Discoid lupus erythematosus

Most common form of chronic cutaneous lupus erythematosus. Lesions are well-demarcated erythematous macules or papules with a scaly surface, which frequently evolve into larger coin-shaped plaques; typically neither pruritic nor painful.

Age of onset usually between 20 and 40 years. Lesions often precipitated or aggravated by ultraviolet light exposure; smoking also considered a risk factor.

Over time, lesions slowly expand, producing areas of peripheral inflammation or hyperpigmentation, leaving a central region of scarring with telangiectasia and hypopigmentation.

Diagnosis is usually made on clinical grounds, but if in doubt is confirmed with a skin biopsy.

The mainstay of treatment is topical corticosteroids, or oral antimalarials if no response.

Discoid lupus erythematosus (DLE) is a chronic inflammatory condition of the skin. DLE lesions begin as well-demarcated erythematous macules or papules with a scaly surface, and frequently evolve into larger coin-shaped plaques. In most DLE patients the condition remains confined to the skin; antinuclear antibodies (ANA) are often negative or present in a low titre.[1]Provost TT. The relationship between discoid and systemic lupus erythematosus. Arch Dermatol. 1994;130:1308-1310. http://www.ncbi.nlm.nih.gov/pubmed/7944515?tool=bestpractice.com Approximately 5% to 10% of patients may develop a mild form of systemic lupus erythematosus (SLE).[2]Healy E, Kieran E, Rogers S. Cutaneous lupus erythematosus - a study of clinical and laboratory prognostic factors in 65 patients. Ir J Med Sci. 1995;164:113-115. http://www.ncbi.nlm.nih.gov/pubmed/7607834?tool=bestpractice.com DLE-like lesions occur in up to 25% of patients with SLE.[3]Pistiner M, Wallace DJ, Nessim S, et al. Lupus erythematosus in the 1980s: a survey of 570 patients. Semin Arthritis Rheum. 1991;21:55-64. http://www.ncbi.nlm.nih.gov/pubmed/1948102?tool=bestpractice.com