Dr. M.J. Bazos, Patient Handout

About Your Diagnosis
Discoid lupus erythematosus (DLE) is a chronic skin disorder characterized by red, raised plaques with sharply defined margins. The lesions usually occur on sun-exposed areas, especially the face, scalp, and neck. The exact cause is unknown, although DLE is likely autoimmune (i.e., a condition in which your immune system mistakenly attacks normal parts of the body, resulting in tissue injury and disease). Discoid lupus erythematosus affects women more frequently than men, typically occurring in adults between 20 and 50 years of age. The condition can be more severe in Afro-Americans. This condition is hereditary but is not infectious or cancerous. Other members of your family may have DLE. Exposure to sunlight increases your risk of developing the condition. Avoiding sunlight exposure and using sunscreen to protect your skin from the effects of sunlight decreases the severity. Diagnosis is usually based upon the appearance of the skin lesions. Your doctor may perform blood tests and a skin biopsy (removal of a small piece of skin or other tissue) for laboratory evaluation to assist in diagnosis. Discoid lupus erythematosus is a chronic condition with periods of remissions occurring between episodes. Treatment aims to control symptoms and to lessen the severity of disease, but does not cure the condition.

Living With Your Diagnosis
Skin lesions are typically red, raised papules (smaller than 1 centimeter) and plaques (larger than 1 centimeter) that have clearly defined borders. Lesions may also have scaling and atrophy. Lesions early in the disease are typically bright red and are raised. Later lesions tend to be flat and are faint pink or white. In Afro-Americans, lesions may be hyperpigmented (darker than the normal skin). Lesions tend to be round or oval with irregular borders. They typically involve the face, scalp, and neck, and may also occur on the nose, forearms, hands, fingers, and toes. Occasionally, the trunk and the lining of the mucous membranes are involved. Scalp lesions are frequently associated with hair loss. Late lesions tend to show atrophy and depression in the central aspect, with slightly raised borders. Scarring is common, particularly in untreated DLE. Lesions scar as they heal and scarring may be extensive. The condition usually burns out in 10– 20 years. More than 95% of individuals with DLE live a normal lifespan. However, 1% to 5% percent of patients progress to systemic lupus erythematosus (SLE), an inflammatory disease of connective tissue. This condition involves multiple body organ systems, including the skin, joints, kidneys, heart, brain, liver, and lungs. Life expectancy in individuals with SLE is shortened, although the symptoms can be controlled for many years in most individuals.

Specific treatment depends upon the location and severity of your DLE, its impact on the quality of your life, and your response to therapy. Treatment does not cure DLE, but it lessens the severity of your condition and reduces scarring. Treatment includes the avoidance of precipitating factors, general measures, and medications. Avoid or decrease exposure to sunlight to lessen the severity of the disease. Remain indoors between 10 AM and 2 PM, when the sun’s ultraviolet rays are strongest. Use maximum-protection sunscreens and wear protective clothing to minimize the harmful effects of sunlight to your skin. Avoid fluorescent lights whenever possible. Your doctor may prescribe a variety of medications to reduce inflammation, scarring, and to lessen the severity of DLE. These medications include:
1. Topical sunscreens (SPF 30).
2. Topical steroid creams, lotions, or ointments are effective in reducing the severity of DLE. Your doctor may recommend placing occlusive dressings over the topical medications to increase their effects. Side effects include skin atrophy, formation of abnormal, small blood vessels, and absorption of medication through the skin into the bloodstream, which can cause toxic effects. To decrease the risk of side effects, do not exceed the recommended dose prescribed by your doctor.
3. Hydroxychloroquine (Plaquenil) inhibits your immune system, thereby lessening the severity of disease. It is effective in treating DLE. Side effects include inflammation of the liver and potential toxicity to the eyes. Your doctor will recommend evaluation by an ophthalmologist (an eye specialist) before starting, and at routine intervals while you are taking this medication. Your doctor will also periodically check laboratory tests to monitor for toxic effects of this medication. 4. Steroid medication injected into skin lesions reduces the severity of your condition and helps to reduce scarring.

The DOs
• Take medications as prescribed by your doctor.
• Inform your doctor of all other medications, including over-the-counter medicines, that you are taking. Continue these medications unless your doctor instructs you to stop them.
• Read the labels of medicines and follow all instructions. Consult your doctor if you have any concerns or if you have possible side effects caused by the medication.
• Avoiding exposure to sunlight lessens the severity of your disease.
• Keep scheduled follow-up appointments with your doctor; they are essential to monitor your condition, your response to therapy, and to screen for possible side effects of treatment. Regular checkups are important, even when your disease is in remission.

The DON’Ts
• Do not stop your medicine or change the prescribed dose without consulting your doctor.
• Do not exceed recommended doses of medicines, because higher doses can increase your risk of toxic effects.
• Do not use potent topical steroids on the skin of the face or genitals, because these areas are most prone to skin atrophy (thinning and wasting of the skin associated with wrinkling and abnormal, small blood vessels).
• Do not abruptly stop steroids or immunosuppressive therapy because you may experience a rebound worsening of your condition. In particular, do not suddenly stop steroid medication, because severe fatigue, weakness, and low blood pressure may result. Consult your doctor before stopping these medications.
• Avoid exposure to sunlight and indoor fluorescent lighting to reduce the severity of your disease.

When to Call Your Doctor
• If you notice that lesions are becoming worse or if new lesions appear despite appropriate therapy.
• If you have new or unexplained symptoms, which may indicate a complication of your condition or side effects from medications.