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Doc: Could butterfly rash be start of systemic lupus?

October 1, 2018

Dear Dr. Roach: I am a 65-year-old woman, very active and in good health, my only medication being a daily 5-mg tablet of Exforge to control high blood pressure. My mother had systemic lupus erythematosus and passed away when I was 13 years old.

For the past three weeks I have had a smooth, bright-red butterfly-shaped blush over my upper cheeks and nose (like I have been sunburned and am very hot), and this is making me very anxious.

I can calm it down with a cold compress, but it returns a few hours later. I am not suffering any other symptoms. Could this be the onset of lupus?

V.J.

Dear V.J.: The term “lupus” is imprecise, since it can refer to any of several related diseases. Systemic lupus erythematosus — the kind your mother had, which was quite fatal 50 years ago and which still causes significant morbidity — is, as its name suggests, a multisystem disease. It often affects the skin, joints, gut, kidneys, bone marrow, blood vessels, eyes, heart and nervous system, but it can affect many others. A person must have findings in multiple organs to make the diagnosis of systemic lupus.

The butterfly rash you mention does sound very suspicious for lupus, but in the absence of other symptoms or findings on exam or laboratory, it would be most consistent with the diagnosis of cutaneous lupus (there are several subtypes).

A dermatologist is the expert to see for diagnosing the rash, and a rheumatologist is best positioned to diagnose and treat systemic lupus.

However, your regular doctor still may be the best person to start with. Given your family history, a careful exam and focused laboratory work to look for other possible signs might be a smart idea.

Dear Dr. Roach: Sadly, I have been plagued by anxiety for most of my life. I always thought that when I died, that would be the end of my problem. Now I worry about being buried ALIVE, like Sir Walter Scott’s mother.

With today’s embalming methods, is there still a chance of waking up in the coffin underground? The thought scares the hell out of me. I am considering cremation. Fifty-seven years of being afraid is enough.

B.R.

Dear B.R.: Taphophobia is the irrational fear of being buried alive. It is not an uncommon fear: Frederic Chopin and George Washington demanded that steps be taken to ensure that they were not buried alive. There are a few historical accounts (although I could find no reliable evidence that this happened to Anne Rutherford, Sir Walter Scott’s mother) and many fictional accounts of people being buried alive.

However, it isn’t impossible, as rare news accounts testify even today. This unfortunately increases the irrational fear.

I suspect this is related to your anxiety disorder, the treatment of which may help with this fear. It sounds as if it has had significant negative impact on your life. It’s time to consult a mental health professional.

Email questions to ToYourGoodHealth@med.cornell.edu.

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