Laura J. Martin, MD
Amanda Greene, 43, stashes a tube of sunscreen in her purse and car so that she can reapply it throughout the day -- as frequently as some women touch up their makeup. Using sun protection is second nature for Greene, who was diagnosed with lupus (SLE) at 15 and is photosensitive.
"I use it from head to toe 365 days a year, whether it's gray or sunny," says Greene, a Los Angeles lupus advocate. "Some women reapply lipstick -- I reapply my SPF. It's part of living with lupus."
Women who have lupus need to take certain precautions managing their beauty regimens to avoid aggravating symptoms of the disease. WebMD talked to three lupus experts to determine the smartest steps you can take to protect your skin and look good at the same time.
Depending on the type of lupus you have, different recommendations may apply. You should talk to your lupus specialist about your individual concerns.
"There's a tremendous amount of confusion about sunscreens," says Andrew G. Franks, Jr., MD, director, Skin Lupus and Autoimmune Connective Tissue Disease Center and clinical professor of dermatology and medicine (rheumatology) at New York University School of Medicine. "Patients with lupus need to avoid ultraviolet [light]. We want them to be sun-conscious and sun-educated."
"It's very important, whether you're photosensitive or not," he says. You may not get a rash after UV exposure, but there could be an increase in auto-antibody production, which can create disequilibrium in the status of your lupus.
Franks recommends using the highest SPF, but emphasizes that sunscreen is not a substitute for taking common-sense precautions like sun avoidance or wearing sun-protective clothing. He says the current numbers only delineate UVB protection, but there is a star system in development that will spell out UVA protection.
"The key is to find a nonirritating, extremely broad-spectrum sunscreen to wear everyday," says Noelle Sherber, MD, dermatologist in private practice in Baltimore. Her top recommendation is La Roche Posay's Anthelios SX Daily Moisturizing Cream SPF15: "The active ingredient, Mexoryl SX, is uniquely effective due to its spectrum of UV protection that fills a gap in other chemical sunscreens in the short UVA range. The formula is gentle and moisturizing."
Although no other brand incorporates Mexoryl, sunscreens with added antioxidants provide an additional layer of defense, Sherber says.
For women with tumid lupus, a rare type of skin lupus that makes a person sensitive to sunlight, Sherber recommends sunscreens containing titanium dioxide and zinc oxide that reflect light. For touch-ups during the day, she recommends keeping a powder with sunscreen handy.
Sherber also recommends donning sun-protective clothing, especially to protect the chest area. "Your basic white T-shirt only has SPF 4," she says. You can buy clothing that has built-in SPF protection or use products that are designed to wash SPF into your clothing.
Some women with lupus get a telltale butterfly rash across the face. To treat this rash, your doctor may prescribe a topical anti-inflammatory immunosuppressant cream such as pimecrolimus (Elidel) or tacrolimus (Protopic).
Moisturizers can also be helpful for dry skin, but don't get rid of red marks unless they have some green tinting, says Victoria Werth, MD, a dermatology professor at the University of Pennsylvania School of Medicine and a member of the Lupus Foundation of America's Medical-Scientific Advisory Council.
To cover up lupus-related scars for darker pigmentation, she recommends a thick concealer like Dermablend or Covermark Cosmetics. Other lighter cosmetics can be used to camouflage lighter marks, she says.
Lupus advocate Greene says she favors the product line from Nicole Paxson Cosmetics, whose founder has lupus. She likes how the bronzer gives her that sun-kissed look without the UV risk. She also uses the line's "pudding", a super-thick foundation, to cover up any bruises that appear on her arms or legs.
Greene admits there are some days when it's hard to get out of bed, much less worry about what you look like when you're going to the grocery store. But she says, "Sometimes, if you look good, you can feel better."
Sherber suggests finding nonirritating skincare products that contain antioxidants like Vitamin C, which can neutralize free radicals and minimize inflammation. Make sure that it comes in an opaque bottle, she adds, so that the antioxidants are still active when it reaches your skin.
Women with lupus need to take precautions before seeking certain beauty treatments like Botox, fillers, or laser treatment. Some procedures can increase the risk of the Koebner phenomenon, which is when lupus develops in a skin area that's provoked or damaged.
"It's hard to generalize," Werth says. "Things that can irritate the skin can sometimes induce skin lesions, depending on the type of lupus. Autoimmune people have to be really careful. If there's any irritation or reaction, that could be a problem."
It's important to coordinate these procedures with your lupus specialist to make sure that your lupus is under control and in remission. "You can't do any of these procedures if the person has active disease," Franks says. "What I say is, 'You can't redecorate the house until you put the fire out.'"
Franks also recommends that patients undergoing procedures take a disease-modifying agent, such as an antimalarial drug, to avoid the Koebner phenomenon.
Seeking treatment to manage your lupus should be a critical part of your beauty regimen. "It's not just a matter of getting rid of the blemishes that are there, but trying to prevent new ones," Werth says.
Figuring out what works best for you is the optimal solution. "I have lupus, but I'm not lupus all the time," Greene says. "You can adjust your life and live beautifully."
SOURCES:Andrew G. Franks Jr., MD, FACP, director, Skin Lupus and Autoimmune Connective Tissue Disease Center and clinical professor of dermatology and medicine (rheumatology), New York University School of Medicine.Noelle Sherber, MD, dermatologist, Baltimore.Victoria Werth, MD, professor of dermatology, University of Pennsylvania School of Medicine; member, Lupus Foundation of America's Medical-Scientific Advisory Council.
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