Discoid lupus erythematosus (DLE) is a disease in which
coin-shaped (discoid) red bumps appear on the skin.
The disease called discoid lupus erythematosus only affects
the skin, although similar discoid skin lesions can occur in the serious
disease called systemic lupus erythematosus (SLE). Only about 10% of all
patients with DLE will go on to develop the multi-organ disease SLE.
The tendency to develop DLE seems to run in some families. Men or women of any age can develop DLE, it typically occurs in women three times more frequently than in men. The typical DLE patient is a woman in her 30s.
The cause of DLE is unknown. It is thought that DLE (like
SLE) may be an autoimmune disorder. Autoimmune disorders are those that occur
when cells of the immune system are misdirected against the body. Normally,
immune cells work to recognize and help destroy foreign invaders like
bacteria, viruses, and fungi. In autoimmune disorders, these cells mistakenly
recognize various tissues of the body as foreign invaders, and attack and
destroy these tissues. In SLE, the misdirected immune cells are antibodies. In
DLE, the damaging cells are believed to be a type of white blood cell called a
T lymphocyte. The injury to the skin results in inflammation and the
characteristic discoid lesions. In
DLE, the characteristic skin lesion is circular and raised. The reddish rash
is about 5-10 mm in diameter, with the center often somewhat scaly and lighter
in color than the darker outer ring. The surface of these lesions is sometimes
described as "warty." There is rarely any itching or pain associated
with discoid lesions but there can be severe pain and sometimes very sensitive
to light. They tend to appear on the face, ears, neck, scalp, chest, back, and
arms. As DLE lesions heal, they leave thickened, scarred areas of skin. When
the scalp is severely affected, there may be associated hair loss (alopecia). People with DLE tend to be quite sensitive to the sun. They
are more likely to get a sunburn, and the sun is likely to worsen their
discoid lesions. Diagnosis of DLE usually requires a skin biopsy. A small
sample of a discoid lesion is removed, specially prepared, and examined under
a microscope. Usually, the lesion has certain microscopic characteristics that
allow it to be identified as a DLE lesion. Blood tests will not reveal the
type of antibodies present in SLE, and physical examination usually does not
reveal anything other than the skin lesions. If antibodies exist in the blood,
or if other symptoms or physical signs are found, it is possible that the
discoid lesions are a sign of SLE rather than DLE. Treatment of DLE primarily involves the use of a variety of
skin creams. Sunscreens are used for protection. Steroid creams can be applied
to decrease inflammation. Occasionally, small amounts of a steroid preparation
will be injected with a needle into a specific lesion. Because of their long
list of side effects, steroid preparations taken by mouth should avoided if
possible. Sometimes, short-term treatment with oral steroids will be used for
particularly severe DLE outbreaks. Medications used to treat the infectious
disease malaria are often used to treat DLE.
Causes
& symptomsDiagnosis
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