Lupus
Before getting into defining what Lupus is, I thought I should offer you some statistics to help you understand the different scopes of this illness & people suffering from it.
[The information for these statistics were gathered by LFA: Lupus Foundation of America]
• Approximately 1.5 million Americans have a form of lupus
• Of individuals diagnosed with lupus, 90% are women
• 80% develop lupus between the ages of 15 to 45
• Lupus is 2 to 3 times more common among people of color
• A survey from the LFA discovered that over 50% of respondents suffered for more than four years before their lupus was properly diagnosed; For most (in the same survey), it took trips to at least three doctors to get the correct diagnosis and nearly half were rightly diagnosed by a rheumatologist
• While the number of deaths attributed to lupus have been on the rise in the last 20 years, it is not known whether this represent an actual increase in mortality or just better identification and reporting of the illness.
• The survey participants cited pain (65%), lifestyle changes (61%), and emotional problems associated with lupus (50%) as the most difficult factors for coping with lupus.
• Four of ten lupus patients are treated by three or more doctors, and take six or more medications to treat symptoms of the disease
• About 5 percent of the children born to individuals with lupus will develop the illness
• 20 percent of people with lupus will have a parent or sibling who already has lupus or may develop lupus
What is Lupus:
Lupus
is a chronic, autoimmune disease that can damage any part of the body
(skin, joints, and/or organs inside the body). Chronic means that the
signs and symptoms tend to last longer than six weeks and often for
many years and in most cases for the rest of a patients’ life. In
lupus, something goes wrong with your immune system, which is the part
of the body that fights off viruses, bacteria, and germs ("foreign
invaders," like the flu).
Normally our immune system produces
proteins called antibodies that protect the body from these invaders.
Autoimmune means your immune system cannot tell the difference between
these foreign invaders and your body’s healthy tissues ("auto" means
"self") and creates auto-antibodies that attack and destroy healthy
tissue. These auto-antibodies cause inflammation, pain, and damage in
various parts of the body.
Lupus is also a disease of flares (the
symptoms worsen and you feel ill) and remissions (the symptoms improve
and you feel better). Lupus can range from mild to life-threatening and
should always be treated by a doctor. With good medical care, most
people with lupus can lead a full life.
Lupus is not contagious, not even through sexual contact. You cannot "catch" lupus from someone or "give" lupus to someone.
Lupus
is not like or related to cancer. Cancer is a condition of malignant,
abnormal tissues that grow rapidly and spread into surrounding tissues.
Lupus is an autoimmune disease, as described above.
Lupus is not
like or related to HIV (Human Immune Deficiency Virus) or AIDS
(Acquired Immune Deficiency Syndrome). In HIV or AIDS the immune system
is underactive; in lupus, the immune system is overactive.
What different forms of Lupus are there?
Systemic Lupus Erythematosus:
Systemic lupus is the most common form of lupus, and is what most people mean when they refer to "lupus." Systemic lupus can be mild or severe. Some of the more serious complications involving major organ systems are:
• inflammation of the kidneys (lupus nephritis), which can affect the body’s ability to filter waste from the blood and can be so damaging that dialysis or kidney transplant may be needed
• an increase in blood pressure in the lungs (pulmonary hypertension)
• inflammation of the nervous system and brain, which can cause memory problems, confusion, headaches, and strokes
• inflammation in the brain’s blood vessels, which can cause high fevers, seizures, behavioral changes,
• hardening of the arteries (coronary artery disease), which is a buildup of deposits on coronary artery walls that can lead to a heart attack
Cutaneous Lupus Erythematosus:
Cutaneous refers to the skin, and this form of lupus is limited to the skin also known as discoid lupus. Although there are many types of rashes and lesions (sores) caused by cutaneous lupus, the most common rash is raised, scaly and red, but not itchy. It is commonly known as a discoid rash, because the areas of rash are shaped like disks, or circles. Another common example of cutaneous lupus is a rash over the cheeks and across the bridge of the nose, known as the butterfly rash. Other rashes or sores may appear on the face, neck, or scalp (areas of the skin that are exposed to sunlight or fluorescent light), or in the mouth, nose, or vagina. Hair loss and changes in the pigment, or color, of the skin are also symptoms of cutaneous lupus.
