Discoid Lupus Erythematosus 

  • Author: Jeffrey P Callen, MD; Chief Editor: William D James, MD   more...
 
Updated: Dec 15, 2011
 

Background

Discoid lupus erythematosus (DLE) is a chronic, scarring, atrophy producing, photosensitive dermatosis. (See the images below.) DLE may occur in patients with systemic lupus erythematosus (SLE), and some patients (< 5%) with DLE progress to SLE.[1] Some patients also have the lesions of subacute cutaneous lupus erythematosus (SCLE), and some may have a malar rash. Patients with DLE rarely fulfill 4 or more of the criteria used to classify SLE. Serologic abnormalities are uncommon. Therapy with sunscreens, topical corticosteroids, and antimalarial agents is usually effective. (See Clinical and Treatment.)

Discoid lupus erythematosus on the face. Discoid lupus erythematosus on the face. Chronic scarred lesion of discoid lupus erythematoChronic scarred lesion of discoid lupus erythematosus.

Patient education

Instruct patients in sun-avoidance techniques and the proper use of sunscreens, hats, and protective clothing. Advise patients to quit smoking. Discuss the possibility of systemic involvement with patients. Pamphlets from the Lupus Foundation of America, Inc. concerning skin disease and photosensitivity are useful adjuncts to verbally delivered information. For patient education information, see the Arthritis Center. (See Prognosis and Treatment.)

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Etiology

Discoid lupus erythematosus (DLE) probably occurs in genetically predisposed individuals, but the exact genetic connection has not been determined. The etiology of discoid lupus erythematosus is not well understood. It has been suggested that a heat-shock protein is induced in the keratinocyte following ultraviolet (UV) light exposure or stress, and this protein may act as a target for gamma (delta) T-cell–mediated epidermal cell cytotoxicity. Toll-like receptors are possibly involved in the etiology.[2]

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Epidemiology

Worldwide, the prevalence of SLE ranges from 17-48 cases per 100,000 population. The highest prevalence of SLE occurs in persons aged 40-60 years, and is approximately 10 times higher in women than in men. Cutaneous lupus erythematosus (CLE) presumably occurs 2-3 times more frequently in women than in men. Discoid lupus erythematosus is responsible for 50-85% of CLE patients. In a 2009 study from Olmstead County, Minn, Duraso et al have demonstrated that the incidence of CLE is equal to that of SLE.[3]

Discoid lupus erythematosus is slightly more common in African Americans than in whites or Asians. The male-to-female ratio of discoid lupus erythematosus is 1:2. Discoid lupus erythematosus may occur at any age but most often occurs in persons aged 20-40 years. The mean age is approximately 38 years.

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Prognosis

The prognosis of patients with chronic CLE is favorable regarding mortality; however, many patients continue to experience pain in their lesions or may experience disfigurement from the scars or atrophy that can develop. Exacerbation is possible, particularly in the spring and summer. The treatment of early lesions may be preventative. Scarring alopecia is particularly disturbing.

Serious systemic disease is rare, but when it occurs, patients may develop life-altering sequelae. Malignant degeneration is rare. Promptly remove new growths within burned-out lesions.

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Contributor Information and Disclosures
Author

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Specialty Editor Board

Craig A Elmets, MD  Professor and Chair, Department of Dermatology, Director, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology

Disclosure: Palomar Medical Technologies Stock None; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor; UpToDate Salary Employment; Biogen Grant/research funds Independent contractor; Clinuvel Independent contractor; Covan Basilea Pharmaceutical Grant/research funds Independent contractor; ISDIN None Consulting; TenX BIopharma Grant/research funds Independent contractor

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Julia R Nunley, MD  Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center

Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

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Discoid lupus erythematosus on the face.
Chronic scarred lesion of discoid lupus erythematosus.
Lesions of discoid lupus erythematosus in the conchal bowl demonstrate patulous follicles with follicular plugging.
Palmar lesions of discoid lupus erythematosus.
Scarring alopecia of discoid lupus erythematosus.
Widespread scarring alopecia.
Hypertrophic lesions of lupus erythematosus on the dorsal hands. Characteristic lesions were observed elsewhere.
 
 
 
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