Discoid Lupus Erythematosus - When Lupus Only Affects the Skin

Find Out About Treatment Options for Discoid Lupus

Lane Oatey / Blue Jean Images/Collection Mix: Subjects/Getty Images

Discoid lupus erythematosus (DLE) is a form of lupus that mainly affects the skin. Although it's the most common form of lupus, it's different from the type of lupus most of us are familiar with, systemic lupus erythematosus (SLE). While SLE can affect any part of the body, DLE is limited to the skin.

What Is Discoid Lupus Erythematosus?

Discoid lupus is an autoimmune disease. In this condition, the immune system attacks the skin.

Chronic inflammatory sores develop on the face, ears, scalp and on other areas of the body.

These lesions can be crusty and scaling, and they often scar. Some patients report lesions and scarring on the scalp, making hair re-growth impossible in those areas.

Discoid lupus is thought to result from combination of genetic factors, environmental factors - especially sun exposure - and hormonal factors.

Women are three times as likely to develop discoid lupus than men, it's been shown to run in families.

The Difference Between Discoid Lupus and Systemic Lupus

In the spectrum of lupus erythematosus (LE) diseases, discoid lupus is at one end, with systemic lupus 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 the 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.

How Discoid Lupus Erythematosus Is Diagnosed and Treated

Your doctor should first check for systemic lupus with 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, the skin lesions can clear up completely. Without effective treatment, permanent scarring can unfortunately result.

Discoid lupus is treated with:

  • topical corticosteroids, such as cortisone ointment
  • topical calcineurin inhibitors, such as pimecrolimus cream or tacrolimus ointment
  • corticosteroid (cortisone) injections into the lesions

If topical treatments don't work for you and your lesions are too widespread for corticosteroid injections, you may be prescribed antimalarial tablets. Hydroxychloroquine, chloroquine and and quinacrine are the antimalarials used in the treatment of discoid lupus. 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 need to avoid sun exposure, wear hats and 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.


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.

Continue Reading