Not everyone one who has cutaneous lupus will develop systemic lupus, only about 10 percent of people who have cutaneous lupus will develop systemic lupus. However, it is likely that these people already had systemic lupus, with the skin rash as their main symptom.
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It is
widely known that Michael Jackson was suffering from Discoid Lupus, so
I will be focusing more on this category of Lupus. Another famous
person suffering from Discoid Lupus is Seal, the singer. You might have
noticed the scars on his face (cheeks) those are due to his Lupus.
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Drug-induced Lupus Erythematosus:
Drug-induced
lupus is a lupus-like disease caused by certain prescription drugs. The
symptoms of drug-induced lupus are similar to those of systemic lupus,
but only rarely will any major organs be affected.
The drugs most
commonly connected with drug-induced lupus are hydralazine (used to
treat high blood pressure or hypertension), procainamide (used to treat
irregular heart rhythms), and isoniazid (used to treat tuberculosis).
Drug-induced lupus is more common in men because they are given these
drugs more often; however, not everyone who takes these drugs will
develop drug-induced lupus. The lupus-like symptoms usually disappear
within six months after these medications are stopped.
Neonatal Lupus:
Neonatal lupus is a rare condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb. At birth, the infant may have a skin rash, liver problems, or low blood cell counts, but these symptoms disappear completely after several months with no lasting effects. Some infants with neonatal lupus can also have a serious heart defect. With proper testing, physicians can now identify most at-risk mothers, and the infant can be treated at or before birth. Most infants of mothers with lupus are entirely healthy.
What causes Lupus?
Genes:
No gene or group of genes has been proven to cause lupus. Lupus does, however, appear in certain families, and when one of two identical twins has lupus, there is an increased chance that the other twin will also develop the disease. These findings, as well as others, strongly suggest that genes are involved in the development of lupus. Although lupus can develop in people with no family history of lupus, there are likely to be other autoimmune diseases in some family members. Certain ethnic groups (people of African, Asian, Hispanic/Latino, Native American, Native Hawaiian, or Pacific Island descent) have a greater risk of developing lupus, which may be related to genes they have in common.
Environment:
While a person’s genes may
increase the chance that he or she will develop lupus, it takes some
kind of environmental trigger to set off the illness or to bring on a
flare. Examples include:
• ultraviolet rays from the sun
• ultraviolet rays from fluorescent light bulbs
• sulfa drugs, which make a person more sensitive to the sun
• sun-sensitizing tetracycline drugs
• penicillin or other antibiotic drugs such as: amoxicillin ; ampicillin
• an infection
• a cold or a viral illness
• exhaustion
• an injury
• emotional stress, such as a divorce, illness, death in the family, or other life complications
• anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth
However, many people cannot remember or identify any specific factor that occurred before they were diagnosed with lupus.
Hormones:
Hormones
are the body’s messengers and they regulate many of the body’s
functions. In particular, the sex hormone estrogen plays a role in
lupus. Men and women both produce estrogen, but estrogen production is
much greater in females. Many women have more lupus symptoms before
menstrual periods and/or during pregnancy, when estrogen production is
high. This may indicate that estrogen somehow regulates the severity of
lupus. However, it does not mean that estrogen, or any other hormone
for that matter, causes lupus.
*******
We don't know
Michael Jackson's full medical history & that of his family, so
it's almost impossible to guess how he could have developed this
illness. It could be a mixture of genes & environmental factors. We
all know about his childhood & the trauma & stress he had to
deal with starting at the tender age of 5; that kind of trauma &
stress is known to cause many different physical complications such as
juvenile diabetes & Lupus.
