Discoid Lupus Erythematosus
Discoid lupus erythematosus (DLE) is a disease in which coin-shaped (discoid) red bumps
appear on the skin.
Description of discoid lupus erythematosus
The disease called discoid lupus erythematosus only affects the skin, although similar
discoid skin lesions can occur in the serious disease called systemic lupus
erythematosus (SLE). Only about 10% of all patients with DLE will go on to develop the
multi-organ disease SLE.
The tendency to develop DLE seems to run in families. Although men or women of any age
can develop DLE, it occurs in women three times more frequently than in men. The typical
DLE patient is a woman in her 30s.
Causes and symptoms of discoid lupus erythematosus
The cause of DLE is unknown. It is thought that DLE (like SLE) may be an autoimmune
disorder. Autoimmune disorders are those that occur when cells of the immune system
are misdirected against the body. Normally, immune cells work to recognize and help
destroy foreign invaders like bacteria, viruses, and fungi. In autoimmune disorders, these
cells mistakenly recognize various tissues of the body as foreign invaders, and attack and
destroy these tissues. In SLE, the misdirected immune cells are antibodies. In DLE, the
damaging cells are believed to be a type of white blood cell called a T lymphocyte. The
injury to the skin results in inflammation and the characteristic discoid lesions.
In DLE, the characteristic skin lesion is circular and raised. The reddish rash is
about 5-10 mm in diameter, with the center often somewhat scaly and lighter in color than
the darker outer ring. The surface of these lesions is sometimes described as
"warty." There is rarely any itching or pain associated with
discoid lesions. They tend to appear on the face, ears, neck, scalp, chest, back, and
arms. As DLE lesions heal, they leave thickened, scarred areas of skin. When the scalp is
severely affected, there may be associated hair loss (alopecia).
People with DLE tend to be quite sensitive to the sun. They are more likely to get a sunburn,
and the sun is likely to worsen their discoid lesions.
Diagnosis of discoid lupus erythematosus
Diagnosis of DLE usually requires a skin biopsy. A small sample of a discoid
lesion is removed, specially prepared, and examined under a microscope. Usually, the
lesion has certain microscopic characteristics that allow it to be identified as a DLE
lesion. Blood tests will not reveal the type of antibodies present in SLE, and physical
examination usually does not reveal anything other than the skin lesions. If
antibodies exist in the blood, or if other symptoms or physical signs are found, it is
possible that the discoid lesions are a sign of SLE rather than DLE.
Treatment of discoid lupus erythematosus
Treatment of DLE primarily involves the use of a variety of skin creams. Sunscreens
are used for protection. Steroid creams can be applied to decrease inflammation.
Occasionally, small amounts of a steroid preparation will be injected with a needle into a
specific lesion. Because of their long list of side effects, steroid preparations taken by
mouth are avoided. Sometimes, short-term treatment with oral steroids will be used for
particularly severe DLE outbreaks. Medications used to treat the infectious disease malaria
are often used to treat DLE.
Alternative treatment of discoid lupus erythematosus
Alternative treatments for DLE include eating a healthy diet, low in red meat and dairy
products and high in fish containing omega-3 fatty acids. These types of fish include
mackerel, sardines, and salmon. Following a healthy diet is thought to decrease
inflammation. Dietary supplements believed to be helpful include vitamins B, C, E,
and selenium. Vitamin A is also recommended to improve DLE lesions. Constitutional
homeopathic treatment can help heal DLE as well as help prevent it developing into SLE.
Prognosis of discoid lupus erythematosus
For the most part, the prognosis for people with DLE is excellent. While the lesions
may be cosmetically unsightly, they are not life threatening and usually do not cause a
patient to change his or her lifestyle. Only about 10% of patients with DLE will go on to
Prevention of discoid lupus erythematosus
DLE cannot be prevented. Recommendations to prevent flares of DLE in patients with the
disease include avoiding exposure to sun and consistently using sunscreen.