Discoid lupus erythematosus

Discoid lupus erythematosus is the most common form of chronic cutaneous lupus erythematosus. Lesions are generally 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 is usually between 20 and 40 years. Lesions are often precipitated or aggravated by ultraviolet light exposure; smoking is 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. In hair-bearing areas, follicular plugging (scale at hair follicle) is often seen and scarring alopecia may be found.

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

The mainstay of treatment for localised/limited disease is topical corticosteroids. Disseminated disease, or severe or refractory localised/limited disease, is treated with antimalarials, progressing to immunosuppressants if there is 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 Oct;130(10):1308-10. 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 Apr-Jun;164(2):113-5. 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 Aug;21(1):55-64. http://www.ncbi.nlm.nih.gov/pubmed/1948102?tool=bestpractice.com