Discoid lupus erythematosus in Adult
See also in: External and Internal Eye,Hair and ScalpAlerts and Notices
Synopsis
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
Codes
ICD10CM:L93.0 – Discoid lupus erythematosus
SNOMEDCT:
200938002 – Discoid lupus erythematosus
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Sarcoidosis
- 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
- Rosacea
- Dermatomyositis
- A single plaque in a lighter skin phototype may be mistaken for squamous cell cancer or squamous cell cancer in situ.
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:10/14/2018
Last Updated:04/03/2023
Last Updated:04/03/2023
Patient Information for Discoid lupus erythematosus in Adult
Overview
Lupus is a disease in which your body's self-protection mechanism (immune system) attacks your own body rather than a foreign invader. The cause of lupus is unknown, and the disease usually takes one of two forms: systemic lupus erythematosus (SLE), which can affect any body organ; and discoid lupus erythematosus (DLE), which is milder and usually affects only the skin. About 5-10% of patients with discoid lupus erythematosus will progress to systemic lupus.Who’s At Risk
Discoid lupus erythematosus most commonly afflicts young adult females, especially individuals of African and Hispanic descent, though it may occur at any age and it occurs worldwide. Lupus sometimes runs in families.Signs & Symptoms
The face (bridge of the nose, cheeks, lower lip, the ears, or inside the mouth) and/or the scalp are most often affected. Sometimes the trunk as well as the arms and legs (extremities) are more extensively involved.The skin lesions may vary in appearance; a red bump or patch may appear first and is usually painless or only slightly itchy. The area may be scaly or even wart-like. With time, the center of the lesion becomes white and scarred, with permanent hair loss. Lesions in darker-skinned people may be darker brown, changing to a purple color at the edges. The lesions often (but not necessarily) occur in sun-exposed areas.
Self-Care Guidelines
- Avoid sunlight exposure.
- Sunscreens with UVB and UVA blockers (such as Parsol 1789, zinc, or titanium dioxide) are recommended.
- Remember that clothing (dark colors and closely woven fabrics) and hats are very effective sun-blockers.
- Excessive heat, excessive cold, and trauma to the affected regions may make the condition worse.
- Use cosmetics (such as Covermark or Dermablend) to cover affected areas.
When to Seek Medical Care
Because discoid lupus erythematosus can cause permanent scars and hair loss, you should seek medical care if you suspect you may have this condition.Treatments
- Blood tests and a biopsy will be done to confirm the diagnosis.
- There is no cure, but treatment will control symptoms until the disease improves on its own, usually after months to years of treatment.
- Topical corticosteroids are generally used first; for small areas, corticosteroids may be injected into the lesions.
- Other topical immunosuppressive agents (such as tacrolimus or pimecrolimus cream) may be helpful.
- Antimalarial drugs (hydroxychloroquine, chloroquine, or quinacrine) can be used for severe cases.
- Other oral medications may include dapsone, acitretin, isotretinoin, or gold. All oral medications have potential side effects. Studies conducted in 2003 and 2011 have shown thalidomide to be effective, but it is generally reserved for severe cases that do not respond to other treatments, and doctors administer it with great caution due to its potential side effects.
References
Bolognia, Jean L., ed. Dermatology, pp.603, 605, 992. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1047. New York: McGraw-Hill, 2003.
Discoid lupus erythematosus in Adult
See also in: External and Internal Eye,Hair and Scalp