Discoid Lupus Erythematosus: When Lupus Only Affects the Skin

If lupus only affects your skin, you may have discoid lupus erythematosus

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Discoid lupus erythematosus (DLE) is a form of lupus that mainly affects your skin. DLE is different from systemic lupus erythematosus (SLE), the most common form of lupus, which can affect any part of the body. 

Discoid lupus is an autoimmune disease where the immune system attacks the skin. If you have discoid lupus, you may develop chronic inflammatory sores on your face, ears, scalp, and other areas of the body.

These lesions can be crusty and scaling, and they often scar. If lesions and scarring are on your scalp, hair regrowth may be impossible in those areas.

Discoid lupus is thought to result from a combination of genetic factors, environmental factors—especially sun exposure—and hormonal factors. Women are three times more likely to develop discoid lupus, and if discoid lupus runs in your family, your risk is increased too. 

The Difference Between Discoid Lupus and Systemic Lupus

Lupus erythematosus (LE) diseases fall on a spectrum—discoid lupus is at one end and systemic lupus is at the other. Although discoid lupus is more benign than systemic lupus, skin symptoms tend to be more severe in DLE.

In SLE, a malar rash in a butterfly pattern may appear across the nose and cheeks of the patients, or red rashes may develop in reaction to sunlight.It's possible for discoid lupus to spread to your internal organs, although this is rare.

Once the disease moves to internal organs, it becomes SLE. About one to five percent of discoid lupus patients go on to develop SLE. If you have discoid lupus, you will need to routinely check in with your doctor to make sure more than just your skin is not evolved.

Diagnosing and Treating Discoid Lupus Erythematosus

If your doctor suspects you have systemic lupus, they will first run blood tests.

If that's ruled out, a skin biopsy may be used to diagnose discoid lupus. When discoid lupus is treated early and effectively, skin lesions can clear up completely. Without effective treatment, permanent scarring may result.

Discoid lupus may be treated with topical corticosteroids, such as cortisone ointment; topical calcineurin inhibitors, like pimecrolimus cream or tacrolimus ointment; and corticosteroid (cortisone) injections. 

If topical treatments don't work for you and your lesions are too widespread for corticosteroid injections, you may be prescribed antimalarial tablets such as hydroxychloroquine, chloroquine, and quinacrine. Taking these antimalarials can cause vision problems, so you'll need a baseline eye exam and periodic eye exams going forward.

In the rare cases, when none of these approaches work, your doctor may suggest more aggressive medications, such as methotrexate, acitretin, isotretinoin, mycophenolate mofetil, or dapsone.

If you've been diagnosed with discoid lupus, you'll also need to avoid sun exposure, wear hats and the sun protective clothing and use broad spectrum sunscreen with an SPF higher than 30. Smoking is also associated with discoid lupus, so quitting smoking should be a priority for you.

Sources

  • Initial management of discoid lupus and subacute cutaneous lupus. UpToDate. May 28, 2015.
  • Management of refractory discoid lupus and subacute cutaneous lupus. UpToDate. October 22, 2015.
  • Panjwani, S. (2009). Early Diagnosis and Treatment of Discoid Lupus Erythematosus. Journal of the American Board of Family Medicine.
  • Discoid Lupus Erythematosus. American Osteopathic College of Dermatology.
  • Definition of Discoid lupus. MedicineNet.com.

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