*******
Diagnosing Lupus:
Unlike other chronic illnesses, trying to reach a diagnosis of lupus isn’t always easy. Because many symptoms of Systemic Lupus Erythematosus (SLE) mimic those of other illnesses, Lupus can be a difficult disease to diagnose. The diagnosis of Lupus is based off of a combination of physical symptoms and laboratory results and for most people is not a one time diagnosis. More often than not it is a diagnosis that evolves over time either towards more certainty that a person does or does not meet the criteria for a diagnosis of Lupus.
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We do know that Michael was diagnosed with Lupus around 1984, after he had the burn incident during the filming of the Pepsi commercial and by then his Vitiligo (change in pigmentation) had started to show. As mentioned in my previous post, loss of pigment is one of the side effects that could affect people who are suffering from Lupus. The de-pigmentation (aka Vitiligo) in men usually starts in upper portions of hands and groin. Vitiligo associated with Lupus is extremely aggressive and tends to affect more than 50% of the body.
I also would like to clarify that the drug-induced Lupus has nothing to do with drug abuse/addiction. Drug-induced Lupus is a direct result of an existing genetic complication that once combined with certain drugs leads to hyperactivity of the body’s immune system and Lupus. Therefore, for one to assume that Michael Jackson’s Lupus was caused by drug abuse is incorrect. Michael was diagnosed with Lupus while undergoing constructive surgery on his scalp. At that time Michael didn’t have any problems with prescription drugs and had already started developing some of the signs of Lupus, namely Vitiligo.
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How Lupus affects the body:
Since we’re looking into Lupus in relation to Michael Jackson, I am going to concentrate on the effect of Cutaneous Lupus on body. One important thing to keep in mind while looking into Lupus is that, people suffering from Systemic Lupus will at some point in their life develop symptoms of Discoid/Cutaneous Lupus, however, the reverse is not the case. If a person with Discoid/Cutaneous Lupus develops symptoms of Systemic Lupus, then it is concluded that they had Systemic Lupus all along and the original diagnosis was wrong.
Throughout the years it has been implied by different individuals that Michael Jackson was indeed suffering from Discoid/Cutaneous Lupus. The proof of that is his signature umbrella to protect him against sun rays, his Vitiligo, and many more other minor things that I will be pointing out throughout my posts.
So here is a look at how Discoid/Cutaneous Lupus affects body:
a) The Eyes:
• Blood vessel changes in the retina -- the light-sensitive lining inside the eye
• Changes in the skin around the eyelids
• Dry eyes
• The skin lesion is well-defined, slightly raised, scaly, and malformed
• Scarring may result in deformities along the edge of the eyelids
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So many speculations have been made throughout the years as to why Michael Jackson was so fond of his sunglasses - it could be a fashion statement, a way to hide away from the stalking crowd, or due to the hypersensitivity of his eyes to light as a result of Lupus, or all of the above. Can you imagine working hard under those strong stage lights? It could have had a painful effect on his eyes.
Also, many of you might remember the creditor’s claim that Dr. Klein made against Michael’s estate that included a long list of procedures Michael had done, amongst which were numerous Restylane, Botox, i.m. injections. These could very well be just cosmetic procedures (let’s face it, if we had the money & resources we would have loved to get rid of our aging lines too) but it may also seem more like a treatment measure taken to deal with the side effects of Discoid Lupus. As mentioned above, this type of Lupus causes lesions and deformities around the eyes, so injecting Restylane/Botox (which is a type of filler) is very common amongst Lupus patients who can afford it. Restylane and Botox injections are usually preceded by i.m. injection (i.e. Demerol) to reduce the pain of the procedures. It is understandable for someone in Michael’s position who is constantly in front of the cameras (whether he likes it or not) to be extremely self conscious and want to correct the skin deformities that could have been very well caused by Lupus. Throughout the years, the tabloids/media have worked hard on portraying everything related to Michael Jackson as bizarre and flamboyant. I hope after reading this post, you will be able to form your own opinion and distinguish the sensationalism caused by the media from the facts that could be very well related to a painful illness called Lupus.
