Sjögren Rashes Signal Internal Organ Damage, Lymphoma Risks, Dray Says

Dr Dray

Cutaneous symptoms like palpable purpura reflect underlying small-vessel vasculitis and systemic organ complications in Sjögren syndrome rather than mere dry skin, requiring full diagnostic workups over simple topical treatments.

AI-assisted summary of Sjögren Syndrome: Skin Symptoms, Rashes & Hair Loss | Dermatologist Explains — original source. Check the original for full context.

Source published: 2026-09-24

Key ideas

A landmark study published in the British Journal of Dermatology revealed that 70.5% of Sjögren syndrome patients in an autoimmune clinic had cutaneous manifestations, most commonly pruritic dermatitis (34%), photosensitivity (27%), and Raynaud phenomenon (27%). (3:07)
Palpable purpura on the lower legs reflects underlying leukocytoclastic vasculitis and can signal cryoglobulinemia, which causes immune complexes to precipitate in cooler temperatures and jeopardizes renal, pulmonary, and neurological function. (9:43)
While most Sjögren syndrome patients never develop lymphoma, a distinct clinical subset exhibits heightened risk indicated by persistent salivary gland swelling, lymphadenopathy, recurrent palpable purpura, hypocomplementemia, and circulating cryoglobulins. (9:43)
Definitive diagnosis of Sjögren syndrome requires objective functional tests and tissue verification—including anti-SSA/Ro and anti-SSB/La serology, Schirmer tear measurement, and minor salivary gland biopsies—rather than reliance on subjective dryness or direct-to-consumer antibody panels. (18:38)

Detailed notes

## Background Published on YouTube by dermatologist Dr Dray on September 24, 2026, this video examines Sjögren syndrome from a dermatology perspective. Dr Dray breaks down how this autoimmune disease affects the skin and hair beyond classic dry eyes and dry mouth, outlining common rashes, vasculitis, diagnostic approaches, and practical skincare management.

## TL;DR While Sjögren syndrome is best known for dry eyes and dry mouth caused by autoimmune damage to exocrine glands, it is a systemic disease that frequently presents with cutaneous manifestations. Dr Dray explains key skin and hair findings, including severe xerosis, photosensitivity, palpable purpura secondary to cutaneous vasculitis, Raynaud phenomenon, and multifactorial non-scarring alopecia. She details the objective diagnostic workup—incorporating ANA, anti-SSA/Ro, and anti-SSB/La serologies alongside tear tests and salivary gland biopsies—while warning against direct-to-consumer testing. Ultimately, she emphasizes that while vascular signs warrant systemic evaluation for cryoglobulinemia or lymphoma risk, daily skin discomfort is typically best managed with straightforward, barrier-focused skincare.

## Atmosphere & style The presentation is clinical yet highly accessible, characterized by Dr Dray's trademark directness, measured delivery, and pragmatic reassurance. She demystifies complex rheumatologic and dermatologic concepts with calm precision, carefully contextualizing frightening red flags without inducing panic. The video feels like an informative and grounded consultation, methodically steering viewers away from self-diagnosis and product hype toward practical barrier care and appropriate medical guidance.

## Bulletin - [03:07](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=187s) A landmark study published in the British Journal of Dermatology revealed that 70.5% of Sjögren syndrome patients in an autoimmune clinic had cutaneous manifestations, most commonly pruritic dermatitis (34%), photosensitivity (27%), and Raynaud phenomenon (27%). - [09:43](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=583s) Palpable purpura on the lower legs reflects underlying leukocytoclastic vasculitis and can signal cryoglobulinemia, which causes immune complexes to precipitate in cooler temperatures and jeopardizes renal, pulmonary, and neurological function. - [09:43](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=583s) While most Sjögren syndrome patients never develop lymphoma, a distinct clinical subset exhibits heightened risk indicated by persistent salivary gland swelling, lymphadenopathy, recurrent palpable purpura, hypocomplementemia, and circulating cryoglobulins. - [18:38](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1118s) Definitive diagnosis of Sjögren syndrome requires objective functional tests and tissue verification—including anti-SSA/Ro and anti-SSB/La serology, Schirmer tear measurement, and minor salivary gland biopsies—rather than reliance on subjective dryness or direct-to-consumer antibody panels.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=0s) Sjögren syndrome is an autoimmune disease targeting exocrine glands—specifically lacrimal, salivary, and eccrine sweat glands—that triggers widespread systemic complications beyond mucosal dryness. - [03:07](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=187s) Skin manifestations affect over 70% of referred Sjögren patients, often providing critical early clues for diagnosing underlying autoimmune disease. - [05:12](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=312s) Xerosis stems from both an impaired epidermal barrier and diminished eccrine sweat output, with pruritus severity often presenting disproportionately to visible flaking. - [05:12](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=312s) Cutaneous dryness in Sjögren syndrome responds effectively to standard barrier-repair moisturizers containing petrolatum, glycerin, or ceramides, making specialized or expensive disease-branded products unnecessary. - [07:32](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=452s) Photosensitive rashes in Sjögren syndrome frequently overlap with systemic lupus erythematosus, though sunlight sensitivity can also be triggered by medications and unrelated dermatoses. - [08:42](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=522s) Palpable purpura on dependent extremities indicates small vessel vasculitis and demands thorough systemic investigation rather than being treated as simple dry skin irritation. - [09:43](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=583s) Cryoglobulinemia can accompany cutaneous vasculitis, producing viscous blood that obstructs small dermal and visceral vessels and requires close monitoring of internal organs. - [09:43](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=583s) Specific red flags—such as persistent parotid enlargement, low complement levels, and cryoglobulins—identify a higher-risk subgroup requiring surveillance for hematologic malignancies like lymphoma. - [12:00](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=720s) Raynaud phenomenon presents with a triphasic vascular spasm (white to blue to red) and occurs at higher rates in secondary Sjögren syndrome associated with systemic sclerosis or lupus. - [12:57](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=777s) Hair thinning in Sjögren patients is generally non-scarring and should not be reflexively blamed on Sjögren's alone, as telogen effluvium, alopecia areata, thyroid disease, and nutritional deficiencies from chewing difficulties are frequent culprits. - [14:14](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=854s) Less common cutaneous comorbidities like vitiligo, livedo reticularis, urticarial vasculitis, and erythema nodosum reflect broader autoimmune dysregulation and require diagnostic differentiation. - [15:53](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=953s) Dermatologists frequently serve as the initial point of detection for Sjögren syndrome through pattern recognition of unexplained rashes and diagnostic tissue biopsies. - [18:38](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1118s) Direct-to-consumer autoantibody tests carry a high risk of misinterpretation due to transient or non-specific positive results and should be avoided in favor of comprehensive physician workups. - [18:38](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1118s) Objective diagnostic confirmation requires anti-SSA (Ro) and anti-SSB (La) serology, Schirmer tear quantification, salivary flow tests, and minor salivary gland biopsies showing focal lymphocytic infiltration.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=0s) What Is Sjögren Syndrome?

When people hear about Sjögren syndrome, the first things that usually come to mind are severely dry eyes and a chronically dry mouth. Sjögren syndrome is an autoimmune disease where the body's immune system attacks exocrine glands—specifically the glands responsible for producing saliva, tears, and sweat. This is distinct from sebaceous glands, which produce oil (sebum). When the lacrimal glands fail to produce sufficient tears, patients develop a gritty, irritated feeling in their eyes, frequently accompanied by redness, extreme light sensitivity, and difficulty wearing contact lenses. Over time, this chronic lack of lubrication can cause lasting damage to the ocular surface.

In the mouth, a lack of saliva causes far more problems than simple discomfort. Saliva is essential for lubricating food to make chewing and swallowing possible, and it contains digestive enzymes such as amylase. It is also vital for dental health; without adequate saliva, patients experience dental pain, rapid cavity formation, and an altered oral microbiome that predisposes them to overgrowth of normal oral flora like *Candida*, leading to oral thrush. Beyond these glandular symptoms, Sjögren syndrome is fundamentally a systemic illness that can cause profound fatigue, joint pain, lung disease, kidney disease, and blood cell abnormalities.

