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 (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. Chronic 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.)
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-cellâmediated epidermal cell cytotoxicity. Toll-like receptors are possibly involved in the etiology.2
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.
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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