You’ve had a rash for a while. Maybe it comes and goes. Maybe it showed up out of nowhere on your face or your arms and joints and nothing seems to help.
That rash might be more than skin deep. For some people, it’s the first sign of an autoimmune disease, a condition where the immune system mistakenly attacks the body’s own healthy tissues.
Some autoimmune rashes remain mild, while others can spread or accompany other symptoms. Here’s what autoimmune rashes look like, which conditions cause them and when it’s time to see your health care provider.
What are autoimmune rashes?
Autoimmune rashes happen when the immune system mistakenly attacks healthy parts of the body, including the skin.
“This happens when the signals from the immune system, which are supposed to protect us, end up attacking us instead,” said Bart Hunter, FNP, a specialist in rheumatology at Banner Health. “It wrongly treats your skin cells as harmful invaders and launches an attack against them.”
This confusion in the immune system causes inflammation in the skin, which can lead to redness, swelling, scaling or other visible changes.
What do autoimmune rashes look like?
Not all rashes need a doctor or specialist. But some signs may mean it’s more than just a simple skin irritation.
Common features of an autoimmune rash include:
- Red, pink, purple, brown or darker patches or spots
- Scaly or dry areas
- Raised or thickened skin
- Blisters or fragile skin
- Patterned rash (butterfly-shaped or circular)
- Skin color changes after inflammation
On lighter skin, rashes may appear red or pink. On darker skin, they may look purple, gray, brown or darker than the surrounding skin.
Other clues
Autoimmune rashes often come with other symptoms in the body. According to Hunter, these may include:
- Joint pain and stiffness
- Profound fatigue or tiredness
- Recurrent low-grade fevers
- Possible weight changes
- Raynaud’s phenomenon (fingers or toes white or blue in the cold)
- Mouth ulcers
- Patchy hair loss
When skin symptoms occur alongside these issues, they might point to an underlying autoimmune condition.
Common autoimmune-related skin conditions
Several autoimmune conditions can affect the skin. Two of the most common are psoriasis and lupus.
Psoriasis
Psoriasis causes thick, red, scaly patches of skin, usually on the elbows, knees, scalp and lower back. It can be itchy, painful and hard to deal with emotionally. Hunter mentioned that it can also affect nails, causing pits or ridges. If left untreated, it may lead to psoriatic arthritis.
Lupus
Lupus is an autoimmune disease that can affect many parts of the body, including the skin.
“The most famous rash for lupus is a butterfly-shaped rash on the face,” Hunter said.
The lupus rash may:
- Appear across the cheeks and bridge of the nose
- Worsen with sun exposure
- Be red, pink or darker depending on skin tone
- Occur with fatigue, joint pain or fever
Other autoimmune rashes you may hear about
While psoriasis and lupus are common, other autoimmune skin conditions include:
Dermatitis herpetiformis
- Very itchy clusters of bumps or blisters
- Often linked to gluten sensitivity (celiac disease)
- Common on elbows, knees and buttocks
Vasculitis
- Purple spots or bruise-like areas
- May affect the legs
- May be tender or painfull
Pemphigoid and pemphigus
- Large, firm blisters
- Often on the arms, legs or abdomen
Vitiligo
- Smooth, white patches of skin
- Caused by loss of pigment
- Usually not painful or itchy
Eczema (atopic dermatitis)
Although it's not an autoimmune disease, some types of dermatitis happen because the immune system overreacts.
- Dry, itchy, inflamed skin
- Often occurs in the folds of the elbows and knees
- Tends to flare and fade
What can trigger an autoimmune rash?
Autoimmune rashes can be triggered by:
- Sun exposure
- Stress
- Illness or infection
- Certain medications
- Skin injury or irritation
- Weather changes
- Hormonal changes
- Food triggers, such as gluten
- Stopping or changing medications without medical guidance
How are autoimmune rashes diagnosed?
