Discoid Lupus Erythematosus
Discoid lupus erythematosus is an uncommon rash, usually made worse by exposure to sunlight. The term ‘lupus erythematosus’ is applied to a range of related disorders. At one end of the range is ‘systemic’ lupus erythematosus, which can damage internal organs: right at the other end of the range is ‘discoid’ lupus erythematosus, which is confined to the skin and does not cause general ill health.
The cause of discoid lupus erythematosus is not fully understood. One theory is that it is a condition in which the immune system, instead of just acting as a defense against infection, attacks the tissues of the body itself (an autoimmune disease).
Most patients find their rash gets worse in sunlight and may be triggered by sunshine. The condition is not infectious. It can affect either sex, at any age; but young women are the group of patients most often affected, and it is rare in children.
It is rare for more than one member of a family to have discoid lupus erythematosus; nevertheless it is well recognized that some families carry genes that raise the risk of developing the condition.
It is usually symptom-free apart from the embarrassment the patches can cause. Occasionally the affected areas can itch: patches on the fingers can be tender. In most patients there is no effect on general health.
Discoid lupus erythematosus lookx like
Discoid lupus erythematosus usually affects the face and scalp, but is occasionally more widespread. The rash consists of red scaly patches, which tend to clear eventually, leaving some thinning, scarring or colour change in the skin. The scaling can sometimes be quite thick and warty. Some patients have chilblain-like patches on their fingers and toes. When the scalp is involved, hair in the affected area may be permanently lost.
Diagnosing discoid lupus erythematosus
- Tests will include a skin biopsy and blood tests to look for other forms of lupus erythematosus.
- Discoid lupus erythematosus can not be cured. The treatments help to keep it under control until it settles, but this may take months or even years.
There are two main types of treatment
- Strong steroid ointments or creams often help but must be used under supervision as they can thin the skin – a side effect that has to be balanced against the risk of the patches scarring if they are under-treated. We therefore typically use stronger creams than would be used on the face for commoner conditions such as eczema.
- Some patients may need anti-malarial tablets - usually one called hydroxychloroquine (Plaquenil). These were originally introduced to treat malaria but were found also to have a powerful effect on inflammation and so help to control discoid lupus erythematosus. These tablets usually cause no side effects at the doses that are currently advised, but at high doses there is a small risk to the eye. You should let your doctor know if you have any visual problems; a simple baseline eye test for the sharpness of your vision is advised for all patients, but some who already have eye problems need to be assessed by an eye specialist.
- If the above treatments do not provide a satisfactory response there are other tablets and ointments that are sometimes used. Your dermatologist will tell you about these if necessary.
If scarring does occurs then cosmetic camouflage is an option.
What you can do
- You should protect yourself from strong sunlight. The regular use of a good sun-block (SPF of 25 or greater) should be part of your daily routine.
- Clothing can also be a very effective sun block, particularly for your shoulders and arms. If you can see through your shirt or blouse easily, then sunlight can get through to your skin. Dark, close-weave but loose-fitting clothing is best. Don’t forget to use sun glasses and a broad-brimmed hat.