Atopic Dermatitis
What it looks like: Red, itchy patches of skin are common signs of autoimmune skin rash caused by atopic dermatitis (eczema). This may lead to cracked, scaly, or oozy skin. Most often these symptoms develop in the creases of the elbows, knees, or neck.
Cause: While not always caused by autoimmune dysfunction, atopic dermatitis involves immune system dysregulation that causes skin to be overreactive to external irritants and allergens.
Triggers: Environmental aggressors, including soaps, detergents, pollen, food allergies, and weather changes. Stress is also commonly linked to eczema flareups.
Alopecia Areata
What it looks like: Patchy hair loss that typically develops quickly and forms circular patterns. In severe cases, it can lead to total loss of scalp or body hair.
Cause: In alopecia areata, the immune system attacks hair follicles, leading to unpredictable hair loss. Hair regrowth may occur over time, but the condition is often recurrent.
Triggers: Stress, illness, or other autoimmune conditions may contribute to more frequent or severe flareups.
When to See a Dermatologist
When it comes to the decision to visit a dermatologist, Dr. Curtiss advises, “Many patients suffer with symptoms of autoimmune skin conditions for far too long before they reach out for support. If you notice anything of concern related to your skin health, it never hurts to schedule an appointment. Without a proper diagnosis, symptoms will often worsen. A dermatologist can provide an accurate explanation for your symptoms, work with you to develop a treatment plan, and partner with rheumatologists and other specialists to create an autoimmune health network of support.” You should always schedule an appointment with a dermatologist if any of the following issues occur:
- Chronic, unexplained skin changes that persist for more than a few weeks.
- Rashes that don’t improve with over-the-counter creams or remedies.
- Sudden or patchy hair loss without an obvious cause.
- Discoloration or changes in skin texture that seem to progress or spread.
Get the Support You Need to Address Autoimmune Skin Concerns
According to Dr. Curtiss, “Dermatologists are often the first specialists to detect autoimmune diseases due to the visibility of skin symptoms. However, they can use their expertise in skin health to look for patterns, track symptom progression, and initiate appropriate diagnostics. I often partner with other specialists to ensure patients receive effective care for both internal and external autoimmune systems.”
Schedule a Dermatology Consultation
If you notice chronic rashes, unexplained hair loss, or other unexplained skin changes, don’t ignore them. Schedule a consultation with your local U.S. Dermatology Partners team to explore possible autoimmune causes, receive an accurate diagnosis, and get the expert care you need from one our trusted dermatologists. Simply take a few moments to complete our online scheduling request form. Once we hear from you, a local team member will be in touch to finalize the details of your visit.
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