An autoimmune disease occurs when your body’s immune system attacks healthy cells within the body. This dysfunctional immune response may lead to various symptoms, like hair loss, skin rash, or even joint pain. When the body mistakenly targets skin cells, you may develop an uncomfortable or concerning rash.
I work with patients suffering from autoimmune disease on a daily basis. Because 5-8% of Americans are likely to experience an autoimmune skin disorder at some point and women are especially at risk (thanks, genetics), I find that it’s easiest to inspect a rash a patient presents with to determine what’s behind it.
The most common autoimmune diseases that may cause rashes include:
- Psoriasis
- Eczema
- Lupus
- Sjogren’s syndrome
- Dermatomyositis
- Hypothyroidism & myxedema
- Celiac disease
- Scleroderma
- Lichen planus
- Behçet’s disease
What Does an Autoimmune Rash Feel Like?
Some of the symptoms most common to autoimmune rashes are:
- Inflamed, red skin: Like with any rash, your skin may turn red or otherwise discolored (some autoimmune rashes are more purple or brown in color) and feel warmer than the surrounding skin.
- Itch: Some, though not all, rashes associated with autoimmune disease cause an urge to itch.
- Pain or discomfort: Some rashes may hurt or feel tender when touched, while others may cause persistent discomfort.
- Varied shapes, sizes, and rash patterns: If you have an autoimmune rash, you may observe its size or shape change. Rash patterns vary and may also morph over time.
What Causes an Autoimmune Rash?
Various types of autoimmune activity may cause any number of rashes. There are several factors that may lead to autoimmune disease and dysregulated immune responses, such as:
- Genetics: Like many conditions, a genetic predisposition to autoimmune disease increases the likelihood you will develop autoimmunity. The more blood relatives you have who suffer from these diseases, the higher your chances will be.
- Hormones: Your hormonal makeup impacts the way your immune system functions. Major changes to hormone levels, like those that occur during menopause and pregnancy, can trigger autoimmunity and related skin rashes. That’s one reason females are more likely than males to have autoimmune issues.
- Mental health: Particularly if you already have an autoimmune condition, anxiety, stress, or other mental health concerns may trigger flare-ups. Your gut and brain are closely connected, so significant changes to your mental health or nervous system function play a part in autoimmune responses.
- Environmental triggers: If you’re sensitive to certain chemicals in everyday items such as detergent, body wash, or makeup, these chemicals may increase your likelihood of developing an autoimmune rash.
Let’s take a look at the specific autoimmune conditions that are most likely to cause a rash and how these rashes may present.
Psoriasis
Psoriasis is the most common autoimmune skin rash, presenting as scaly, dry, and often red skin. Psoriasis can show up anywhere on the body but most commonly affects the elbows, knees, lower back, and scalp. It’s likely to cause itching and pain or sensitivity to the touch. As much as possible, avoid scratching these patches of scaly skin, which may cause bleeding and lead to infection.
Eczema
Eczema is an itchy skin condition that affects children more than adults. Though eczema often goes away after puberty, it can persist into adulthood. Some eczema attacks are contact dermatitis, caused by exposure to a chemical irritant or an allergic reaction. However, the most common form of eczema is atopic dermatitis, caused by genetics and/or autoimmune disease. Many people experience atopic dermatitis, asthma, and hay fever together.
If you have eczema, you may experience rashes all over your body, especially on the hands, feet, arms, legs, elbow, knees, scalp, and the back of the neck.
Lupus
Among other symptoms, two-thirds of lupus patients will develop a skin condition. Skin disease in lupus may present as rashes, sores, lesions, or cherry angiomas — a bright red, raised patch of skin. Up to 70% of lupus cases are worsened by sun exposure or extended time under fluorescent lights. Many lupus-related rashes will appear in sun-exposed areas of the skin, often a butterfly-shaped rash across the nose and cheeks.
Cutaneous lupus refers to a form of lupus that only affects the skin. (When people say “lupus,” they’re usually talking about systemic lupus erythematosus (SLE), which is different from cutaneous lupus.) You can have multiple forms of lupus or only one form.
Neonatal lupus is a very rare condition that affects infants of mothers who have some form of lupus. At birth, the infant may exhibit a skin rash, low blood cell count, liver problems, or a slow heartbeat.
Sjögren’s Syndrome
Sjögren’s syndrome is an autoimmune disease that most frequently causes dry eyes and dry mouth. It’s most common in women over the age of 40, and it can cause multiple skin problems, such as:
- Dry, rough skin (AKA xerosis)
- Blood spots on your legs (AKA purpura) due to blood vessel inflammation (AKA vasculitis)
- Purple-to-red skin rash that does not lighten under pressure
- Red, ring-shaped skin lesions around a pale center (AKA annular erythema)
If you experience purpura or annular erythema, schedule a visit with your doctor or dermatologist right away.
Dermatomyositis
Dermatomyositis is a very rare autoimmune disorder that can cause:
- Red or purple skin rash on a sun-exposed area
- Calcium deposits underneath your skin (AKA calcinosis)
- Inflammation around your fingernails
- Muscle weakness
- Trouble swallowing (AKA dysphagia)
- Difficulty talking
- Fatigue
Dermatomyositis-related skin rashes most often occur in these 8 parts of the body:
- Eyelids
- Nose
- Cheeks
- Back
- Upper chest
- Elbows
- Knees
- Knuckles
Individuals who experience skin rash but not muscle weakness likely suffer from amyopathic dermatomyositis, also called “dermatomyositis sine myositis.”
