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. Approximately 5% to 10% of patients may develop a mild form of systemic lupus erythematosus (SLE). DLE-like lesions occur in up to 25% of patients with SLE.
History and exam
Key diagnostic factors
- disc-shaped erythematous maculopapular scaly lesions
- age 20 to 40 years
- history of ultraviolet light exposure
- smoking history
Other diagnostic factors
- absence of pruritus and/or pain
- telangiectasia, hyperpigmentation and/or hypopigmentation
- permanent scarring alopecia
- systemic features (arthritis, pleuritis, pericarditis, seizures, psychosis)
- age 20 to 40 years
- ultraviolet light exposure
- female sex
- non-specific skin injury
1st investigations to order
- antinuclear antibodies, double-stranded (ds) DNA
- urea and electrolytes
Investigations to consider
- skin biopsy
- Systemic lupus erythematosus (SLE)
- Subacute cutaneous lupus erythematosus (SCLE)
- S2k guideline for treatment of cutaneous lupus erythematosus - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV)
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