Clinicians historically categorize the condition into primary Sjögren syndrome—occurring on its own without another linked autoimmune condition—and secondary Sjögren syndrome, which arises alongside systemic conditions such as systemic lupus erythematosus (lupus) or systemic sclerosis (scleroderma). While this distinction is useful in clinical research and helps explain overlapping symptom profiles, patients should not become overly stressed trying to pigeonhole their diagnosis, as both forms share significant management principles.

```mermaid flowchart TD accTitle: Exocrine Gland Involvement in Sjögren Syndrome accDescr: Diagram illustrating autoimmune destruction of exocrine glands and resulting clinical effects. A["Autoimmune Attack on Exocrine Glands"] --> B["Lacrimal Glands (Tears)"] A --> C["Salivary Glands (Saliva)"] A --> D["Eccrine Glands (Sweat)"]

B --> B1["Gritty eyes, redness, light sensitivity, ocular damage"] C --> C1["Chewing difficulties, cavities, oral thrush (Candida)"] D --> D1["Decreased thermoregulation & dry skin"] ```

---

[03:07](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=187s) Dermatologic Clues and the British Journal of Dermatology Study

Skin manifestations are surprisingly common in Sjögren syndrome, serving as initial clinical clues or warning signs of systemic involvement. A landmark study published in the *British Journal of Dermatology* evaluated 185 patients diagnosed with Sjögren syndrome seen in a specialized dermatology autoimmune clinic. While this cohort carries an inherent specialist referral bias toward more severe disease or overt skin complaints, approximately 70.5% of the evaluated patients presented with distinct cutaneous manifestations linked directly to their Sjögren syndrome.

Rather than presenting with a single characteristic rash, Sjögren syndrome displays a wide variety of hair, skin, and nail findings:

- **Dermatitis and Pruritus (34%):** Generalized skin inflammation and persistent itch were the most common complaints. - **Photosensitivity (27%):** Skin reactions or flares triggered by sun exposure. - **Raynaud Phenomenon (27%):** Vasospastic episodes in the extremities. - **Leukocytoclastic Vasculitis (17%):** Inflammation of small dermal blood vessels. - **Non-scarring Alopecia (10%):** Hair loss patterns that preserve the hair follicles rather than destroying them with scar tissue.

---

[05:12](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=312s) Dry, Itchy Skin (Xerosis) and Skin Barrier Management

The most straightforward dermatologic issue in Sjögren syndrome is xerosis, the medical term for dry skin. Although the term sounds basic, the resulting condition is often intense and remarkably uncomfortable. This dryness is driven by two combined mechanisms: a defect in the skin barrier itself and a marked reduction in the outflow of eccrine sweat, the watery perspiration that normally hydrates the surface and cools the body during heat exposure or exercise.

A critical clinical reality of Sjögren-related skin disease is that pruritus (itch) does not always correlate with the visual severity of the dry skin. A patient may present with mild, barely visible flaking while experiencing unrelenting, severe itching that disrupts daily life. Despite its autoimmune origin, the daily management of Sjögren-induced dry skin follows standard skin barrier repair principles:

- Use gentle body cleansers and avoid prolonged, scalding showers or over-bathing. - Generously apply moisturizers containing occlusive and humectant ingredients like petrolatum and glycerin, supplemented by ceramides where accessible. - Avoid searching for specialized, overpriced "Sjögren's specific" moisturizers or washes, as standard barrier-repair formulas work via the same mechanisms. - Consult a physician for topical anti-inflammatory prescription therapies if scratching and chronic dryness cause secondary dermatitis, rather than attempting to "persevere through just aggressive moisturizing."

---

[07:32](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=452s) Photosensitivity and the Overlap with Lupus

Sun-induced skin eruptions represent another notable cutaneous pattern. Diagnosing these can be challenging because systemic lupus erythematosus is also defined by pronounced photosensitivity, and the two diseases often overlap as secondary Sjögren syndrome. In the *British Journal of Dermatology* cohort, about 22% of the patients exhibited lupus-specific skin manifestations, and 28% experienced photosensitivity.

When a patient presents with dry eyes and mouth alongside sun-triggered rashes, physicians must evaluate whether they are dealing with Sjögren syndrome, lupus, or an overlap of both. However, photosensitivity by itself is not definitive proof of an autoimmune disorder, as it can readily be induced by photosensitizing prescription medications, dietary supplements, or unrelated inflammatory skin conditions such as rosacea.

---

[08:42](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=522s) Cutaneous Vasculitis and Palpable Purpura

Cutaneous vasculitis refers to inflammation directed at the blood vessel walls within the skin. When the small dermal blood vessels are attacked, blood leaks into the surrounding tissue, creating a distinctive clinical sign known as "palpable purpura."

These are red or purple spots that are literally palpable—meaning an examining dermatologist can feel that they are physically raised above the surrounding skin surface when running a hand over them or viewing them under angled tangential side lighting. Small vessel vasculitis characteristically settles in dependent areas, primarily appearing on the lower legs. In the published autoimmune cohort, leukocytoclastic vasculitis was documented in roughly 17% of patients. It is vital that patients do not mistake these red spots on their lower legs for simple irritation from dry skin, as palpable purpura reflects vascular inflammation that warrants thorough medical evaluation.

[09:43](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=583s) Cutaneous Vasculitis, Cryoglobulinemia, and Lymphoma Clues

Palpable purpura in Sjögren syndrome often points to underlying small vessel vasculitis occurring alongside generalized dry skin. Dr. Dray emphasizes that while small vessel vasculitis serves as an important clinical marker of systemic immune activity, it is not by itself diagnostic of Sjögren syndrome. Cutaneous vasculitis can arise secondary to an array of different medical conditions, infections, or medications. When a patient presents with these lesions, a dermatologist must first confirm the diagnosis of small vessel vasculitis and then embark on a broader medical workup to uncover the underlying cause, ordering tests tailored to the patient's individual clinical history.

```mermaid flowchart TD accTitle: High-Risk Features for Lymphoma in Sjögren Syndrome accDescr: Clinical and laboratory warning signs that indicate an elevated risk of lymphoma. subgraph Clinical["Physical Findings"] A["Persistent Salivary Gland Enlargement"] B["Palpable Purpura"] C["Lymph Node Enlargement"] end subgraph Lab["Laboratory Findings"] D["Low Complement Levels"] E["Cryoglobulinemia"] end Clinical --> F["Elevated Lymphoma Risk Subgroup"] Lab --> F ```

In many instances, this vasculitis occurs in association with cryoglobulinemia. Dr. Dray breaks down cryoglobulinemia in plain terms: the blood becomes unusually "sticky" because it contains abnormal circulating antibodies that precipitate or behave erratically in cooler temperatures. These abnormal immune complexes can plug up small vessels and cause severe downstream damage to internal organs, notably mucking up the kidneys, lungs, and nervous system. Because cryoglobulins indicate serious risks inside the body, their presence warrants close, proactive monitoring of pulmonary, renal, and neurological function rather than letting clinicians "sleep on all that."

Specific dermatologic and systemic warning signs also correlate with a heightened risk of lymphoma, a malignancy of the blood and lymphatic system. Dr. Dray reassures viewers that most people living with Sjögren syndrome will never develop lymphoma. However, certain persistent abnormalities identify a higher-risk subset of patients requiring vigilant surveillance: - Persistent, painless enlargement of the salivary glands (parotid or submandibular glands). - Generalized lymph node enlargement (lymphadenopathy). - Recurrent or widespread palpable purpura. - Depleted blood complement levels (hypocomplementemia), reflecting active immune complex consumption. - The laboratory presence of circulating cryoglobulins.

