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 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. 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 localized/limited disease is with topical corticosteroids. Disseminated disease, or severe or refractory localized/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; anti-nuclear antibodies (ANA) are often negative or present in a low titer. 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
- disk-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
- nonspecific skin injury
1st investigations to order
- antinuclear antibodies, double-stranded (ds) DNA
- BUN and electrolytes
Investigations to consider
- skin biopsy
nonsevere localized/limited disease
severe or refractory localized/limited disease; disseminated disease
- Systemic lupus erythematosus (SLE)
- Subacute cutaneous lupus erythematosus (SCLE)
- Guideline for vaccinations in patients with rheumatic and musculoskeletal diseases
- Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus
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