Discoid lupus erythematosus is a chronic autoimmune disorder of the skin with inflammation, red scaly patches, which usually heals with scarring, atrophy, hair loss, and pigmentation changes in skin. It is the most common type of Cutaneous lupus erythematosus. These lesions are mainly restricted to the skin and specially to sun-exposed areas. Though face, ears, and scalp are frequently affected area, it may sometime involve neck, upper back, hands and soles. In some patients mucosal involvement like oral, nasal and genital are also noticed.
Discoid Lupus Erythematosus occurs twice more commonly in women then in men. It usually common in aged between 20-40 but can occur at any age.
The exact cause of disease is unknown, but thought to be precipitated by UV light exposure, trauma, stress and exposure to cold and cigarette smoking. The lesion of Discoid Lupus Erythematosus may also resemble like lichen planus, hypertrophic psoriasis, keratoacanthoma, verrucae, or squamous cell carcinoma. So a skin biopsy needs to be done to confirm the diagnosis. Visceral involvement usually don’t occur, but less then 5% of patients with DLE may later develop a systemic lupus erythematosus.
Most patients are asymptomatic but may present with mild pruritus or occasional pain within the lesions. In some patient, arthralgia or arthritis can occur. These lesions often are distributed in sun exposed area, but unexposed skin area also may be affected. The scalp is a common area of involvement, and if scalp is involved permanent alopecia may result. Sometimes it may involve inside the mouth and lips, causing ulcers and scaling and these lesion may further predispose to squamous cell carcinoma.
The main aim in the treatment is just to improve your appearance, to limit the existing lesions and prevent scarring, and prevention of further lesions. There is no sufficient evidence for which treatment is most effective, as these lesion are exacerbated by ultravoilet exposure, so sun-protective measures like sunscreens, protective clothing are suggested. Smoking cessation and avoid exposure to secondary smoke as it may further exacerbate DLE.
Potent topical steroids and antimalarials are the standard therapy of treatment. Potent steroid creams and ointments are applied to the lesion once or two times a day. After the lesion are less severe mild steroids may be applied. Intralesional corticosteroid injections have been used with success for small patches. Thought Discoid Lupus Erythematosus is not caused by malaria parasites, but antimalarial have shown to work in most of the cases as they have anti-inflammatory properties. Antimalarials are less effective in patients who smoke.
Other treatments that have been tried for severe DLE may include isotretinoin, acitretin, ciclosporin, methotrexate, thalidomide, cyclophosphamide, dapsone, clofazamine, intravenous immunoglobulin and biological response modifiers. The lesion may also be excised surgically or treated with laser therapy but reactivation may occur.
Scarring, atrophy and pigmentation change are common but may be prevented if treated early. Serious systemic involvement is rare but may occur. So follow-up with your doctor is very important atleast every six months so the doctor could make sure that the disease is not involving the internal organs.