---

[12:00](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=720s) Raynaud Phenomenon and Autoimmune Overlap

Another classic clinical clue that frequently intersects with Sjögren syndrome is Raynaud phenomenon, a temporary vascular disorder affecting the extremities. Dr. Dray describes the characteristic triphasic color sequence seen when blood vessels spasm in response to cold or stress: one or multiple fingers or toes turn "bone white" due to a marked, sudden reduction in blood flow; as stagnant blood loses its oxygen, the digits transition to blue; and finally, as the vascular spasm subsides and the body mounts a corrective response, blood rushes back into the tissue, turning the skin bright red.

```mermaid flowchart LR accTitle: Triphasic Phases of Raynaud Phenomenon accDescr: Sequence of color transitions in the digits during a Raynaud attack. W["Phase 1: White (Arterial vasospasm & ischemia)"] --> B["Phase 2: Blue (Cyanosis & tissue hypoxia)"] B --> R["Phase 3: Red (Reactive reperfusion & hyperemia)"] ```

In the dermatologic cohort discussed, Raynaud phenomenon was documented in approximately 27% of patients overall. However, it was substantially more prevalent in individuals diagnosed with secondary Sjögren syndrome—meaning their Sjögren's coexisted alongside another connective tissue disorder. Dr. Dray points out that whenever a patient presents with Raynaud phenomenon, particularly when paired with photosensitive rashes, clinicians must aggressively evaluate for other systemic autoimmune conditions, most notably systemic sclerosis (scleroderma), an autoimmune disease she affectionately refers to as "this bad boy."

---

[12:57](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=777s) Hair Loss and Non-Scarring Alopecia

Hair loss can occur in the setting of Sjögren syndrome, presenting in the dermatologic cohort as non-scarring alopecia. Dr. Dray clarifies how dermatologists categorize hair thinning: the critical first distinction is whether the hair follicle is permanently destroyed (scarring alopecia) or preserved and capable of regrowth (non-scarring alopecia). However, she strongly cautions against the automatic assumption that non-scarring hair loss in a Sjögren patient is directly triggered by Sjögren syndrome itself.

Hair loss is notoriously multifactorial, and a full diagnostic evaluation is essential before assigning blame: - **Telogen effluvium:** Widespread, temporary shedding triggered by systemic physical stressors, chronic systemic inflammation, or illness. - **Alopecia areata:** A distinct autoimmune condition in which the immune system attacks the hair follicles directly, resulting in patchy hair loss. Because autoimmune disorders tend to cluster, having Sjögren syndrome elevates the baseline probability of developing concurrent alopecia areata. - **Nutritional deficiencies:** Profound xerostomia (dry mouth) can make chewing and swallowing painful or difficult, leading to poor dietary intake and subsequent nutrient deficiencies that trigger shedding. - **Autoimmune thyroid disease:** Hashimoto thyroiditis or Graves disease frequently co-occur with Sjögren syndrome, and thyroid hormone imbalances are notorious culprits behind diffuse hair thinning.

Because each of these underlying etiologies requires a completely different treatment plan, patients noticing hair loss should never simply shrug it off as an unavoidable symptom of Sjögren's, and clinicians must conduct an exhaustive workup just as they would for any other patient presenting with alopecia.

---

[14:14](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=854s) Additional Cutaneous Manifestations and Comorbidities

Dr. Dray reviews a collection of less common, yet clinically relevant, dermatologic presentations associated with Sjögren syndrome. While these conditions can each occur in individuals who have "not a lick of Sjögren's," recognizing them is helpful because they can signify overlapping autoimmune conditions or heightened systemic inflammation.

- **Livedo reticularis:** A mottled, purplish, net-like or lace-like vascular pattern across the skin caused by altered microcirculation. - **Urticarial vasculitis:** Intensely itchy or burning lesions that visually resemble ordinary hives (urticaria), but represent true vascular inflammation around the blood vessels; unlike typical transient hives, these individual wheals often persist longer than 24 hours and may leave subtle bruising. - **Erythema nodosum:** Tender, painful, inflammatory nodules that crop up deep under the skin, most characteristically on the lower legs and shins. - **Vitiligo:** Another autoimmune disorder where the immune system, having attacked the salivary and tear glands, "decided, 'Hey, while I'm at it, I'm going to attack the melanocytes,'" destroying pigment-producing cells and leaving patches of skin completely depigmented and "bone white." - **Lichen planus:** An inflammatory skin and mucosal condition producing itchy, polygonal, flat-topped violaceous papules. - **Erythema elevatum diutinum:** A very rare, chronic form of cutaneous leukocytoclastic vasculitis presenting as firm, red-to-brown or purplish papules, plaques, or nodules over extensor surfaces; Dr. Dray invites anyone in the audience diagnosed with it to "comment below cuz that is a rare one, but I have seen cases of it."

Dr. Dray issues a firm warning against trying to self-diagnose Sjögren syndrome based on Google image galleries of these rashes. None of these skin findings are exclusively diagnostic of Sjögren's; their true clinical utility lies in acting as diagnostic flags for physicians to screen for comorbid autoimmune illnesses and systemic complications.

---

[15:53](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=953s) Systemic Involvement and the Dermatologist's Clinical Role

Sjögren syndrome extends far beyond the simplified reputation of merely causing autoimmune dry eyes and a dry mouth. It is a full-body, systemic autoimmune disease that can affect virtually every organ system. Patients frequently endure debilitating, profound fatigue, chronic joint pain, inflammatory lung involvement, renal disease, and neurological complications. The skin is uniquely valuable simply because it is readily visible to the naked eye, allowing skilled observers to catch internal disease processes early if they know what to look for.

In the specialized dermatology cohort referenced by Dr. Dray, internal organ involvement was documented in approximately 66% of patients. She explains the critical role of referral bias in understanding that high statistic: patients who make it to a dermatologist's office represent a selected, specialized subset. Often, they have severe or atypical disease manifestations that have puzzled their primary care physician or rheumatologist—perhaps presenting with an unusual rash, or a classic lesion that looks unfamiliar across different skin tones. Other times, the managing specialist suspects the diagnosis but refers the patient to obtain the dermatologist's expert confirmation and biopsy.

```mermaid flowchart TD accTitle: Patient Pathways to Dermatologic Diagnosis of Sjögren Syndrome accDescr: The two distinct clinical routes through which patients with Sjögren syndrome interface with a dermatologist. subgraph Pathway1["Pathway 1: Specialist Referral"] A1["Known Sjögren's / Autoimmune Workup"] --> B1["Atypical Rash or Diagnostic Uncertainty"] B1 --> C1["Referral to Dermatologist for Biopsy & Confirmation"] end subgraph Pathway2["Pathway 2: Direct Presentation"] A2["Unexplained Skin Rash or Lesions"] --> B2["Patient Consults Dermatologist Directly"] B2 --> C2["Dermatologist Recognizes Pattern & Initiates Autoimmune Workup"] end ```

Conversely, many patients walk into a dermatology clinic with no prior autoimmune diagnosis at all. A patient might develop a bizarre, persistent rash that their regular physician cannot identify, prompting a direct consultation or self-referral. By recognizing specific visual morphological patterns on the skin, the dermatologist is often the very first medical provider to suspect an underlying systemic disease and order the comprehensive laboratory panels needed to uncover Sjögren syndrome.

---

[18:20](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1100s) The Diagnostic Puzzle: Beyond Dry Eyes and Mouth

Dr. Dray transitions into the complex mechanics of how Sjögren syndrome is officially diagnosed. While cardinal symptoms like persistent dry mouth (xerostomia) and severe dry eyes (keratoconjunctivitis sicca) raise immediate red flags, they are not diagnostic on their own. Countless medications, environmental factors, and age-related changes can cause dryness. Clinicians must gather objective evidence through formal clinical and laboratory testing, because there is no single, simple blood test that can conclusively deliver a straightforward "yes or no" answer on whether a patient has Sjögren syndrome.

