Clinically, many rheumatic and immune disease patients often visit multiple departments—orthopedics, dentistry, dermatology—before consulting a rheumatology specialist, yet remain unable to identify the root cause. Gu Weijie, Deputy Director of Dermatology at the PLA Air Force Medical Center, reminds us that rheumatic diseases frequently manifest as skin discomfort. Patients can use the following symptoms for preliminary assessment to accurately identify the appropriate department and implement meticulous care.
Facial Erythema
Dr. Wang Weiguo, Chief Physician at the Department of Rheumatology and Immunology, Huashan Hospital Affiliated to Fudan University, explains that butterfly rash is a characteristic manifestation of systemic lupus erythematosus (SLE). This symmetrical, butterfly-shaped erythema appears on the cheeks, causing itching but generally no pain.Additionally, exposed skin becomes highly photosensitive, with erythema appearing on areas like the nose and ears due to light exposure. During flare-ups, most patients also experience systemic symptoms including various types of fever, particularly low-to-moderate temperatures. Discoid lupus manifestations may accompany these symptoms, along with oral ulcers, fever, and fatigue.
Care Guidelines: 1. Maintain regular sleep patterns; avoid irritating foods; quit smoking and drinking; 2. Avoid photosensitizing foods (amaranth, shepherd's purse, etc.) and photosensitizing medications (ofloxacin, etc.). Continue consuming protein-rich foods like fish, meat, eggs, and dairy before renal impairment develops; restrict protein intake if renal damage occurs;3. Practice sun protection by wearing sunglasses, masks, and using umbrellas. Apply sunscreen as needed. For existing skin lesions, temporarily use mild corticosteroid creams (e.g., hydrocortisone butyrate) and moisturizers. 4. Avoid irritating cosmetics (e.g., whitening, spot-removing, or exfoliating products) containing ingredients like fruit acids or alcohol that may aggravate skin sensitivity.5. Keep skin warm, especially extremities. Joint Nodules Clinically, numerous conditions can cause nodule formation, commonly appearing near wrists, elbows, knees, and ankles. These subcutaneous nodules typically measure 2–5 mm in diameter, though some may reach 1–2 cm, varying in number. Rheumatoid nodules represent a specific type of subcutaneous nodule and are a hallmark manifestation of rheumatoid arthritis.Due to the fragility of small blood vessels at bony prominences, rheumatoid factors containing immune complexes deposit in these areas, forming nodules. Consequently, they often appear subcutaneously at joint protrusions and pressure points, such as fingers, toes, wrists, ankles, and knees.
Care methods: 1. If the patient experiences severe pain, apply Voltaren externally while treating the underlying condition; 2.Create a quiet, comfortable resting environment to prevent sensory overload from exacerbating pain. 3. Keep joints warm and avoid triggers like dampness or cold. Wear loose gloves during sleep for warmth. Soak stiff joints in warm or hot water before morning activities. 4. Wear loose clothing to prevent discomfort from friction or tightness on affected joints.5. Maintain a light diet, avoiding greasy, overly salty foods, and seafood products. Alcohol should be strictly avoided.
Eyelid Edema
Edematous erythema on both upper eyelids and around the orbital area is a classic dermatological manifestation of dermatomyositis. The erythema appears pale red or pink and may spread to the face, neck, and other areas. Additionally, patients may experience muscle weakness and pain.
Care Approach: Specific care for dermatomyositis resembles that for systemic lupus erythematosus, including maintaining regular routines, avoiding overexertion and sun exposure, supplementing with high-quality protein, and avoiding photosensitive foods and spicy/irritating foods. Skin lesion care involves topical moisturizers and short-term application of low-potency steroid ointments.It is important to note that 20% of dermatomyositis patients have concurrent tumors. Therefore, patients diagnosed with dermatomyositis should undergo tumor screening first. After ruling out tumors, treatment may include oral or injectable corticosteroids, hydroxychloroquine tablets, and methotrexate.
Recurrent Oral Ulcers
Behçet's disease, systemic lupus erythematosus (SLE), and Sjögren's syndrome may all cause recurrent oral ulcers. SLE ulcers commonly occur on the hard palate and buccal mucosa, while Sjögren's patients experience severe dry mouth due to salivary gland dysfunction.
Care Methods:Patients should maintain a vitamin-rich diet with fresh fruits, vegetables, and whole grains. Avoid spicy foods and hard-shelled seafood like shrimp and crab. Eat slowly during meals. If pain is severe, temporarily switch to liquid diets. Practice good oral hygiene after meals, avoiding mint-flavored toothpaste. Briefly rinse with baking soda solution post-meal to prevent fungal infections.