What Is Discoid Lupus Erythematosus?

Discoid lupus erythematosus (DLE) is a chronic skin condition that is characterized by light-sensitive skin flare-up, which can be localized or widespread. If not treated effectively, discoid lupus erythematosus can cause permanent scarring. Red rough patches will develop leaving discoloration and lesions. These lesions are asymptomatic and they will have slight itchiness or pain in the scars. The affected areas are those that are exposed to the sun, mainly at the back of the hands, cheeks, nose, neck, upper back, and ears. Discoid lupus erythematosus scars can become hypertrophic (raised scar) resulting in a lump-like wound at the extensor part of the arm. It mostly occurs in women than in men. Sometimes, it can affect the lips and mouth, resulting in ulcers and scaling. There is no age bracket for males or females to be affected, but most often, the onset occurs between 20 and 40 years old.

Discoid lupus erythematosus (DLE) is the most common form of lupus, compared to systemic lupus erythematosus (SLE). For every 100,000 people, there are 20-40 people affected by the condition.      

People with discoid lupus erythematosus only have a skin-associated ailment, which is also known as cutaneous lupus erythematosus. This type of lupus cannot cause systemic symptoms. However, research has shown that about 5 to 25 percent of discoid lupus erythematosus patients develop systemic lupus erythematosus where more organs might be affected. Most of the time, the symptoms are usually mild.

Discoid lupus erythematosus can be localized from the neck upwards at 80 percent or generalized neck upwards or downwards at 20 percent. 

Permanent disfigurement will occur if the person with discoid lupus erythematosus doesn't get adequate treatment.

What causes discoid lupus erythematosus?

The exact cause of DLE is not known. Research is still underway to determine the precise cause of the disease. It is believed to be an autoimmune disorder that mainly affects the skin, causing rashes and swelling. The presence of discoid lupus erythematous is caused by the lack of immune response in the skin. Risk factors that can cause discoid lupus erythematosus are sun exposure, hormones, genetic susceptibility, and toxins from cigarette smoking.

Signs and Symptoms of Discoid Lupus Erythematosus

The symptoms can differ from person to person varying mostly in intensity. It can occur daily or infrequently. Some of the common symptoms of DLE are hair loss, permanent wounds from injuries, and red, round cracking patches on the skin.

Signs of a Localized Discoid Lupus Erythematosus

• primary lesions appear as scaly red patches
• red patches that develop into indurated infections that have adherent scales
• follicular keratosis (lumps of keratin inside hair follicles are evident with the removal of surface scales with a tape)
• older wounds are discolored mostly at the edge of the infection
• damage occurs in the middle and there is a loss of color and skin
• DLE is normally situated on the nose, cheeks, concha, and earlobe
• can involve the eyelids, lips, oral mucosa, or nose
• temporary hair loss on scalp lesions
• hypertrophic lupus erythematosus (red, thickened infection) 

 Signs of a Widespread Discoid Lupus Erythematosus

• infections on the front of the chest, at the back of your hands, and upper back
• Other times the infection is on the upper and lower limbs.
• Palms and soles are not affected
• the anogenital region (skin around the anus and genitals) is not affected either

People with DLE are mainly concerned about the unappealing appearance caused by the infections aside from them being irritating or painful.

Diagnosis

• Discoid lupus erythematosus is mainly diagnosed by your health practitioner on how it has spread from the exposed spots and its clinical look.
• Skin biopsy is mainly used to diagnose discoid lupus erythematosus where distinctive features are noted.
• A blood test is also used to diagnose the disease.

Treatment 

Discoid lupus erythematosus (DLE) is a chronic (long-term) ailment that can disfigure you. The scarring is seen more often on darker tones of the skin. The dermatology department should be the starting point for a DLE treatment. It is advised to start with an SLE assessment to see if there is systemic involvement, which will include your whole history, a physical examination, and laboratory tests such as:

• complete blood count (CBC)
• erythrocyte sedimentation rate (ESR)
• antinuclear antibody (ANA) test
• urinalysis (urine test)

If systemic lupus erythematosus is presumed, an extractable nuclear antigen (ENA) panel, C3/C4, renal review, and anti-double-stranded (anti-dsDNA) should be included.

Preventive Measures

• It is important to protect yourself from the sun by using protective clothes, sunscreen, and other accessories.
• Avoid smoking at all times.
• Take vitamin D supplements.
• When indoors, it is advised to stay away from windows. A UV-blocking film can also be placed on the windows. 

Managing Discoid Lupus Erythematosus

Since a cutaneous wound can be triggered by an ultraviolet light exposure, people with DLE are supposed to be given information on how they come into contact with ultraviolet light. They should avoid the sun, especially from 10 a.m. to 4 p.m. Sand, snow, and water can also reflect ultraviolet light, which can cause harm. Thus, people with DLE should protect themselves by wearing appropriate gears.

Other measures include the following:

Topical Corticosteroids

One main treatment of discoid lupus erythematosus is a potent topical corticosteroid. These are to be applied directly on the skin abrasions for a few weeks. The potency of the medication depends on the body area and thickness of the infection. Potent topical steroids will cause a weakening of the skin surrounding the scar. The formation of blood vessels will also be increased.

Makeup can be applied to conceal and improve a person's appearance. 

Intralesional Steroids

For a hypertrophic DLE, intralesional injections of corticosteroids can sometimes be used. They are injected directly under the skin and can take care of dermal inflammatory effectively. They minimize the chance of skin thinning on the surface and are administered in high concentration to the affected area. Through bypassing the obstacle of a stiffened stratum corneum, they are able to work effectively.

Antimalarials

Immunomodulatory properties might be in antimalarial medications. Hydroxychloroquine and chloroquine phosphate have really shown tremendous valuable effects in treating DLE. Furthermore, antimalarial medications can help prevent a systemic type of lupus from developing for people with discoid lupus erythematosus. A cardiovascular disease risk might also be decreased. Quinacrine can be added either to hydroxychloroquine or chloroquine. Due to a high risk of ocular toxicity, hydroxychloroquine or chloroquine cannot be used together. Other agents might be useful to some people as reported by therapies, small open-label trials, and anecdotal reports.

The Bottom Line

The major aims of controlling discoid lupus erythematosus are to improve the look of the patient, manage existing abrasion and control scarring, and to stop the development of more lesions. Counseling people with severe systemic disease development is possible, but rare. Consistent visits for clinical evaluation along with basic laboratory studies is enough to observe the development from major cutaneous ailment to systemic ones.   

Preventing flares is one of the aims of controlling minor to major lupus symptoms. You can:

• rest adequately to minimize stress
• evade the sun by always wearing protective sunscreen and clothing while outside
• exercise often to avoid getting tired and having joint pains
• avoid smoking
• know what triggers your flares so that you can control them before they get worse

If you follow the above information, you will live a normal life and do your normal activities comfortably. It is also important to talk to your family members and friends to know your limits and requirements to counteract your flares.