Discoid Lupus Erythematosus

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Discoid Lupus Erythematosus

Definition

Discoid Lupus Erythematosus (DLE) is a chronic inflammatory skin disorder that causes red, raised, coin shaped (discoid) lesions usually on the face, or scalp. These lesions can appear elsewhere on the body also.

Cause

While the exact cause is not known, patients with DLE probably have a genetic predisposition. This condition does tend to run in families. The disease usually becomes active after UV light exposure but scientists believe there must be other triggering factors. Women also develop this disease three times more than men.

Symptoms

Discoid lesions develop with red inflamed areas that may become thick, scaly and crusty and may cause scarring. The rash is typically painless and does not typically itch. The rash may last for anywhere from days to years and may reoccur. Rash on the scalp may cause hair loss that is usually permanent. Lupus Panniculitis is common. Arthralgia or arthritis may occur. Some patients also have Systemic Lupus Erythematosus (SLE). Patients without SLE may still manifest SLE symptoms with DLE.

Diagnosis

If DLE is suspected a biopsy of the lesions may be done. Blood work may include ANA (positive in 20% of DLE patients), Anti-Ro (SSA) (positive in 1-3%), Anti-dsDNA (positive in <5%), sedimentation rate (may be elevated), RA factor (may be positive), and complement levels (may be low).

Treatment

The most important thing for DLE patients is avoidance of UV light. Use of sun block, protective clothing and avoiding sunlight and tanning beds is very important. Topical corticosteroids may be used as well as corticosteroid injections. Sometimes antimalarials are also used. Retinoid drugs such as isotretinoin (Accutane), etretinate (Tegison), and acitretin (Soriatane) are some times used in resistant cases. Immunosuppressants such as Methotrexate and cyclophosphamide (Cytoxan) may be used for potentially disabling cases.

DLE Variants

DLE lesions that develop very thick scale (hyperkeratosis) are called verrucous (wart like) lesions or hypertrophic (thickened) lesions. Mucosal DLE is lesions affecting the mucous membranes in the mouth, nose and eyes. If lesions occur on the hands it is called Palmar DLE and Plantar DLE on the feet. Chilblain Lupus is also a variant of DLE.

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