What Is Discoid Lupus?

Overview

Discoid lupus is the name commonly used to refer to discoid lupus erythematosus (DLE). It is a chronic autoimmune condition that primarily affects the skin. Round oval-shaped skin lesions are characteristic of this autoimmune condition. They are usually raised, scaly and red and may itch or hurt and, can become scarred and thickened. The condition cannot be cured, however, treatment can alleviate symptoms and reduce the liklihood of complicatons.¹

Causes of discoid lupus

As with other autoimmune diseases, discoid lupus occurs when your immune system mistakenly attacks your healthy cells and tissues. In the case of discoid lupus, your immune system primarily targets your skin cells, this leads to inflammation and the characteristic skin lesions of discoid lupus.

The exact cause of this is  not known. However, it is widely believed to be the result of a combination of immune, genetic and environmental factors. Factors that may contribute to the development of discoid lupus include:

• Genetic predisposition: a family history of lupus or other autoimmune immune disease increases the risk of discoid lupus development²
• Autoimmune dysfunction: as with other autoimmune conditions, discoid lupus arises when the immune system mistakes healthy skin cells
• Environmental triggers for example, exposure to ultraviolet radiation (from sunlight) can trigger or worsen discoid lupus³
• Hormonal influences/ changes including those that occur during puberty, pregnancy or menopause can contribute to the development or worsening of discoid lupus
• Medications, for example,some anti-seizure and blood pressure medications have been linked to the development of a drug-induced form of discoid lupus

These factors are known to increase the risk of discid lupus development but they do not necessarily means you will develop the condition. 

Signs and symptoms of discoid lupus

The signs and symptoms of discoid lupus erythematosus (DLE) primarily affect the skin. Common symptoms associated with this condition include:

Skin lesions: these are the hallmark symptom of discoid lupus. They are usually round or oval-shaped but may vary in size. They can be red, scaly, raised and could have a well-defined border. They usually appear on sun-exposed regions like the scalp, face, arms and ears

Inflammation and redness: The affected areas of skin may become inflamed, red and tender. The skin around the lesions can also become hardened.

Scaling and crusting: The skin lesions associated with discoid lupus can develop yellow/brown crusty texture.

Itching or pain: It is common for the skin lesions to be ithy and painful. There severity of this can vary.

Hair loss: If discoid lupus affects your scalp, it can cause hair loss (alopecia) in the affected areas. This can result in patchy hair loss or thinning of your hair.^.4

Photosensitivity: Sunlight exposure is known to trigger or worsen the symptoms, it leads to flare-ups of skin lesions. As a result, individuals with discoid lupus are usually advised to take precautions to protect their skin from excessive sun exposure.³

Generally speaking, discoid lupus primarily affects the skin. However, in some cases discoid lupus is associated with systemic lupus erythematosus (SLE). SLE is a more generalised form of lupus that affects multiple organs.

Management and treatment for discoid lupus

There is no cure for discoid lupus, therefore the current treatment aims to control symptoms, prevent flare-ups, and minimize skin damage. The specific treatment approach may vary according to the severity of the skin condition and individual factors. Commonly used strategies include:

• Sun protection to prevent and reduce the symptoms of discoid lupus flare-ups^{1, 3}
• Topical medications, for example, corticosteriod creams/ ointments¹
• Intralesional corticosteroid injections are used for more persistent or resistant skin lesions
• Antimalarial medications such as hydroxychloroquine or chloroquine can modulate the immune system, and therefore, control inflammation and prevent flare-ups¹
• Systemic medications may be used for severe cases of discoid lupus that is associated with systemic lupus erythematosus; these may work by suppressing the immune system and controlling inflammation to reduce symtpoms
• Management of symptoms can be done using over the counter medications for example anti-itch creams and oral anti-histamines

You should work closely with your dermatologist/ rheumatologist to achieve a suitable treatment plan specific to your situation. Starting treatment sooner and having regular follow ups reduces your risk of permanent scarring. 

Diagnosis

A medical proffessional will typically diagnose discoid erythematosus lupus through a combination of assessing your medical and family history, a physical examination, and additional diagnostic tests.

These additional diagnostic tests include: 

• A skin biopsy
• Blood tests

Complications

As mentioned above discoid lupus primarily effects the skin. As a result complications such as scarring and skin changes may occur. If this scarring affects the scalp, it can result in permanent hair loss in an effected area. 

An open or broken skin lesion can become infected with bacteria or fungi. These infections can cause additional inflammation and delays in wound healing.

In addition, the increased sunlight sensitivity associated with DLE can also increase the risk of skin cancer.³

Around 5% of people with discoid lupus will also have or devlop systemic lupus erthematosus (SLE). This is a more generalised form of lupus that affects multiple organs. 

As with most chronic conditions, it can take a toll on your emotional and psychological welfare. The characteristic skin changes caused by discoid lupus can have a significant impact on a persons self-esteem and as a result, their quality of life. 

Risk factors

There are several risk factors believed to contribute to a heightened risk of discoid lupus. These risk factors include:

• Gender: DLE is more common in women⁵
• Age: It is most commonly diagnosed between the ages of 20–40
• Family history
• Race and ethnicity: DLE is more commonly seen in people of African, Asian and Hispanic descent; although it can affect anyone of any race or ethnicity⁵
• Sun exposure^{1, 3}
• Hormonal factors

Whilst these risk factors may increase the likelihood of discoid lupus development, they do not guarantee its occurrence. 

FAQs

How can I prevent discoid lupus

While it is not be possible to prevent discoid lupus erythematosus (DLE) entirely, there are steps you can take to reduce the risk of developing or exacerbating the condition. Examples include: 

• Sun protection
• Monitering medications you are taking that are known to induce or exacerbate lupus
• Managing stress as it can worsen the perceived symptoms of the patient⁶
• Regular follow-ups with your healthcare provider are important if you have previously been diagnosed with discoid lupus

How common is discoid lupus

Discoid lupus erythematosus (DLE) is less common than systemic lupus erythematosus (SLE), which is a more generalized form of lupus. According to patient info discoid lupus affects between 2-5 people per 10,000.

When should I see a doctor

If you suspect you may have discoid lupus or are concerned about your symptoms, you should consult with a healthcare professional or dermatologist for a proper evaluation and diagnosis.

Summary

To summarise, discoid lupus is an autoimmune skin condition that is characterised by oval/round skin lesions. There is no cure, however, the condition can be managed with treatment.