[18:38](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1118s) Diagnostic Testing: Antibody Pitfalls, Biopsies, and Secretion Tests

Evaluating a patient for Sjögren syndrome involves interpreting specialized lab work, which can be tricky because autoantibodies often appear transiently under a variety of non-specific circumstances. Dr. Dray issues a firm warning against ordering these panels through direct-to-consumer lab testing services to self-diagnose. While these antibody tests are genuinely useful in clinical practice, navigating and interpreting the results without a physician is a "very, very dangerous path you can go on."

When doctors evaluate blood work for Sjögren syndrome, a positive ANA (antinuclear antibody) commonly provides an initial signal, accompanied by specific extractable nuclear antigen markers: anti-SSA (also known as anti-Ro) and anti-SSB (also known as anti-La). In addition to blood panels, objective clinical tests and tissue sampling are used to confirm glandular involvement. Providers will often perform a minor salivary gland biopsy to check for focal lymphocytic infiltration, where inflammatory lymphocytes cluster within the salivary gland tissue. Clinicians also measure glandular output directly using a Schirmer test to quantify tear outflow from the lacrimal glands, alongside objective tests that measure salivary flow rate.

```mermaid flowchart TD accTitle: Diagnostic Workup for Sjögren Syndrome accDescr: Flowchart outlining the laboratory, functional, and histologic testing used to diagnose Sjögren syndrome.

subgraph Serology["Serologic Testing"] ANA["ANA Screening"] SSA["Anti-SSA / Ro"] SSB["Anti-SSB / La"] ANA --> SSA ANA --> SSB end

subgraph Functional["Functional Secretion Tests"] ST["Schirmer Test (Quantifies tear outflow)"] SF["Salivary Flow Test (Measures saliva production)"] end

subgraph Histology["Tissue Evaluation"] BX["Minor Salivary Gland Biopsy (Shows focal lymphocytic inflammation)"] end ```

- Direct-to-consumer autoantibody testing is strongly discouraged due to the high risk of misinterpretation from transient, non-specific positive results. - Key diagnostic antibodies include anti-SSA (Ro) and anti-SSB (La), frequently presenting alongside a positive ANA. - A Schirmer test quantifies ocular tear production, while salivary flow tests evaluate oral dryness. - Minor salivary gland biopsy confirms diagnosis by demonstrating focal lymphocytic inflammation within the gland.

[19:54](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1194s) Skin Management and Treatment Realities

When managing the cutaneous manifestations of Sjögren syndrome, the effective therapeutic approach can sound surprisingly basic. Dr. Dray notes that although it might feel "underwhelming," the vast majority of skin issues that arise do not require heavy, specialized dermatologic therapies or disease-specific systemic prescriptions. Instead, consistent, gentle skincare regimens centered on mild cleansers and barrier-supporting moisturizers are typically what make the most substantial difference in relieving persistent dryness and irritation.

- Most cuticular issues related to Sjögren syndrome respond effectively to fundamental barrier care rather than complex, specialized dermatologic medications. - Prioritizing gentle skincare practices and regular moisturizer application addresses the vast majority of everyday cutaneous discomfort.

[20:14](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1214s) The Bottom Line and Autoimmune Overlap

Dr. Dray emphasizes that Sjögren syndrome must be recognized as a systemic autoimmune disease rather than a condition restricted solely to dry eyes and dry mouth. While sicca symptoms are classic hallmarks, the skin frequently presents critical clues that point toward an underlying autoimmune process.

Patients diagnosed with Sjögren syndrome face an elevated risk of developing concurrent autoimmune conditions. Dr. Dray encourages viewers to remain aware of skin warning signs that could indicate related diseases, directing them to her other dedicated educational videos on: - Vitiligo - Alopecia areata - Systemic sclerosis (scleroderma) - Systemic lupus erythematosus (SLE)

Closing out the video, Dr. Dray thanks the community for requesting coverage of Sjögren syndrome, signs off with her signature reminder to "don't forget sunscreen and subscribe," and promises to talk to everyone tomorrow.

## Notable quotes > [05:12](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=312s) persevere through just aggressive moisturizing — Dr. Dray

> [08:42](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=522s) palpable purpura — Dr. Dray

> [09:43](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=583s) sleep on all that — Dr. Dray

> [12:00](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=720s) bone white — Dr. Dray

> [12:00](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=720s) this bad boy — Dr. Dray

> [14:14](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=854s) not a lick of Sjögren's — Dr. Dray

> [14:14](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=854s) decided, 'Hey, while I'm at it, I'm going to attack the melanocytes,' — Dr. Dray

> [14:14](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=854s) comment below cuz that is a rare one, but I have seen cases of it — Dr. Dray

> [18:38](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1118s) very, very dangerous path you can go on — Dr. Dray

> [19:54](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1194s) underwhelming — Dr. Dray

> [20:14](https://www.youtube.com/watch?v=rec-vcmQ6Sc&t=1214s) don't forget sunscreen and subscribe — Dr. Dray

## Mentioned Dr. Dray, British Journal of Dermatology, Candida, Hashimoto thyroiditis, Graves disease

## Video description Sjögren syndrome is a systemic autoimmune disease best known for causing dry eyes and dry mouth, but its effects can extend well beyond the salivary and lacrimal glands. In this video, dermatologist Dr. Dray explains Sjögren syndrome from a dermatology perspective, including the skin symptoms and other dermatologic findings that may occur with this condition.

Sjögren syndrome can be associated with dry, itchy skin, photosensitive rashes, Raynaud phenomenon, purpura, cutaneous vasculitis, hair loss, and other inflammatory skin conditions. Recognizing these findings can sometimes provide an important clue that a patient may have an underlying systemic autoimmune disease.

Dr. Dray discusses how Sjögren syndrome affects the skin, what different rashes can look like, why palpable purpura and vasculitis deserve medical evaluation, and how hair loss should be evaluated rather than automatically attributed to Sjögren syndrome.

The video also explains how Sjögren syndrome is diagnosed, including anti-SSA/Ro antibodies, Schirmer testing, salivary gland testing, and, in some cases, minor salivary gland biopsy, as well as practical approaches to treating dry, itchy skin and other skin manifestations.

Topics covered:

0:00 Introduction 0:35 What Is Sjögren Syndrome? 3:07 The Skin Can Be an Important Clue 5:12 Dry, Itchy Skin 7:32 Rashes and Photosensitivity 8:42 Purpura and Vasculitis 12:00 Raynaud Phenomenon 12:57 Hair Loss 14:14 Other Skin Findings 15:53 Sjögren Syndrome Is More Than Dry Skin 18:20 How Is Sjögren Syndrome Diagnosed? 19:54 How Is the Skin Treated? 20:14 The Bottom Line

Important: Dry skin, dry eyes, dry mouth, hair loss, Raynaud phenomenon, or a rash are common symptoms with many possible causes and do not by themselves mean someone has Sjögren syndrome. This video is for educational purposes and is not intended to diagnose or treat an individual medical condition. Anyone with persistent or concerning symptoms should discuss them with a qualified healthcare professional.

#SjögrenSyndrome #Sjogrens #AutoimmuneDisease #Dermatology #SkinHealth #DrySkin #SkinRash #HairLoss #RaynaudPhenomenon #Vasculitis

FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links.

💜Shop my Amazon store https://o.bttn.io/0BwiPWFIZLG 💜Follow me on liketoknowit https://www.liketoknow.it/drdrayzday 💜Social media Instagram @drdrayzday Pinterest https://www.pinterest.com/drdrayzday/ Facebook @DrDrayzDay Twitter: @drdrayzday Tiktok: @drdrayzday

Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=rec-vcmQ6Sc)

中文简报

干燥综合征的皮肤症状、皮疹与脱发：皮肤科医生详解 Dray医生解释称，干燥综合征（Sjögren syndrome）是一种全身性自身免疫性疾病，其累及的外分泌腺不仅限于泪液和唾液分泌腺，还会显著影响外泌汗腺及皮肤屏障。严重瘙痒、白细胞碎裂性血管炎引起的可触及性紫癜、光敏性以及雷诺现象（Raynaud phenomenon）等皮肤表现，既可作为早期诊断线索，也可能提示与红斑狼疮或硬皮病等疾病存在重叠。视频还强调了冷球蛋白血症和淋巴瘤等并发症的预警指标，告诫患者切勿自行诊断脱发或自行购买面向消费者的抗体检测套餐，并详细介绍了包括抗SSA/SSB血清学检测、Schirmer试验、小唾液腺活检在内的标准诊断流程，以及温和修护屏障的皮肤护理方法。《英国皮肤病学杂志》（British Journal of Dermatology）发表的一项里程碑式研究显示，在皮肤科专科门诊就诊的干燥综合征患者中，约70.5%出现了可直接归因于该病的皮肤表现。 (3:07) 干燥综合征患者的皮肤干燥程度往往与瘙痒严重程度脱节，这意味着患者即使表面仅有轻微或几乎察觉不到的脱屑，也可能承受剧烈且令人极度痛苦的瘙痒。 (5:12) 特定的临床指标——尤其是可触及性紫癜、冷球蛋白血症、低补体水平和持续性唾液腺肿大——提示存在高危亚群，需密切监测全身器官损伤及淋巴瘤的发生。 (9:43) 干燥综合征引起的头发变稀疏通常属于非瘢痕性脱发，在评估休止期脱发、营养缺乏或合并存在的其他自身免疫性疾病之前，不应直接将其归咎于干燥综合征本身。 (12:57)

Reading summary

Dermatologist Dr Dray explains that while Sjögren syndrome is primarily known for causing severely dry eyes and mouth, cutaneous manifestations frequently serve as critical indicators of systemic immune activity, organ involvement, and comorbid autoimmune diseases. Exocrine Gland Damage and Systemic Disease (0:00) Sjögren syndrome is an autoimmune disease where the immune system attacks exocrine glands—specifically the lacrimal, salivary, and eccrine (sweat) glands, while sparing sebum-producing sebaceous glands. Decreased tear production causes ocular surface irritation and light sensitivity, while insufficient saliva leads to swallowing difficulties, rapid dental decay, and opportunistic infections such as oral thrush (Candida). Although historically categorized as primary or secondary based on coexisting connective tissue disorders, Dr Dray emphasizes that both types share fundamental management principles and can cause systemic complications, including profound fatigue, joint pain, and pulmonary or renal disease. Xerosis, Pruritus, and Skin Barrier Repair (5:12) A study in the British Journal of Dermatology evaluated 185 Sjögren syndrome patients at a specialized autoimmune clinic and identified cutaneous manifestations in approximately 70.5% of cases, though Dr Dray notes this reflects an inherent specialist referral bias. The most frequent issues include dermatitis and pruritus (34%), photosensitivity (27%), and xerosis. This severe dryness stems from both skin barrier defects and diminished eccrine sweat output. Crucially, the intensity of itching often does not correlate with visible flaking. Management focuses on standard skin barrier restoration rather than costly condition-specific products. Dr Dray advises using gentle cleansers, avoiding long, hot showers, and applying moisturizers formulated with humectants and occlusives such as glycerin, petrolatum, and ceramides. If secondary dermatitis develops from chronic scratching, prescription topical anti-inflammatory treatments are required rather than attempting to rely solely on aggressive moisturizing. Vasculitis, Cryoglobulinemia, and Lymphoma Indicators (9:43) Roughly 17% of patients in the dermatology cohort presented with leukocytoclastic vasculitis, characterized by palpable purpura—raised, non-blanching red or purple spots typically found on dependent areas like the lower legs. These lesions often coincide with cryoglobulinemia, in which abnormal circulating antibodies precipitate at lower temperatures, risking vascular occlusion and damage to the kidneys, lungs, and nervous system. Raynaud phenomenon occurred in 27% of the cohort and was notably more prevalent in secondary Sjögren syndrome, warranting screening for systemic sclerosis. While most individuals with Sjögren syndrome do not develop lymphoma, Dr Dray identifies a distinct high-risk subset requiring vigilant surveillance. Warning markers include persistent, painless salivary gland enlargement, generalized lymphadenopathy, recurrent palpable purpura, low blood complement levels, and circulating cryoglobulins. Diagnostic Workup and Autoimmune Overlaps (18:38) Hair loss in Sjögren syndrome typically presents as non-scarring alopecia (documented in 10% of the cohort), but Dr Dray cautions that it should not automatically be blamed on Sjögren's directly. Alopecia requires a full differential workup to evaluate for telogen effluvium, concurrent alopecia areata, nutritional deficiencies caused by painful swallowing, or comorbid autoimmune thyroid disease. Diagnosing Sjögren syndrome requires objective clinical and laboratory validation rather than reliance on sicca symptoms alone, which can stem from medications or aging. Dr Dray firmly discourages direct-to-consumer autoantibody testing due to the complexity of interpreting transient, non-specific antibodies. A definitive diagnosis integrates screening for antinuclear antibodies, anti-SSA (Ro), and anti-SSB (La), quantitative functional secretion tests (such as the Schirmer test for tears and salivary flow measurements), and a minor salivary gland biopsy demonstrating focal lymphocytic infiltration. Cutaneous symptoms in Sjögren syndrome range from basic barrier failure to severe vascular inflammation, functioning as accessible visual windows into broader autoimmune activity. While everyday skin symptoms usually resolve with standard gentle barrier care, recognizing complex presentations such as palpable purpura and overlapping connective tissue disorders ensures timely systemic surveillance.

Source quotes

[5:12] Dr. Dray: persevere through just aggressive moisturizing [8:42] Dr. Dray: palpable purpura [9:43] Dr. Dray: sleep on all that [12:00] Dr. Dray: bone white [12:00] Dr. Dray: this bad boy [14:14] Dr. Dray: not a lick of Sjögren's [14:14] Dr. Dray: decided, 'Hey, while I'm at it, I'm going to attack the melanocytes,' [14:14] Dr. Dray: comment below cuz that is a rare one, but I have seen cases of it [18:38] Dr. Dray: very, very dangerous path you can go on [19:54] Dr. Dray: underwhelming [20:14] Dr. Dray: don't forget sunscreen and subscribe

Original transcript

[0:00] Well, hey guys. Welcome back. And if [0:01] you're new here, I'm Dr. Dray. I'm a [0:03] board-certified dermatologist. When you [0:06] hear Sjogren's syndrome, if it's not [0:08] your first time hearing about it, maybe [0:10] you'd think, "Hmm, isn't that that thing [0:12] that causes your mouth to be really dry [0:14] and for you to have dry eyes?" And [0:15] that's correct. Sjogren's disease is an [0:17] autoimmune condition that affects the [0:19] glands that make saliva in our mouth and [0:22] tears in our eyes. But, Sjogren's [0:24] syndrome is a systemic disease, and as a [0:26] dermatologist, there are some very [0:28] important skin clues that need to be [0:31] recognized, identified, and can be [0:33] game-changing for making the diagnosis. [0:35] If you've never heard of Sjogren's [0:37] syndrome before, it's an autoimmune [0:38] disease where your body attacks glands, [0:41] specifically the glands that make [0:44] saliva, tears, and sweat. These are [0:46] known as exocrine glands. This is in [0:48] contrast to those oil glands in your [0:50] skin that make sebum, aka oil. When the [0:53] glands in your eyes don't produce enough [0:55] tears, that leads to the sensation of [0:57] dry, gritty eyes, leaving the eyes prone [1:00] to redness and irritation. And they can [1:02] go on to be become very sensitive to [1:04] light. It can be very difficult to even [1:06] put in contact lenses. That chronic [1:08] dryness in the eyes can lead to ocular [1:10] surface damage over time. And when the [1:12] salivary glands in your mouth don't [1:14] produce enough saliva because they're [1:16] being attacked by your immune system, [1:18] well, that leads to, yes, dry mouth. [1:20] But, saliva helps to lubricate our food [1:23] to make it easier to chew, and it [1:25] releases enzymes like amylase that are [1:28] very important for digestion. Not to [1:30] mention, it's pivotal in maintenance of [1:33] dental health. And the decline in saliva [1:35] production can lead to pain in the mouth [1:37] and problems with your teeth, cavities. [1:40] It also changes the microflora in your [1:42] mouth to have a decrease in saliva, and [1:44] that predisposes you to overgrowth of [1:47] the yeast that naturally