Rheumatic Conditions, Autoimmune Diseases, and the Skin: How does our skin relate to arthritis? – by Ashley Boynes

The skin is the largest organ of our bodies….but we so often forget about it. Don’t neglect your skin, and don’t ignore skin-related symptoms! There are many rheumatic autoimmune disorders that affect the skin. I personally have high autoimmunity, a few different conditions, and have had a slew of dermatologic issues ranging from vitiligo, to dermatofibroma, hives, dermagraphism, and a possible pilar cyst, and so I was determined to find the cause or at least a link. I can’t accept “oh, it just happens” as an explanation. I learned that some of these skin issues are quite common with autoimmune disorders. So, please, read on to learn about “arthritis and the skin!”

Perhaps the most obvious example of an arthritis-skin connection is Psoriatic Arthritis. Psoriatic arthritis is a chronic disease characterized by inflammation of the skin (psoriasis) and joints (arthritis). It is estimated that between five and 23 percent of people with psoriasis will develop psoriatic arthritis, according to the Arthritis Foundation Website. Psoriasis results in itchy patches of skin that have a red base with a silvery scale on top, often appearing on the scalp but it may appear anywhere on the body and will sometimes even affect fingernails, toenails, etc. Like other autoimmune disorders and rheumatic diseases, psoriatic arthritis can affect more than one part of the body and should be taken seriously as it can be quite debilitating.

Another example that is fairly well-known is the ‘butterfly rash’ associated with Lupus. In fact, this rash is one of the hallmark, telltale signs of systemic lupus erythematosus. SLE is an inflammatory, autoimmune disease that affects nearly every organ system in the body, including the skin, joints, kidneys, heart, lungs, and central nervous system. The Arthritis Foundation recognizes it as one of the 100 types of arthritis and related rheumatic disease, but while lupus shares many traits with RA and other arthritic conditions, it has other characteristics that make it stand on its own. One of the ways that many rheumatologists will be able to diagnose lupus is by the “butterfly rash” which is, “a rash that extends across the cheeks of the face and the bridge of the nose. It can be flat or raised; it can be bright red or it can be just a mild blushing, light pink coloration to the skin. It appears on the face in a pattern that looks like a butterfly; the wings are beneath both eyes and the body of the butterfly covers the bridge of the nose.” Lupus can affect the skin, too, by forming discoid rashes, as well.

These are not the only types of arthritis that can affect the skin. Scleroderma, another type, literally means “hard skin,” which is a finding common to a group of diseases that involves the abnormal growth of connective tissue. It is a “widespread connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs.” Patients with scleroderma may  have hardened skin, skin that is very light or very dark in color, skin that is particularly shiny, thickening of skin, a tight mask-like skin, ulcerations or white lumps on the skin, reddening of the skin, etc. and it usually presents with arthritis, joint pain, stiffness, or inflammation, as well as the possibility of respiratory, eye, or gastrointestinal problems.

Myositis, another form of rheumatic disease, has a specific subtype called dermatomyositis. When someone has dermatomyositis, certain skin symptoms usually come about prior to the joint and muscle symptoms, which makes myositis challenging to diagnose. Without the muscle or joint symptoms, it can be difficult for a doctor to know what the rash may be resulting from.

Patients with rheumatoid arthritis may even experience symptoms. RA can affect every major organ of the body – and this includes skin. People wtih RA can have a wide variety of non-specific skin changes including atrophic skin (thin, wrinkly, easy-to-bruise), pale or translucent skin on back of hands, brittle nails, thinning hair, reddened palms (also called palmar erythma.) Some RA patients will experience acne from the use of certain steroid medications given to treat the disease.

EDS, or Ehlers-Danlos syndrome, affects the skin, too. This condition is marked by a deficit in collagen production that may result in increased elasticity of the skin. Some signs of EDS relating to skin could be velvety-smooth skin, extra-stretchy skin, loose or sagging skin, abnormal wound healing and scar formation, fragile skin, more noticeable skin folds, and pseudotumors, benign skin tumors, or nodules. This is all coupled with hypermobility and displacement of the joints. (While EDS isn’t autoimmune in nature, it is an arthritis-related disease, which is why we are listing it.)

Sometimes, people with fibromyalgia (another non-autoimmune, arthritis-related disease) can experience rashes, itchy, tender skin, mottled skin, or dry skin, too. People with multiple sclerosis – which is sometimes classified as both rheumatic and neurologic – often have itching skin, too – particularly in reaction to heat.

With Sjogren’s Syndrome – in addition to autoimmunity and joint pain – patients will experience very dry mucosal glands including tear ducts and skin, as well!

There are many other associations of skin problems with autoimmune disorders. Some skin problems ARE autoimmune disorders – for example vitiligo (a skin condition in which there is loss of pigmentation/color  from an area of skin, resulting in irregular white patches that feel like normal skin) and autoimmune urticaria which is inflammation and an itchy, red rash caused from an autoimmune reaction.

All-over itching can also be a sign of an allergic reaction (to food, medications, chemicals in products, or environment) or even a kidney disorder, so if it lasts and is ongoing, be sure to consult a dermatologist, rheumatologist, or allergist to figure out what is going on!

After learning all of this, though, the most important “skin-related” thing to remember when living with arthritis or other autoimmune/rheumatic disease? Love the skin you’re in – no matter what! :)

Stay well,

Ashley Boynes


3 thoughts on “Rheumatic Conditions, Autoimmune Diseases, and the Skin: How does our skin relate to arthritis? – by Ashley Boynes

  1. I had chronic urticaria from CFS/ME. Luckily it responded very well to low dose naltrexone, like most of my major symptoms.

    Seborrhea is another skin condition that’s extremely common with many chronic diseases, at least CFS/ME and MS.

    I think you should make it clearer that EDS and fibromyalgia aren’t autoimmune conditions, just associated with them. Of course most of us already know it, but non-disabled people may be confused. :->

    • Thanks for clarifying. Maybe I will revise to make it more clear. The Arthritis Foundation does list both in their list of 100+ arthritis-related diseases which includes not just autoimmune conditions, but also rheumatic, connective tissue, and muscoskeletal disorders.

  2. I <3 this! Very informative & well written! I knew probably 85% of this, but most people don't, and it's interesting seeing it all clumped together. In the past, I've just read on one condition to another instead of grouping similarities. Wonderful idea.
    Dermatomyositis & polymyositis also have all-over itching. Even where there is no rash. My little one has MCTD with JDM, JA, Raynaud's & Scleroderma. We had attributed her itchiness to the Scleroderma. Makes sense, right? She noted that her Methotrexate injections made the itchiness go away for a while, but she's still very itchy. She has the red patches on her knees and elbows, the inflammation of the hands, the capillary abnormalities, and the classic heliotrope rash around the eyes. And then there's the steroid rash…

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