Definition
Discoid Lupus Erythematosus
(DLE) is a chronic inflammatory skin disorder that causes red,
raised, coin shaped (discoid)
lesions usually on the face, or scalp.
These lesions can appear elsewhere on the body also.
Cause
While the exact cause is
not known, patients with DLE probably have a genetic
predisposition. This condition does tend to run in
families. The disease usually becomes active after UV
light exposure but scientists believe there must be other
triggering factors. Women also develop this disease three
times more than men.
Symptoms
Discoid lesions develop
with red inflamed areas that may become thick, scaly and crusty
and may cause scarring. The rash is typically painless and
does not typically itch. The rash may last for anywhere
from days to years and may reoccur. Rash on the scalp may
cause hair loss that is usually permanent.
Lupus Panniculitis is common.
Arthralgia
or arthritis
may occur. Some patients also have Systemic Lupus Erythematosus
(SLE). Patients without SLE may still manifest
SLE symptoms with DLE.
Diagnosis
If DLE is suspected a
biopsy of the lesions may be done.
Blood work may
include ANA (positive
in 20% of DLE patients), Anti-Ro (SSA) (positive in 1-3%),
Anti-dsDNA (positive in <5%),
sedimentation rate (may be
elevated), RA factor (may be positive), and
complement
levels (may be low).
Treatment
The most important thing
for DLE patients is avoidance of UV light. Use of sun
block, protective clothing and avoiding sunlight and tanning
beds is very important. Topical corticosteroids may be
used as well as corticosteroid injections. Sometimes
antimalarials are also used. Retinoid drugs such as
isotretinoin (Accutane), etretinate (Tegison), and acitretin
(Soriatane) are some times used in resistant cases.
Immunosuppressants such as Methotrexate and cyclophosphamide
(Cytoxan) may be used for potentially disabling cases.
DLE Variants
DLE lesions that develop
very thick scale (hyperkeratosis) are called verrucous (wart
like) lesions or hypertrophic (thickened) lesions. Mucosal
DLE is lesions affecting the mucous membranes in the mouth, nose
and eyes. If lesions occur on the hands it is called
Palmar DLE and Plantar DLE on the feet.
Chilblain Lupus is
also a variant of DLE.
Pictures
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