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Is that true that the lupus rash won't turn white when you press on it? The rash on my face turns white when pressed and then goes red again. Does that mean it's not a lupus rash?
 

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I have started a separate thread for your question which arises from a comment made by a doctor

However, it wasn't really flaring when I saw him, and although there was a good red patch on one cheek he said it was pretty definitely rosacea rather than lupus, as when he pressed on it, it went white. Since being home I have had a flare of the butterfly rash, and guess what - apart from that little patch of red that is always there, the rest doesn't go white when you press it. ...............
All I can say is that I have never heard of blanching, going white, as a test for either lupus or rosacea skin or for distinguishing between them. Maybe it is one of those 'unofficial' things, a little rule of thumb, that's never been written about because it's not that important. However since it is quite often hard to know what is lupus related or not, I'd have thought there would be common mention of it. I will ask a lupus skin expert dermy what he thinks.

The picture sites of typical lupus skin problems are linked to in a sticky post about Skin and Lupus at the top of this section. I think they are of more interest than usefulness. Pictures are only two dimensional of course and even in the flesh, lupus skin can resemble other skin diseases.
Sometimes lupus skin is so untypical that even a good dermy can't tell and will order a biopsy. Sometimes even the biopsy can't be definite.

Your skin problems might be lupus related or might not be. You've taken photos of it and need to note what makes it worse, if it comes and goes when it occurs if there is a pattern for example is it worse before your periods and whether it itches or not and if there's a variety of forms - any blistering for example.

There is most often enough other evidence of lupus in symptoms and blood work.

Cheers
Clare
 

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Hi,

This is definately not true. The only rash that doesn't blanche is the vasculitic ones- purpura, petechia, echymosis. All other rashes will balnche. So it is of very little clinical value. By the way, a better check of blanching is not to press on it with your finger, but to press a clear glass onto it that you can look through whilst pressing. Most rashes do blanche, but sometimes the blood flows back so quickly you won't see the blanching just by pushing with a finger - hence the glass test.

The exception is meningitis, where multiple petechia (non blanching) can be a critical warning to get to the hospital quickly or for the doctor to act promptly.

Apparently it is very difficult to tell just by looking whether a malar rash is rosacia or the lupus rash (ACL). A biopsy is a better way of being sure.

Also, having rosacia and ACL are not exclusive. You can have both at the same time.

If you 'need' the malar rash to get a diagnosis, the best step is to have it biopsied. If you have a diagnosis already, then knowing precisely what it is is no longer so important.

X C X
 

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now I'm confused

It was me that made that original comment, which came from seeing Dr Khamashta recently at the London Lupus Clinic. From the photos of my face (over 10 years) he said it looked like a classic lupus rash. I have also had a lumpy bumpiness at times when it has flared in a different way too. I suspected that I had rosacea as well as the classic lupus butterfly, and several times had been told it looked like rosacea. However the day I saw Dr Khamashta it was only the lower part of my cheek (where the rosacea type rash is most obvious) that was red, and this is the bit he checked for blanching. I am sure that he said because it blanched it wasn't lupus. If either I misunderstood, or he got it wrong, then I'm back to square one, and I guess I should go for a biopsy. Last time a biopsy was suggested though they said they would take it from my face. Am I right in thinking that you should biopsy normal skin, and not the actual rash though? Or can you tell from a rash bit that it is lupus? I actually did have a biopsy from my arm some time ago but that just confused the issue as it showed macular amyloidosis with no evidence of lupus. In the end they decided I didn't have the macular amyloidosis anyway (because it didn't have the clinical appearance of it), so the whole exercise didn't get me any further.
 
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