Discoid lupus erythematosus is the most common type of chronic cutaneous lupus (CCLE), an autoimmune skin condition on the lupus erythematosus spectrum of illnesses. It presents with red, inflamed, coin-shaped patches of skin with a scaling and crusty appearance, most often on the scalp, cheeks, and ears. Hair loss may occur if the lesions are on the scalp. The lesions can then develop severe scarring, and the centre areas may appear lighter in color with a rim darker than the normal skin. These lesions can last for years without treatment.
Discoid lupus has an unknown incidence, although it is two to three times more common than systemic lupus erythematosus. The disease tends to affect young adults, and women are affected more than men in a 2:1 ratio.
Treatment for discoid lupus erythematosus includes smoking cessation and a sunscreen that protects against both UVA and UVB light as well as very strong topical steroids or steroids injected into the lesions. Other topical treatments, tacrolimus or pimecrolimus can also be used. If this does not help the patient, his or her physician can prescribe an antimalarial medication such as oral hydroxychloroquine or chloroquine.
Other oral medications used to treat discoid lupus include retinoids (isotretinoin or acitretin), dapsone, thalidomide (teratogenic, side effects include peripheral neuropathy), azathioprine, methotrexate, or gold. The topical steroid fluocinonide is more effective than hydrocortisone in the treatment of discoid lupus erythematosus. For oral treatment, hydroxychloroquine and acitretin are equally effective; however, acitretin was associated with more adverse effects.
Pulsed dye laser is also an effective treatment for patients with localized discoid lupus. For patients with scalp disease, hair transplantation can help with their hair loss.
Discoid lupus erythematosus is a chronic condition, and lesions will last for several years without treatment. 50% of patients will eventually get better on their own. If a patient does not have any signs of systemic lupus erythematosus, such as generalized hair loss, ulcers in the mouth or nose, Raynaud's phenomenon, arthritis, or fever at the time that he develops discoid lupus, he will most likely only have discoid lupus and will never develop systemic lupus erythematosus.
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