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Hypothyroidism & Myxedema
Severe, untreated hypothyroidism may lead to myxedema, which either means “severely advanced hypothyroidism” or skin problems related to severely advanced hypothyroidism. Myxedema leads to skin changes, though these may not technically be considered rashes. Myxedema may result in swelling and thickening of your skin.
Myxedema and severe hypothyroidism require immediate treatment and management. “Myxedema crisis” is when the body no longer tolerates the severe hypothyroidism symptoms. Your body starts to shut down. Myxedema crisis may result in coma, seizures, and death.
Call your doctor or emergency services immediately if you believe you’re having a myxedema crisis.
Celiac Disease
Although celiac disease most frequently triggers gastrointestinal distress, it can also trigger an autoimmune rash called “dermatitis herpetiformis”, an itchy, blistering rash on your skin. This usually appears on the elbows, knees, or buttocks.
Fewer than 10% of individuals with celiac experience both skin problems and the more common digestive symptoms. More often than not, patients have only one or the other.
Scleroderma
Also known as systemic sclerosis, scleroderma is a condition in which your immune system mistakenly attacks your own healthy tissues, namely, the skin. When you have scleroderma, your skin changes in appearance and feel, due to increased collagen production. It may become shiny and thicker.
Morphea is sometimes synonymous with scleroderma, but morphea is actually a severe type of scleroderma. Morphea specifically refers to oval-shaped areas of thick, red skin.
Lichen Planus
Oral lichen planus is an autoimmune disease that may trigger swelling and irritation on your skin, scalp, nails, genitals, and mucous membranes. Lichen planus typically causes purple, itchy, flat bumps on the skin. It may also result in lacy-white lesions in the mouth.
Behçet’s disease
Behçet’s disease is a very rare autoimmune disorder that leads to blood vessel inflammation (vasculitis).
Autoimmune Blistering Diseases
We’ve been talking a lot about skin rashes. However, some autoimmune conditions can cause skin blistering, too.
Also known as autoimmune bullous diseases, the most common autoimmune diseases that can cause blistering are:
- Epidermolysis bullosa acquisita
- IgA-mediated bullous dermatoses
- Ocular cicatricial pemphigoid
- Bullous pemphigoid
- Pemphigus
When to Call Your Doctor
It’s always advisable to keep an eye on a new rash. Here are some signs that you should see a healthcare professional:
- Sudden onset of a new rash
- Fever
- Pain
- Blisters
- Swelling
- Discharge
- Bruising
- A bad smell
- The rash area is spreading
FAQs
What autoimmune diseases cause an itchy rash?
Some autoimmune diseases that may cause an itchy rash are cutaneous lupus, oral lichen planus, and erythrodermic psoriasis.
Certain conditions are also known for causing scalp itch, including:
- Psoriasis
- Eczema
- Lichen planus
- Lupus
- Scleroderma
- Sjögren’s syndrome
Why do autoimmune conditions cause a rash?
Autoimmune conditions may cause a rash because they trigger inflammation in skin cells. These diseases are often characterized by chronic inflammation in your internal organs, your skin, and everywhere in between.
How long does an autoimmune rash last?
Autoimmune rashes last varying lengths of time based on the type of rash and the autoimmune disease that caused it. Some rashes can go away after a few days, while others may last up to years.
What do autoimmune rashes look like?
Autoimmune rashes can look like scaly red patches, purplish bumps, or more. The appearance of autoimmune rashes will be different, depending on which autoimmune condition is triggering the skin rash. For example, cutaneous lupus may cause a scaly red patch that does not hurt or itch. Scalp psoriasis may cause plaque buildup that results in hair loss. Lichen planus may cause purplish, itchy, flat bumps on your skin.
What autoimmune conditions may cause hives?
Autoimmune hives are itchy red bumps or welts often caused by allergic reactions. An overactive immune system can also cause them. Autoimmune diseases that may cause hives are:
- Lupus
- Sjögren’s
- Celiac disease
- Type 1 diabetes
- Rheumatoid arthritis
- Vitiligo
How will my doctor test for autoimmune disease?
No single test is designed to test for all autoimmune diseases. If you’re seeking a diagnosis, several blood tests can help your healthcare provider determine if you have an autoimmune disease.
Here are 4 common diagnostic tests for autoimmune disease:
- Antinuclear Antibody (ANA)
- Autoantibodies
- C-Reactive Protein (CRP)
- Erythrocyte Sedimentation Rate (ESR)
Will I need a skin biopsy? Your doctor may recommend a biopsy to learn more about a new rash. This is to rule out bacterial or fungal infections, cancer, or other skin conditions.
What to Do About Autoimmune Rashes
The best way to treat autoimmune rash (and autoimmune disorders in general) is to identify and treat the underlying cause. There are many possible causes of autoimmunity. For immediate relief, over-the-counter corticosteroid creams may help with discomfort. For a long-term solution, talk to a healthcare provider near you about the best approach to treatment and management.
If you’re in Colorado, come see us at PrimeHealth! We spend 1-2 hours at each appointment with our patients to thoroughly understand their unique needs and circumstances.
