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 UV 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 usually made on clinical grounds, but if in doubt is confirmed with 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