Lupus: what are its different forms?

Systemic lupus erythematosus (SLE).

The most common form of lupus is systemic lupus, also known as systemic lupus erythematosus (SLE). It is called systemic or disseminated because it can affect several organs at the same time. It is driven by the production of autoantibodies, particularly anti–double-stranded DNA antibodies, which cause widespread inflammation. Its clinical manifestations are highly varied. Beyond severe fatigue, fever, or joint pain, it can affect the mucous membranes with oral lupus (lesions or ulcers in the mouth) or present as rarer skin forms such as bullous lupus, characterized by the appearance of blisters. These symptoms vary greatly from one person to another, ranging from very mild signs to more complex organ involvement, making each care journey unique.

The severity of SLE mainly depends on internal organ involvement, particularly when it progresses to lupus nephritis through a direct attack on the kidney filters. This severity also increases in forms of neurological lupus, where involvement of the nervous system can impair cognitive or motor functions.

Lupus érythémateux systémique. — Systemic lupus erythematosus.
Source: ARNAUD L. Systemic lupus erythematosus – Antiphospholipid syndrome (2020).

4 minutes to understand your skin. Our dermatological diagnostic guides you toward the ideal skincare for your specific needs. Simple, quick, personalized.

≈ 70%

people with lupus have a systemic form.

30 to 50%

some patients develop kidney involvement.

25 to 75%

some patients exhibit neurological deficits.

30 to 40%

develop cardiovascular and pulmonary disorders.

Cutaneous lupus erythematosus (CLE).

Unlike systemic lupus, cutaneous lupus is primarily limited to the skin. It accounts for a significant proportion of the cases seen in dermatology.

Discoid lupus erythematosus (DLE), a scarring form.

Discoid lupus is the most common form of chronic cutaneous lupus. It presents as well-defined red patches with a scaly surface that often appear on sun-exposed areas such as the face, scalp, or ears. Over time, these lesions can leave permanent scars and may even cause irreversible hair loss if the scalp is affected. The chronic inflammation of discoid lupus does not only attack the hair shaft; it also deeply damages the hair follicle. This inflammatory process leads to fibrosis (the transformation of normal tissue into rigid scar tissue) that permanently replaces the hair roots, thereby preventing any new hair growth.

In some rarer cases, the condition takes on an unusual form called verrucous lupus, in which the patches become very thick, firm, and rough in appearance, resembling warts. Although this form is striking because of its raised, bumpy surface, it remains confined to the skin and does not necessarily mean that internal organs are affected, even though regular follow-up is essential to ensure that the disease does not spread to the rest of the body.

Lupus érythémateux discoïde. — Discoid lupus erythematosus.
Source: ARNAUD L. Systemic lupus erythematosus – Antiphospholipid syndrome (2020).

Subacute cutaneous lupus, a highly photosensitive form.

Subacute cutaneous lupus is characterized by marked sensitivity to sunlight. It presents as ring-shaped lesions and red plaques that resemble psoriasis. However, unlike psoriasis, it appears less dry, with fine scales localized to sun-exposed areas. These lesions occur mainly on the trunk and arms, and often spare the face, since it is usually better protected in daily life (sunscreens, hats, avoidance habits). These areas of the body also react differently to UV radiation; their cells are more sensitive and more readily trigger the lupus-related immune response. Unlike discoid lupus, they do not leave scars but can cause pigmentary disorders due to inflammation that stimulates melanin production (post-inflammatory hyperpigmentation).

Lupus cutané subaigu. — Subacute cutaneous lupus.
Source: ARNAUD L. Systemic lupus erythematosus – Antiphospholipid syndrome (2020).

Drug-induced lupus erythematosus.

Drug-induced lupus is a particular form of the disease that is triggered by certain treatments. Some molecules modify the expression of DNA in cells, which disrupts immune recognition. The immune system then begins to regard these cells as foreign. Among these molecules are isoniazid, used in the treatment of tuberculosis, and hydralazine, recommended for severe arterial hypertension. Similarly, biologic therapies such as TNF-α inhibitors, often used to treat Crohn’s disease, rheumatoid arthritis, or psoriasis, can occasionally cause lupus-like symptoms. The most typical sign of this form is the presence of anti-histone antibodies (90% of cases). Clinically, symptoms such as fever, joint pain, and fatigue are observed. However, in contrast to systemic lupus, serious organ involvement (kidney, brain) is very rare.

In most cases, the symptoms resolve after discontinuation of the treatment responsible for this form of lupus.

Neonatal lupus erythematosus (NLE).

Neonatal lupus is a specific form of the disease, linked to the systematic transfer of maternal antibodies (anti‑SSA/Ro and anti‑SSB/La) to the fetus during pregnancy, but the disease develops in only 1 to 2% of cases. The difference lies in the genetic susceptibility of the fetus and in local environmental factors, such as inflammation or cellular stress. These elements must come together for the antibodies to actually “attack” the baby’s tissues instead of simply circulating.

This form of lupus presents in newborns with transient skin lesions and, more rarely, cardiac abnormalities. The most serious complication is atrioventricular block, caused by damage to the heart’s electrical conduction system. In most cases, the skin manifestations resolve spontaneously within a few months, as the maternal antibodies are cleared. However, nearly 5% of patients with neonatal lupus erythematosus (NLE) may go on to develop systemic lupus erythematosus (SLE) during adolescence or early adulthood.

Whether it appears only in the skin or affects the body more broadly, lupus varies greatly from one individual to another. It is precisely this variability that can make the initial diagnosis confusing.