Could I have Systemic Lupus? (photo)

I have been getting this rash probably about once a month for the past two years. It doesn't hurt and its not itchy, it just feels really hot. I was tested for lupus, and i had a positive ANA (1:320) but my doctor said that it was normal.. i experience raynauds, and sometimes i have a low WBC, and low HCT.

Doctor Answers 1

How to Diagnose Systemic Lupus Erythematosus

Hello Stephanie,
   You present a very interesting question and I know a very important and worrisome problem for yourself.  Neither I nor any physician can properly diagnose lupus in a forum such as this, but let me give you some general information, which you might be able to act upon.
   First of all, I am a dermatologist and the photo you show is of some concern.  It does have the appearance of the so-called "butterfly" or malar cheek rash.  But there are other disorders that can cause this appearance too.  For example, an irritant or contact dermatitis; a photosensitivity either on its own or as a result of something you have applied to the affected area; there is something called the erythemato-telangiectatic form of rosacea that could cause a similar picture; and there are other light sensitivities such as polymorphous light eruption.  All of that being said, I would want a skin biopsy along with some special testing called immunofluorescence testing.  Your dermatologist does this.
  Now, the positive ANA: Your level is not insignificant, however, a certain percentage of the population may have false positive ANA and be perfectly healthy.  So, the take-home lesson is that the ANA test must be interpreted along with the clinical symptoms that accompany it, and in light of any other medication you might be taking (this is because some medications may elicit a false positive ANA reaction).
  Now, for the low WBC count and blood count: Once again, the magnitude of these cytopenias is important, and other clinical factors must be taken into account.  For example, if you are a young menstruating woman, it is certainly not uncommon to see an anemia as a result.  The low WBC count is a bit different, and if the magnitude is significant, these cytopenias may be relevant to lupus. Alternatively, one may have something like a cyclical neutropenia, which is not related to lupus.
   You do not mention other clinical and laboratory information.  For example, do you have arthritis?  Is your kidney function normal?  Is your urinalysis normal?  Do you have other antibodies in your blood? Have you had any seizures?
   The Raynauds phenomenon (vasospasm of the fingertips in response to cold) may be seen with autoimmune disease such as lupus, but is most commonly seen with scleroderma...if it is associated with an immune disease at all.  So once again, alone, it may not be that relevant.
   So you asked the question:  COULD you have lupus, and unfortunately with the various manifestations mentioned above, you COULD.  But DO YOU is a different matter.  I would suggest you see both a board certified rheumatologist and dermatologist and let them work together to get to the bottom of your question...and hopefully you do not have a rheumatic disease, but just a mixture of various assorted issues.
   I hope this helps you.

Fort Myers Dermatologist

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