Discoid Lupus Erythematosus: Causes, Risk Factors, Diagnosis, Complications, Treatment, Prevention and Prognosis

It is known as a group of various persistent autoimmune inflammatory diseases and often specifically affects the skin.

Discoid lupus erythematosus is the most common chronic form of cutaneous lupus. It is characterized by persistent, disc-shaped scaly plaques that appear especially in:

  • The scalp
  • The face.
  • Ears.

And they can cause pigment changes, scarring, and hair loss if not diagnosed and treated early.

Causes of discoid lupus erythematosus

The manifestations or appearance of discoid lupus erythematosus are due to the loss of regulation of the immune system in the skin and among the most common causes that generate this condition can be mentioned:

  • Genetic predisposition.
  • Exposure to sunlight.
  • Toxins such as cigarette smoke.
  • Hormones

Risk factor’s

It can affect men and women of any age. This condition is 5 times more common in women than in men, and the onset is usually between the ages of 20 and 40.

Discoid lupus erythematosus is more common in patients with darker skin than in regular Caucasians, and people who are usually active smokers are more likely to suffer from it, and nicotine reduces the effectiveness of antimalarials and other therapies.

This disease can be located above the neck in 80% or generalized, which means that they are found above and below the neck, but only 20% of those affected externalize it in this way.

The signs or symptoms of localized discoid lupus erythematosus include:

  • Dry, red patches or lesions evolve into red or hyperpigmented plaques with an adherent scale.
  • Follicular keratoses are keratin plugs within the hair follicles, it is observed when the superficial scale is removed.
  • Older lesions are hyperpigmented, especially at the edge of the plaques.
  • Scarring produces a central loss of pigment (white spots) and atrophy of the skin (loss of tissue).
  • Discoid lupus erythematosus can include lips, oral mucosa, nose, or eyelids.
  • Scalp injuries cause temporary or permanent patches of hair loss.
  • The main concern for the patient is the unsightly appearance of the plaques, but they can also be itchy or painful.

Diagnosis of discoid lupus erythematosus

It is diagnosed based on its distribution in places exposed to the sun and the clinical appearance of the plaques. After a careful history, the patient should undergo a comprehensive general examination, to find out if other forms of lupus may be present.

The diagnosis is usually confirmed by a skin biopsy , which shows the typical features of lupus:

  • Interface.
  • Perianexial dermatitis.
  • Follicular obstruction.
  • Atrophy.
  • Cicatrization.

Direct immunofluorescence is often positive on skin damaged by this condition.

Complications

About 25% of patients also develop systemic lupus erythematosus within months to decades of diagnosis of the skin disease.

Discoid lupus erythematosus can leave permanent scarring, even when active disease has responded to treatment.

Treatment for discoid lupus erythematosus

Intermittent treatments of strong topical corticosteroids are the main treatment for this disease.

They must be applied precisely to skin lesions for several weeks. The stem should be selected to suit the body site and the thickness of the plate.

Very strong topical steroids can cause the surrounding skin to become thinner and increase blood vessel formation.

Calcineurin inhibitors tacrolimus ointment and pimecrolimus cream can also be used.

Precautionary measures

The following measures are important to reduce the chance of flare-ups of discoid lupus erythematosus:

  • Careful year-round protection from sun exposure with thickly applied broad spectrum SPF 50+ clothing, accessories and sunscreens. Sunscreens alone are not suitable.
  • Vitamin D supplements should be recommended for those who strictly avoid the sun.
  • Give up smoking.

Discoid lupus erythematosus prognosis

It tends to persist for years or decades. In some patients, all signs of active disease resolve in time.

Squamous cell carcinoma can rarely arise within a plaque of long-standing disease on the skin or mucous membrane. It presents as an enlarged warty growth or ulcer. It is usually treated surgically.