Lupus erythematosus panniculitis (LEP) is one of the less common types of lupus, which causes painful lesions under the skin.

Lupus is a chronic autoimmune disease affecting about 1.5 million people in the United States, according to the Lupus Foundation of America. There are several different types of lupus.

Panniculitis is a type of inflammation affecting your panniculus, which is a layer of fat just below your skin. Many conditions can cause panniculitis, including Crohn’s disease, diabetes, and rheumatoid arthritis.

Panniculitis can also be caused by lupus.

One of the less common types of lupus is called lupus erythematosus panniculitis (LEP). Sometimes this term is used interchangeably with “lupus erythematosus profundus,” but not all experts agree on whether these terms describe distinct conditions.

Let’s learn more about the causes, symptoms, and treatments available to people with LEP.

The most common symptom of LEP is the development of spots, called nodules, beneath your skin.

The nodules typically range in size from 1–5 centimeters, or from as small as a pencil eraser to as large as the end of an AA battery. They remain for a long period of time, and they can be painful.

Nodules can form anywhere on your body, but commonly affected areas include:

  • arms
  • shoulders
  • trunk
  • breasts
  • thighs
  • buttocks
  • face
  • scalp

In lighter skin tones, the skin around affected areas can appear red. It may be less noticeable on darker skin tones. If the inflammation is chronic or recurring, the spots may appear darker. In some cases, your skin might develop lesions. These areas might dimple, scar, or undergo tissue loss.

It’s possible for symptoms to go away on their own, but they often follow a cycle of flare-ups and remission.

The exact causes of lupus are unknown.

Lupus is an autoimmune disease, meaning that your body’s natural defense systems mistakenly attack healthy tissue as if it were diseased.

In the case of LEP, your immune system attacks the tissue of your panniculus below the surface of your skin, causing inflammation that eventually leads to the symptoms you’d start to notice.

Language matters

You’ll notice that “women” is used instead of “people assigned female at birth” when discussing stats and other data points in this article.

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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There are many types of lupus, and LEP is one of the rarer types. It can occur on its own, or at the same time as other types of lupus.

One 2020 review found that 62% of people with LEP also had either systemic lupus erythematosus (SLE) or discoid lupus erythematosus. In most of these cases, SLE or discoid lupus came before LEP.

Anyone can have LEP, but it’s most common among women between the ages of 30 and 60 years.

A family history of lupus or other autoimmune diseases may increase your risk of lupus. Other risk factors could include:

  • ultraviolet (UV) radiation exposure
  • some medications
  • cigarette smoking
  • some viruses
  • genetics

The inflammation and lesions caused by LEP can be painful. After lesions heal, they can result in scarring and tissue loss. This can have a significant emotional and psychological effect, especially when these complications affect more noticeable parts of your body, such as your face.

If you have LEP, the first priority is to reduce inflammation and prevent future flare-ups. Once the symptoms of LEP are well managed, a doctor may be able to help treat resulting tissue loss with dermal filler injections or other methods to help improve your mental well-being.

Speak with a doctor about the advantages and disadvantages of using fillers as a treatment. People with autoimmune conditions are more prone to experiencing side effects from fillers.

Because LEP symptoms can overlap with the symptoms of certain types of lymphoma, it’s important to get checked out promptly to be sure you’re starting the right treatment plan.

Lupus, when treated, isn’t generally a life threatening disease. However, untreated lupus can lead to complications with your kidneys, heart, and other organs. These complications can be serious, or even fatal.

To be certain, if you think you might have symptoms of LEP, you should try to make an appointment with a doctor for an evaluation.

LEP can frequently share the same symptoms of subcutaneous panniculitis-like T-cell lymphoma (SPTCL). This can lead to a misdiagnosis of either condition, resulting in using the wrong treatment plan.

It’s important to work with a doctor to ensure you get the correct diagnosis and treatment.

To diagnose LEP, a doctor will take a sample of the damaged area by using a procedure called a skin biopsy. The sample will be sent to a laboratory and examined under a microscope. The results of this test can be used to diagnose LEP.

The first treatment for LEP is usually steroids. These can take the form of topical creams or injections into your existing lesions.

Another common first-line treatment for LEP is antimalarial medication. This could include chloroquine or hydroxychloroquine (Plaquenil).

If these treatments aren’t effective, there’s no treatment that’s well tested and agreed upon by experts, although there are many small or individual case studies of successful treatment using medications such as:

There’s no known cure for lupus today.

You may still have some questions about LEP. Let’s take a look at some of the most common.

Is lupus panniculitis fatal?

Lupus, including LEP, isn’t generally a fatal disease when managed properly.

Lupus can affect many of the organs and systems of your body. Without treatment, lupus can lead to complications like kidney failure. These complications could be fatal if not addressed, but this is no longer common.

Can lupus panniculitis be cured?

There’s currently no known cure for lupus, which includes LEP.

However, the symptoms of LEP can be treated with medications and lifestyle changes. In many cases, flare-ups can be reduced and managed.

Lupus is an autoimmune disease with many subtypes. Lupus erythematosus panniculitis (LEP) is one of these subtypes.

It’s possible and even common to have LEP alongside other subtypes of lupus, but this won’t be true for everyone.

LEP features painful skin lesions that can scar and cause tissue loss. There are treatments available for both LEP and for the skin damage it causes.