Discoid Lupus Erythematosus

The cause of DLE is not fully known but is thought to be an autoimmune disease.

We all have an immune system that makes the antibodies that are needed to fight off infections. Usually, these antibodies do not attack their own body tissues.

However, in an autoimmune disease, the immune system makes a mistake and fights our own body instead. The mistake made by the immune system in DLE is that our immunity cells see our skin cells as foreign bodies and act against them.

Factors that may increase your risk of DLE or make it worse include stress, infection, and trauma. Some medications are also thought to be a trigger.

The condition is not infectious and is not due to food allergy. DLE rarely affects children; although it can affect males and females equally, there is evidence that females aged between 20 and 40 are more prone to this condition.

Occasionally the patches can cause some discomfort and itch. When the plaques resolve, they may also cause scarring and permanent changes to the color of the involved skin. In most patients, there is no effect on their general health.

DLE commonly affects the face and areas of the scalp containing hair but occasionally can spread to other body sites, including arms, legs, and torso.

The rash consists of red scaly patches, which tend to clear eventually, resulting in thinning, scarring, or color change in the skin.

The scaling can sometimes be quite thick and resemble a wart. When the scalp is involved, hair in the affected area may be permanently lost.

How can discoid lupus erythematosus be diagnosed?

This condition can be easily diagnosed on clinical examination; however, sometimes required skin biopsy (removing a small sample of skin for analysis under a microscope).

No. Like many autoimmune conditions, DLE is generally a lifelong condition. However, there are treatments available that are usually effective and can help keep symptoms under control.

If you smoke, we strongly recommend that you stop. Smoking can make this condition worse and may also result in an inadequate response to treatment.

Sun Protection. This self-care should be part of your daily routine:

Protect your skin with clothing and don’t forget to wear a hat that protects your face, neck, and ears, and a pair of UV protective sunglasses. Daily sunscreen is recommended:

• When choosing a sunscreen, always look for high SPF (SPF 30 or more) to protect against UVB and UVA. Apply plenty of sunscreen 15 to 30 minutes before going out in the sun, and reapply every two hours and straight after swimming or towel-drying.
• Clothing can be a very effective sunblock, particularly for your shoulders and arms. However, if you can see through your shirt or blouse easily, then sunlight can get through to your skin. White, close-weave but loose-fitting clothing is best.
• Strictly avoiding sunlight can reduce Vitamin D levels. Therefore, it may be worth taking Vitamin D supplements, available from pharmacies and supermarkets. 

• Strong steroid creams or steroid injections. A trained physician would administer injections according to local protocol. These can help reduce inflammation but must be used under supervision as they can thin the skin.
• Steroid-sparing creams and ointments. Examples include calcineurin Inhibitors and Tacrolimus ointment. These treatments do not contain steroids and act on the immune system to help reduce inflammation.
• Skin camouflage can be used to areas of plaque involvement or if scarring occurs. 

• Anti-malarial tablets, including Hydroxychloroquine and Mepacrine. 

These medications were originally introduced to treat malaria but were also found to have a powerful effect on inflammation and so help to control DLE.

These tablets are usually safe at standard doses. You will be asked to attend for an eye test before starting treatment and after five years if still on treatment

Please let your doctor know if you develop any visual problems while taking the medication.

• Steroid tablets. A course of tablets may benefit patients who have severe, extensive or scarring DLE.
• Medications that modify the immune system. When there is no response to standard therapy, other medications may be used; for example, methotrexate or mycophenolate mofetil.

There are risks associated with these treatments; therefore, they are reserved for selected cases that are severe or non-responsive. They also require additional monitoring.