15 Nose and Nasal Skin Changes Associated With Rosacea and Autoimmune Conditions

8. Lupus-Associated Nasal Lesions and Malar Involvement

Systemic lupus erythematosus frequently manifests with characteristic nasal and perinasal skin changes that can significantly impact diagnosis and disease monitoring, most notably the classic malar rash that extends across the nasal bridge and cheeks in a butterfly distribution. This distinctive eruption typically spares the nasolabial folds and presents as erythematous, sometimes scaly patches that may be photosensitive and can range from subtle pink discoloration to intense, edematous plaques. The nasal involvement in lupus often includes the nasal bridge, dorsum, and sometimes the nasal tip, creating a characteristic pattern that helps differentiate lupus from other inflammatory conditions affecting the face. Histopathologically, lupus-associated nasal lesions demonstrate interface dermatitis with basal cell vacuolization, dermal mucin deposition, and perivascular lymphocytic infiltration that can be confirmed through skin biopsy when diagnosis is uncertain. In some patients, nasal lesions may present as discoid lupus erythematosus with well-demarcated, scaly plaques that can lead to scarring and permanent pigmentary changes if left untreated. The photosensitive nature of many lupus-associated nasal lesions emphasizes the importance of sun protection and may help explain the predilection for sun-exposed areas like the nose. Additionally, lupus patients may develop nasal mucosal ulcerations, particularly in the setting of active systemic disease, which can cause pain, crusting, and potential complications including septal perforation in severe cases.