Discoid lupus erythematosus (DLE) is a disfiguring autoimmune skin disease and the most common form of chronic cutaneous lupus erythematosus. It has a characteristic clinical appearance consisting of red, scaly plaques with resulting pigmentary changes and scars; the plaques are frequently found on the face and scalp. DLE most commonly afflicts women in the third and fourth decades of life, although it may occur at any age. Individuals of African and Hispanic descent are at increased risk, and there may be a positive family history of lupus or connective tissue disease.
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.
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.
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.
An atrophic, scarred, pink plaque with raised borders on the lower forehead and eyebrow. Note the permanent loss of eyebrow hairs within the scarred area.
Patient Information for Discoid lupus erythematosus - Hair and Scalp