Discoid lupus erythematosus in Adult
Discoid rash is one of the 11 diagnostic criteria for systemic lupus erythematosus (SLE), and 20% of patients with SLE will manifest discoid lesions. However, only 5%-10% of patients with DLE demonstrate systemic involvement or will go on to develop SLE. Risk factors for the development of SLE include widespread DLE, arthralgias ⁄ arthritis, nail changes, anemia, leukopenia, an elevated ESR, and a positive test for antinuclear antibodies (ANA).
Squamous cell carcinoma may rarely develop in chronic DLE scars, especially in sun-exposed areas.
The presence of erythema multiforme-like lesions in a patient with lupus, along with a speckled pattern of antinuclear antibody (ANA), positive anti-Ro/SSA or anti-La/SSB, and positive rheumatoid factor (RF) is known as Rowell syndrome. This syndrome has been described in patients with DLE, subacute cutaneous lupus erythematosus (SCLE), and SLE. Its existence as a distinct entity has been debated in the literature; some authors believe the association is coincidental. Prednisone with or without hydroxychloroquine, dapsone, or immunosuppressive drugs such as cyclosporin have been cited as therapy.
Related topics: tumid lupus erythematosus, lupus panniculitis, drug-induced lupus erythematosus
L93.0 – Discoid lupus erythematosus
200938002 – Discoid lupus erythematosus
Differential Diagnosis & Pitfalls
- Granuloma faciale
- Lichen planus
- DLE lesions have been associated with chronic granulomatous disease. In familial cases, check for complement deficiency.
- Other forms of scarring alopecia, such as tinea capitis, lichen planopilaris, and central centrifugal cicatricial alopecia
- Subacute cutaneous lupus erythematosus
- A single plaque in a lighter skin phototype may be mistaken for squamous cell cancer or squamous cell cancer in situ.
Drug Reaction Data