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. May not be reproduced in any form without permission from the publisher, except fair uses permitted under Lupus Erythematosus 33
time to time, painful red nodules can form on the legs. Occasionally, these red nodules may
also ulcerate. Steroid therapy may make the skin thin, and more prone to damage and
infection.
Nails must be cut carefully; it is often easier and safer to file them rather than cut them,
particularly if they are thick or uneven. The patients feet should be washed and examined
daily for any damage or problems. Any dry skin should be kept moist with a good
moisturizing cream, to prevent cracks from occurring [113-114]. It is vital to wear well-
fitting, supportive footwear.
Ideally, shoes should also have a soft cushioned sole, a pliable yielding upper and fasten
firmly around the instep. There should be no high-pressure areas on the shoes which rub the
skin. Also, the feet must be kept warm. Two thin pairs of socks are warmer than one thick
pair; in cold weather, thermal insoles should be put into shoes and bed socks worn at night.
Lupus patients should visit a podiatrist on at least one occasion for foot care advice [113-
114].
mouthwash may be warranted. Approximately a third of lupus patients have some sort of eye
problem related to their disease. Fortunately, in most people only the surface of the eye is
affected [119]. Corneal dryness does not significantly affect the vision, and is readily treated
with eye drops. Much less commonly, the disease may involve the interior of the eye or the
visual pathways within the brain.
These complications may reduce vision and usually require systemic treatment, either by
oral or intravenous routes. A retinopathy due to antimalarial medications should also be
excluded in patients receiving this treatment [120]. Lupus may cause scleritis, which may
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