Dr. M.J. Bazos,
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
Living With Your
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.
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
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
1. Topical sunscreens (SPF
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
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
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
• Take medications as
prescribed by your doctor.
your doctor of all other medications, including over-the-counter medicines, that
you are taking. Continue these medications unless your doctor instructs you to
• 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
• Avoiding exposure to
sunlight lessens the severity of your
• 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
• Do not stop your
medicine or change the prescribed dose without consulting your
• Do not exceed recommended
doses of medicines, because higher doses can increase your risk of toxic
• 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).
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
When to Call Your
• If you notice that
lesions are becoming worse or if new lesions appear despite appropriate
• If you have new or
unexplained symptoms, which may indicate a complication of your condition or
side effects from medications.