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The Skin:
Skin disease in Lupus can cause rashes or sores (lesions), most of which will appear on sun-exposed areas such as your face, ears, neck, arms, and legs. It is worth mentioning that most of these skin conditions are chronic and need to be treated by a professional dermatologist. People with Discoid Lupus usually have disk-shaped, round lesions. The sores usually appear on your scalp and face, but sometimes they will occur on other parts of body as well. The color & texture of these lesions depend on the race and skin color of the sufferer. Usually they do not hurt or itch, but over time these lesions can produce scarring and skin discoloration (darkly colored and/or lightly colored areas depending on the patient’s original skin color). Many of you might know the singer Seal - he is famous for the scars on his cheek bones. Seal is also a Lupus sufferer, whose scars are caused by Discoid Lupus.
Another
effect that could be associated with Lupus, but is also recognized as a
separate condition is Vitiligo induced by Lupus. Vitiligo is mostly
considered a genetic illness, however, it is very common for people
with Lupus to suffer from skin discoloration named Vitiligo. It is
worth mentioning that if a person has the genetic defect that causes
Vitiligo as well as Lupus, their Vitilgo tends to be aggressive and it
will affect more than 50% of their body, usually starting from hands
and groin. You can imagine that for a person like Michael Jackson who
is always in the public eye, it is a big challenge dealing with the
Lupus lesions and Vitiligo, especially since his Vitiligo was
aggressive. So once the lesions had spread to his face and neck, the
best course of action for him would be to lighten the unaffected areas
in order to blend his skin color, hence the change from black to a very
pale white. Many Vitiligo and Lupus sufferers indicate that if they had
the financial resources, they too would use the same technique to
achieve a uni-tone skin color. So although many tried to say that
Michael Jackson was not proud of his race and attempted to change his
color, he was simply trying to look normal despite the illness that had
plagued him and his appearance.
The scars are hard to get rid of and
might be managed by plastic surgery, although since Lupus is an
autoimmune disease, it means that recovery from the scar tissue of such
surgeries is a long and difficult ordeal.
Many might recall that whenever asked about the number of plastic surgeries done on his nose, Michael Jackson would say not more than two, and many people would think it’s an understatement since his nose had changed remarkably throughout the years. But there’s a simple explanation for it: Michael could have had only two plastic surgeries done on his nose, but due to his Lupus, the scarring from the surgery is worsened by the Lupus. So not only does his body have to deal with healing the surgery scar tissues, but also the Lupus lesions. This means that he needed to get corrective surgery to get rid of the scarring. Corrective surgery means removal of the scarred tissue and this process goes on like a chain. So while he might have had only two nose jobs, he had to go through few corrective surgeries to deal with the scarred tissue and remove them; that means that he’s losing tissue hence the shrinkage of the nose.
Discoid lesions that occur on the scalp may cause hair fall, sometime this hair loss could be permanent. This could answer the speculation of Michael Jackson using wigs/hair extensions in recent years. Discoid Lupus is not life threatening and can be managed with proper treatment. The most important thing for people with Discoid Lupus is to avoid sun exposure, and while indoors, avoid prolonged exposure to fluorescent lights. That is the main reason Michael Jackson would carry an umbrella whenever he was outdoors.
Treating Lupus:
Unfortunately,
Lupus doesn’t have a cure. Health professionals continue to search for
better ways to care for and treat people with Lupus. For most people
with Lupus, proper treatment can minimize symptoms, reduce inflammation
and pain, and stop the development of serious organ damage.
Some of the common medications used to treat Discoid Lupus, its side effects, and the pain associated with them are:
• Common painkillers such as Aspirin, Tylenol, etc.
•
Steroid in forms of pills and creams (Discoid cases usually use
creams). In the list of medication found in Michael Jackson’s home were
Prednison tablets and Ultravate Ointment - both very commonly
prescribed to Lupus patients. [for detailed information refer to my
previous post on the medication found on the scene]