lives in [1:49] everyone's mouth. As a side note, [1:51] candida. You can develop a condition [1:53] known as thrush, which is very [1:54] uncomfortable. Sjogren's syndrome, [1:56] however, is not simply limited to dry [1:59] eyes, dry mouth, and these [2:00] complications. It's a systemic disease. [2:02] It can lead to significant fatigue, [2:04] joint pain, lung disease, kidney [2:06] disease, problems with the blood cells. [2:09] There's also an important distinction [2:10] between what is traditionally called [2:12] primary Sjögren syndrome and secondary [2:14] Sjögren syndrome. Primary Sjögren [2:16] syndrome refers to Sjögren syndrome that [2:19] is not occurring in association with [2:21] other autoimmune diseases. The term [2:23] secondary Sjögren syndrome, however, has [2:26] historically been used to describe cases [2:28] of Sjögren syndrome that are occurring [2:30] in someone who has another autoimmune [2:33] systemic disease, like lupus or systemic [2:36] sclerosis. And as a side note, I have [2:38] videos on these conditions and their [2:40] respective skin warning signs, so [2:42] definitely check those out if you are [2:43] someone who is in the midst of trying to [2:45] navigate autoimmune conditions. I'm [2:47] merely pointing this distinction out to [2:49] you guys cuz it'll come up later on in [2:51] this video, but don't get too hung up on [2:54] these details and trying to figure out [2:56] if yours is primary or secondary. It [2:59] really is meant for the purposes of a [3:01] research setting primarily, so I [3:03] wouldn't put too much emphasis on it, [3:05] but like I said, it will come up in this [3:07] video. One of the reasons Sjögren [3:09] syndrome is interesting from a [3:11] dermatologist perspective is that skin [3:14] manifestations are actually pretty [3:15] common. And again, they can be not only [3:18] some of the first indicators of Sjögren [3:21] syndrome, but they also can signal [3:23] potential risk factors that are unique [3:26] to some subgroups of Sjögren syndrome. [3:28] One very informative study was published [3:31] in the British Journal of Dermatology. [3:33] This study looked at 185 patients with [3:36] Sjögren syndrome who were being seen [3:38] through a dermatology autoimmune disease [3:41] clinic. Not necessarily representative [3:43] of everyone with Sjögren syndrome, you [3:45] are getting that specialist referral [3:47] bias there of probably more extensive [3:50] cases, cases that of course likely by [3:53] nature being referred to the [3:55] dermatologist have some sort of [3:56] cutaneous manifestation, but [3:58] approximately 70.5% of these patients [4:01] did in fact have some form of a skin [4:03] manifestation that was teased out and [4:05] thought to be specific to the Sjogren's [4:08] and not some bystander. And the most [4:09] common dermatitis, which is just an [4:12] umbrella term for inflammation of the [4:13] skin, not really diagnostic or helpful [4:15] as a side note, or pruritus, which is [4:18] the medical term for itch. This happened [4:20] in about 34% of the patients in this [4:22] paper. Photosensitivity, [4:24] meaning problems with your skin in the [4:27] sun, happened in about 27%. Then a [4:29] condition known as Raynaud's phenomenon, [4:31] which we'll talk more about later in the [4:33] video, that happened in 27% and another [4:35] condition we're going to talk about in [4:37] detail, leukocytoclastic vasculitis, 17% [4:41] of patients. Also, hair, 10% of patients [4:44] had a non-scarring alopecia. Alopecia is [4:47] just the medical term for hair loss. In [4:49] a dermatology we break hair loss into [4:51] scarring and non-scarring diagnoses. [4:54] There isn't one single Sjogren's [4:56] syndrome rash. Not everyone with [4:58] Sjogren's syndrome has cutaneous [5:00] manifestations, but research suggests [5:02] and clinical experience suggests that [5:05] clinical findings on the skin, the hair, [5:07] and the nails, they're not rare in [5:09] Sjogren's syndrome and can be very [5:11] helpful manifestation. Probably the most [5:14] straightforward dermatologic [5:15] manifestation is, are you ready for this [5:18] complicated diagnosis? Xerosis. Sounds [5:21] scary. You know what? It means dry skin. [5:23] It's a medical term for dry skin, but it [5:25] can be surprisingly uncomfortable and [5:28] intense [clears throat] with Sjogren's [5:29] syndrome. There might be something else [5:31] going on, really, that leads to the dry [5:34] skin here, some sort of problem with the [5:37] barrier. And so, it does end up being a [5:39] very common manifestation coupled with a [5:42] reduction in the outflow of eccrine [5:45] sweat, which is a sweat your body [5:46] produces to cool yourself when you get [5:49] hot, like when you're working out, for [5:50] example. Itch can be a particularly [5:53] particularly important and it can easily [5:55] be overlooked or dismissed because, [5:58] contrary to what you might think, the [6:00] dry skin and the itch don't necessarily [6:03] go hand-in-hand, meaning you can have [6:05] kind of mild to barely noticeable dry [6:08] skin and be incredibly incredibly itchy. [6:10] From a practical standpoint though, the [6:13] treatment for the itch the dry skin, the [6:15] treatment approach is the same as for [6:18] anyone who has dry skin and itch. So, [6:21] I'm telling you that because if you're [6:22] someone who has Sjogren's syndrome, [6:24] you're coping with the dry skin, the [6:25] itch, you're like, "Oh, okay, it's my [6:27] barrier. What do I do?" Check out my [6:29] videos on how to repair the skin barrier [6:32] and all of my videos on dry skin care, [6:35] tips for dry skin. Just put into the [6:37] YouTube search bar Dr. Dray skin [6:39] barrier, Dr. Dray impaired barrier, Dr. [6:42] Dray dry skin, Dr. Dray itchy skin. I [6:45] have a whole playlist. So, these videos [6:47] These videos will serve you. Just [6:49] because they don't say Sjogren's in the [6:50] title, the problem is the same, the [6:53] management is the same. There's not a [6:55] Sjogren's unique moisturizer. There's [6:57] not a Sjogren's unique body wash. The [6:59] same tips for Sjogren's dryness and itch [7:02] are the same tips everyone gets for [7:04] dryness and itch. Moisturizers with [7:05] petrolatum, glycerin, maybe ceramides if [7:08] you can, you know, if you can get them. [7:10] Not necessary, but maybe additionally [7:12] helpful. Avoiding over bathing, long [7:15] showers. If a rash develops secondary to [7:18] the scratching, the itch, the dryness, [7:20] well, a topical anti-inflammatory [7:21] medication might be prescribed. So, if [7:23] you're really suffering with this, don't [7:25] try and suffer in silence and persevere [7:27] through just aggressive moisturizing. A [7:29] prescription medication might help you [7:31] get over a hump. Some patients with [7:33] Sjogren's syndrome, not all, but some do [7:35] go on to develop what are referred to as [7:37] photosensitive eruptions. This can be [7:40] particularly tricky because the [7:42] autoimmune condition systemic lupus [7:44] erythematosus, of course, has notable [7:47] photosensitivity and there can be [7:49] overlap. You can have secondary [7:51] Sjogren's Syndrome in somebody who has [7:54] lupus. That's why I made the distinction [7:56] early on on the two types there. So, in [7:58] the dermatology cohort that I mentioned [8:01] earlier, about 22% of those patients [8:03] actually had a lupus-specific [8:06] skin manifestation and photosensitivity [8:08] among them was reported to be [8:10] approximately 28%. So, in other words, [8:13] if someone has dry eyes, they have dry [8:15] mouth, and they're coming to the [8:17] dermatologist or to the rheumatologist, [8:19] we need to be thinking maybe Sjogren's, [8:21] maybe lupus, maybe both. And we need to [8:24] be testing for those things and we'll [8:26] get into how Sjogren's is diagnosed [8:28] later on in the video. But, remember [8:29] from some of my other videos, [8:31] photosensitivity is not diagnostic for [8:34] an autoimmune disease, either. There are [8:36] many reasons to have photosensitivity [8:38] such as medications, dietary [8:40] supplements, other skin conditions like [8:42] rosacea. There's something called [8:43] purpura and something called cutaneous [8:46] vasculitis. Vasculitis is just fancy [8:49] medical speak for inflammation around a [8:52] blood vessel. And it when it's the small [8:54] blood vessels that course through your [8:56] skin, when those are the ones that are [8:57] getting inflamed, the skin develops a [9:00] very interesting manifestation known as [9:02] palpable purpura. You get these inflamed [9:05] red spots that by definition are [9:07] palpable. What does that mean? That [9:09] means that dermatologist going to run [9:11] their hands over the surface of your [9:12] skin or look at it in side lighting and [9:14] they're going to see that it's actually [9:16] elevated above the surface of the skin. [9:18] The nature of small vessel vasculitis is [9:20] that it tends to primarily show up on [9:24] the lower legs. The dermatology cohort [9:27] found leukocytoclastic [9:30] vasculitis, an important type, to exist [9:33] in about 17% of patients. So, it matters [9:36] because if you have dry skin, you may [9:38] see this rash on your lower legs and [9:40] think, "Oh my gosh, that's related to [9:41] this dry skin I'm dealing with." But, it [9:43] could actually be a small vescal vessel [9:45] vasculitis plus the dry skin of [9:48] Sjogren's syndrome. So, it's an [9:49] important marker in particular of [9:52] systemic immune activity. Small vessel [9:54] vasculitis is not a is not diagnostic, [9:58] however, of Sjogren's disease. It's [10:00] something that can happen secondary to a [10:02] variety of things. So, a dermatologist [10:04] is first task with diagnosing, "Oh yes, [10:07] this is a small vessel vasculitis." And [10:10] then, they are simultaneously tasked [10:12] with figuring out what is the underlying [10:14] cause, and they're going to test for [10:16] everything in most cases, or everything [10:18] that seems to be relevant or germane [10:20] based on your history, including [10:21] Sjogren's if relevant. It can occur in [10:23] association with something else known as [10:25] cryoglobulinemia. [10:27] Cryoglobulinemia [10:29] is kind of like your blood becomes very [10:31] sticky because it has a lot of these [10:33] abnormal anti- bodies that, for whatever [10:36] reason, act really funny in cooler [10:39] temperature. They can also muck up your [10:42] kidneys, your lungs, and other organs. [10:45] So, in other words, this is something [10:46] that needs to be evaluated, the presence [10:48] of these cryoglobulins, to make sure [10:50] that that's not going on because it's a [10:52] marker of other risks to you internally [10:56] that, of course, would need to be [10:57] monitored and assessed for, such as your [10:59] kidney and lung function. Don't want to [11:01] don't want to sleep on all that, as well [11:03] as your nervous system. There's also [11:05] important association between certain [11:07] skin findings of Sjogren's syndrome and [11:10] the risk of lymphoma. Um I'm not [11:12] bringing this up to alarm anyone. I want [11:14] to emphasize that most patients who have [11:16] Sjogren's syndrome will not develop [11:19] lymphoma, which is a cancer of the blood [11:21] cells, to just describe it generally. [11:23] But, there are certain skin findings [11:25] that deserve medical attention because [11:27] they can be clues to this risk. And that [11:30] includes persistent enlargement of your [11:33] salivary glands, as well as something [11:35] called complement in your body being [11:38] low. Lymph node enlargement, which is [11:40] always, you know, potentially concerning [11:42] for blood diseases. Palpable purpura, we [11:45] already discussed. Low complement [11:47] levels, complement is something in your [11:49] blood related to your immune system. And [11:51] or the presence of these cryoglobulins. [11:54] In patients who have Sjogren's syndrome, [11:56] if they have these things, they're a [11:58] more at risk group for getting a [12:00] lymphoma. Another possible clue to [12:02] Sjogren's syndrome is a condition that [12:04] I've talked about in some of the other [12:05] autoimmune skin disease videos. It's [12:07] called Raynaud's phenomenon. First, one [12:10] or multiple fingers or your toes turn [12:13] bone white due to a marked reduction in [12:16] blood flow temporarily. They then turn [12:18] blue due to a drop in the oxygen. Then [12:21] your body is like, we need to fix this, [12:23] and a bunch of blood rushes in, and they [12:24] turn red. So, it goes from white to blue [12:27] to red. Raynaud's phenomenon was found [12:29] in 27% of the patients overall in that [12:32] paper, but it was substantially more [12:34] likely in patients who had secondary [12:37] Sjogren's syndrome, meaning they had [12:39] another autoimmune disease. In other [12:40] words, if you have Raynaud's phenomenon, [12:42] plus or minus photosensitivity, another [12:44] one, that's where we need to start [12:45] querying other autoimmune diseases. [12:48] Specifically, a condition known as [12:50] systemic sclerosis, otherwise known as [12:52] scleroderma. I have a whole video on [12:54] this bad boy, too, okay? So, if you've [12:56] got that, don't miss that video. And [12:58] then I want to address hair loss. [13:00] Sjogren's syndrome can be associated [13:02] with hair loss, and in the dermatology [13:04] cohort, it was a non-scarring alopecia. [13:06] Like I said, we break down hair loss [13:08] into does it scar or does it not scar? [13:10] But, this is an area though where you [13:12] can't assume hair loss that's [13:14] non-scarring equals Sjogren's syndrome, [13:17] or that the Sjogren's syndrome, if you [13:18] have it, is causing your hair loss, [13:20] okay? Cuz hair loss is complicated, a [13:23] lot of different types of hair loss, [13:24] many different types of non-scarring [13:26] hair loss. You could have telogen [13:28] effluvium, you could have alopecia [13:30] areata, an autoimmune hair loss. You [13:32] could have a nutritional deficiency cuz [13:35] your mouth is dry, you're not eating [13:36] well. You could have autoimmune thyroid [13:39] disease because you have Sjögren's [13:40] syndrome, an autoimmune disease makes it [13:42] more likely that you have other [13:43] autoimmune diseases like autoimmune [13:45] thyroid. Could be your thyroid, could be [13:48] autoimmune hair loss. Again, if you have [13:50] Sjögren's syndrome, you're more likely [13:52] to have other autoimmune diseases [13:54] including auto immune hair loss, [13:55] alopecia areata. These are all very [13:57] different diagnoses. Each are going to [13:59] be managed very differently. In other [14:01] words, you having Sjögren's syndrome, if [14:03] you notice hair loss, bring it to the [14:04] attention of your health care provider, [14:06] but they cannot assume that the hair [14:08] loss is due to your Sjögren's syndrome. [14:10] They got to do a full workup just as [14:13] they would work up anyone with hair [14:15] loss. Now, there are a number of less [14:17] common dermatologic findings in patients [14:19] with Sjögren's syndrome that are worth [14:21] at least having some familiarity with [14:23] the terms. They include a condition [14:24] known as livedo reticularis as well as a [14:28] type of vasculitis called urticarial [14:30] vasculitis. Very, very itchy, looks like [14:33] hives, but it's not hives, it's [14:36] inflammation around the blood vessels, [14:37] okay? So, that's another one. Then that [14:39] condition that we talked about a couple [14:42] of years ago, if you need a refresher, [14:44] check out the video erythema nodosum. [14:46] Those bizarre nodules on your lower [14:48] legs, got a video on that. Like I said, [14:50] patients who have Sjögren's syndrome, [14:51] they're more likely to have other [14:53] autoimmune diseases. You guessed it, [14:55] vitiligo. Not only is your immune system [14:57] attacking the salivary gland, the tear [14:59] gland, but it also decided, "Hey, while [15:02] I'm at it, I'm going to attack the [15:03] melanocytes and turn patches of your [15:05] skin bone white." Definitely happens. [15:07] Another