Symptoms of systemic lupus erythematosus (SLE, often referred to as simply lupus) can be quite different, because there are different types of lupus, and not all affected people show the same symptoms. Nevertheless, there are certain symptoms commonly associated with the condition. General symptoms associated with lupus include low-grade fever, loss of appetite, nausea, muscle aches, joint pains, and fatigue. More specific symptoms include skin changes (see below), ulcers of the mouth and nose, photosensitivity (sensitivity to sunlight), and decreased circulation to the fingers and toes with cold exposure. Raynaud's phenomenon is a manifestation of this change in circulation. The most typical skin symptom of lupus is the development of the so-called "butterfly rash" over the nose and cheeks. The rash is painless and does not itch. It may worsen with sun exposure, like other inflammatory processes associated with the disease. People with discoid lupus have involvement of only the skin. Those with this condition often have a rash over the face and scalp that can lead, with time, to scarring and hair loss (alopecia). People with lupus can have a decrease in platelets and white blood cells, increasing the risks for bleeding and infection. Anemia may also be present. Widespread inflammation in different areas of the body can have serious consequences, including vasculitis (inflammation of blood vessels, which can impair circulation and oxygen delivery), pleuritis (inflammation of the lining of the lungs), and pericarditis (inflammation of the lining sac of the heart). Pleuritis and pericarditis can result in chest pain. Inflammation in the kidneys due to lupus (lupus nephritis) can cause leakage of protein into the urine (proteinuria), fluid retention, high blood pressure, and even kidney failure. This can lead to worsening of fatigue and swelling of the legs and feet. Involvement of the brain can cause personality changes, thought disorders (psychosis), seizures, and even coma. Lupus-related nerve damage can cause numbness, tingling, and weakness of the involved body parts or extremities.