Many rashes can look very similar, even when they are caused by different things. A rash by itself usually isn't enough to figure out what’s wrong.
“There are thousands of distinct skin and systemic conditions but the skin can only show so many patterns: redness, swelling, scaling, itching, burning or blisters,” Hunter said.
Because many conditions look alike on the outside, your health care provider needs to consider everything (your symptoms, medical history and sometimes tests) to make an accurate diagnosis.
Your provider may use:
- Blood tests to check for signs of autoimmune disease or inflammation
- Skin biopsy (a small sample of skin) in some cases
- Collaboration with rheumatology and dermatology providers
How autoimmune rashes are treated
Treatment varies depending on the cause, how severe it is and how your body is affected. Autoimmune conditions are often long-lasting. The main goal is to control symptoms, prevent flare-ups and improve your quality of life.
Options may include:
- Topical or oral corticosteroids to reduce inflammation
- Oral medicines that calm the immune system
- Targeted therapies for specific autoimmune diseases
- Light therapy for some skin problems
- Making lifestyle changes like protecting your skin from the sun and eating a gluten-free diet
- Regular visits to specialists like dermatologists and rheumatologists
When to see your health care provider
You should schedule a visit if you have:
- A rash that lasts more than a few days
- A rash that spreads or keeps returning
- Skin changes with joint pain, fatigue or fever
- Thick, scaly, blistering or painful skin
- New or unexplained pigment changes
- A rash that gets worse after sun exposure
- Digestive symptoms with an itchy, blistering rash
- A known autoimmune condition with new skin changes
- Over-the-counter (OTC) care is not helping
Seek emergency care right away
Call 911 or go to the nearest ER if you notice a rash along with:
- Difficulty breathing or swelling of the face or throat
- High fever with a rapidly spreading rash
- A rash involving the eyes, mouth or genitals
- Signs of a skin infection, such as pus, warmth or severe pain
- Sudden, severe illness
Takeaway
Autoimmune rashes happen when the immune system mistakenly attacks the body’s own skin. They can look different from person to person and often come with other symptoms besides skin issues.
If you notice a rash that lasts a while, changes or comes with other symptoms, it's best to see your health care provider or a Banner Health specialist. They can help find out what’s causing it and suggest the right treatment for you.
Frequently asked questions about autoimmune rashes
What does an autoimmune rash look like?
An autoimmune rash can appear as red or scaly patches, raised bumps, purple spots, blisters, fragile skin, lighter or darker patches or a butterfly-shaped rash across the cheeks and nose. Many rashes look similar, so it's important to see a health care provider to find out the cause.
How do I know if my rash is autoimmune?
You cannot always tell by looking. A rash might be autoimmune if it lasts a long time, keeps coming back, gets worse in the sun or is paired with symptoms like joint pain, tiredness, fever, mouth sores or digestive issues.
Are autoimmune rashes itchy?
Some rashes are itchy but not all. Autoimmune rashes can also burn, hurt, blister, peel or feel swollen.
Can stress cause an autoimmune rash?
Stress can cause or make worse flare-ups in some autoimmune skin conditions but it's not usually the only cause.
What autoimmune disease causes a butterfly rash?
A butterfly-shaped rash on the cheeks and nose is often linked with lupus but a health care provider should check the rash and any other symptoms.
What autoimmune rash is linked to celiac disease?
Dermatitis herpetiformis is a very itchy skin rash that causes blisters. It is connected to celiac disease. The rash usually shows up on the elbows, knees, buttocks, scalp or back.
Can autoimmune rashes go away on their own?
Some rashes may get better and then come back. Others need treatment to reduce swelling and stop flare-ups. Repeating or worsening rashes should be checked by a health care provider.
What kind of doctor treats autoimmune rashes?
Usually, a dermatologist checks skin symptoms. Depending on the cause, other doctors like a rheumatologist, gastroenterologist, allergist/immunologist or your primary care provider might also need to help.