condition called lichen planus, [15:09] more likely in patients who have [15:11] Sjögren's syndrome. As a side note, [15:13] we've got videos on lichen planus here. [15:15] And a type of vasculitis called erythema [15:17] elevatum diutinum. If you have that, [15:20] comment below cuz that is a rare one, [15:23] but I have seen cases of it. I don't [15:25] want to create the impression, however, [15:26] that someone should just look at a long [15:28] list of rashes and pictures on Google [15:31] and try and self-diagnose themselves [15:33] with Sjogren's. All of these different [15:35] conditions, you can have without having [15:37] a lick of Sjogren's, okay? So, they're [15:39] not diagnostic, but people with [15:41] Sjogren's often have these things, and [15:43] sometimes, depending on what they are, [15:45] they can be very important indicators of [15:47] some other things we should be looking [15:48] out for, like comorbid autoimmune [15:50] diseases and/or greater risk for [15:52] complications like lymphoma. In making [15:54] this video, hopefully it's clear to you [15:56] all that skin disease with Sjogren's [15:58] syndrome is common. Sjogren's syndrome [16:00] is not simply, "Oh, you've got [16:01] autoimmune dry eyes and dry mouth." No, [16:03] remember, it's a systemic disease. It [16:05] can involve all organs, including your [16:08] skin. The skin just happens to be [16:09] something that our eyes hit, and so it's [16:12] nice in that way in that we can pick up [16:14] on things if we know what to look for. [16:15] But these patients often deal with [16:17] profound fatigue, joint pain. Um they [16:19] can have neurologic disease. They can [16:21] have lung involvement. And if you have [16:23] this, I'm not telling you guys this to [16:24] scare you that you're going to, you [16:26] know, go down in flames, but you need to [16:27] have some aware- awareness that this [16:29] disease it can show up inside your body [16:31] in certain organs, like your kidney, for [16:33] example. Um and there can be [16:35] abnormalities in the blood. So, the [16:37] dermatology cohort that I mentioned, [16:39] they found internal organ involvement in [16:41] approximately 66% of patients. That was [16:44] a specialized cohort of people. People [16:46] who are being referred to a [16:48] dermatologist. [16:49] to a specialist means that you are a [16:52] specialized case, right? Like you tend [16:55] to have a more extensive case, that [16:57] you're to a point where you've got [16:59] something going on that's puzzling the [17:01] specialist that's managing you, usually. [17:03] In that case, it might be Maybe it's [17:05] your primary doctor, but maybe it's your [17:07] rheumatologist. They're like, "I don't [17:08] know about this rash. I have not seen [17:10] this." Or maybe they've not seen it in [17:11] your skin tone, they're not entirely [17:13] sure, or they're pretty sure what it is, [17:15] but they want the dermatologist's [17:16] blessing cuz like I said, a lot of these [17:18] things have multiple underlying [17:20] etiologies that could explain them [17:23] besides the Sjogren's that need to be [17:24] evaluated. So, that's what gets you that [17:27] referral into a dermatologist. [17:29] Sometimes, it's not that way, however. [17:31] Sometimes, patients show up to the [17:33] dermatologist without any diagnosis of [17:36] Sjogren's. That's That's often the case [17:38] as well. You have a strange, [17:39] funny-looking rash, a rash that your [17:42] doctor doesn't know what it is, they [17:43] refer you, or you do your own thing and [17:46] you make an appointment with a [17:47] dermatologist, maybe your insurance [17:49] allows you to do that, and you get in to [17:50] see one of your own accord, and you're [17:52] like, "I don't know what's going on." [17:54] They're like, "Hmm, that looks like [17:57] Let's make sure she doesn't have this, [17:58] that, and the other." And they'll [17:59] they'll go testing for things like [18:01] Sjogren's, okay? So, that's often times [18:03] how dermatologists make medical [18:05] diagnoses, okay? It's because patients [18:07] come in with problems, they don't know [18:08] what they are. They're like, "That could [18:09] be this underlying medical condition, so [18:11] we're going to make sure that it's not [18:13] that, and we're going to test for all [18:14] the other things." how diagnoses get [18:16] made in the skin clinic, just by looking [18:18] and knowing, okay? Knowing what you're [18:20] looking at and knowing what you're [18:21] looking for. How is Sjogren's syndrome [18:23] diagnosed? This is important. Someone [18:24] can have symptoms that raise a red flag [18:27] for Sjogren's, dry eyes, dry mouth, but [18:29] that's not diagnostic. You got to do [18:31] some tests and things of that sort. [18:32] There's not one blood test that simply [18:34] says, "Yes, you have Sjogren's." So, if [18:36] you've ever been to a rheumatologist or [18:38] maybe your primary doctor has ordered [18:40] some of these labs for different [18:42] antibodies, they're tricky to interpret [18:44] because they can come out temporarily in [18:47] a variety of non-specific circumstances. [18:50] And I'm telling you guys that I'm not to [18:52] be like they're not helpful, because [18:54] they certainly certainly are, but to [18:56] warn you all that these are not tests [18:58] you should just get from a [19:00] direct-to-consumer lab testing site and [19:02] try and interpret yourself. Very, very [19:04] dangerous path you can go on by trying [19:06] to self-diagnose through your own blood [19:08] work, okay? Because these are tricky [19:10] labs to to navigate. But when it comes [19:13] specifically to what types of antibodies [19:15] clue us in, of course it's usually a [19:17] positive ANA, but also something called [19:19] anti-SSA or anti-Ro, and anti-SSB or [19:24] anti-La. These names are funny, I know. [19:27] They'll biopsy your salivary gland, [19:29] okay? And it's going to show something [19:31] very specific, focal lymphocytic, [19:34] meaning lymphocytes coming into your [19:36] salivary gland and causing inflammation. [19:38] They're also going to do something [19:40] called a Schirmer test. That basically [19:42] quantifies your tear outflow, and [19:44] they're going to measure the salivary [19:46] flow. So anti-SSA and anti-Ro are very [19:49] helpful and likely would be ordered. The [19:51] good news is that for the majority of [19:54] skin problems you're likely to have if [19:56] you have Sjögren's disease, it's kind of [19:58] basic skin care that can really really [20:01] help you out a lot. Sounds [20:02] underwhelming, but you don't actually [20:04] often need very specialized dermatologic [20:07] therapies or dermatologic directed [20:10] medication. It's kind of the basic [20:12] gentle skin care, moisturizers. [20:15] Sjögren's syndrome is not just about [20:17] having dry eyes and dry mouth. It's a [20:19] systemic disease. Dry eyes and dry mouth [20:21] are part of it, but they're not the only [20:23] thing, and there can be some very [20:24] important skin clues. Hopefully today's [20:26] video shed some light on that for you [20:28] guys. I know many of you have this [20:30] condition. You've been asking for a [20:31] video on this for a while, so I hope [20:33] this was helpful to you all. And again, [20:35] make sure you check out some of my other [20:36] videos on my channel about skin warning [20:38] signs of other autoimmune diseases. If [20:40] you have this especially, you are a lot [20:42] more likely to have things like [20:43] vitiligo, alopecia areata, systemic [20:46] sclerosis, lupus. And I have videos on [20:49] all these conditions, so definitely [20:51] check those out if you want more [20:52] information about different skin things [20:54] that you might be dealing with uniquely. [20:56] All right, y'all. I hope today's video [20:58] was helpful. If you liked it, give it a [21:00] thumbs up, share it with your friends, [21:01] and as always, don't forget sunscreen [21:03] and subscribe. I'll talk to you guys [21:04] tomorrow. Bye. [21:06] >> [music] [21:12] [music] [21:22] [music]