Discoid lupus erythematosus

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 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. Of note, patients with systemic lupus erythematous develop discoid lupus lesions with some frequency. However, patients who present initially with discoid lupus infrequently develop systemic lupus. Discoid lupus can be divided into localized, generalized, and childhood discoid lupus. The lesions are diagnosed by biopsy. Patients are first treated with sunscreen and topical steroids. If this does not work, an oral medication—most likely hydroxycloroquine or a related medication—can be tried. Discoid lupus erythematosus skin lesions first present as dull or purplish red, disc-shaped flat or raised and firm areas of skin. These lesions then develop increasing amounts of white, adherent scale. Finally, the lesions develop extensive scarring and/or atrophy, as well as pigment changes. They may also have overlying dried fluid, known as crust. On darker skin, the lesions often lose skin pigmentation in the center and develop increased, dark skin pigmentation around the rim. On lighter skin, the lesions often develop a gray color or have very little color change. More rarely, the lesions may be bright red and look like hives. The skin lesions are most often in sun-exposed areas localized above the neck, with favored sites being the scalp, bridge of the nose, upper cheeks, lower lip, and ears. 24% of patients also have lesions in the mouth (most often the palate), nose, eye, or vulva, which are all mucosal parts of the body. More rarely, patients may have lesions on the head and neck as well as the arms and trunk. When discoid lupus is on the scalp, it starts as a red flat or raised area of skin that then loses hair and develops extensive scarring. The lesions often lose skin pigment and become white with areas of increased skin pigment, with or without areas of redness, and have a sunken appearance. They can have a smooth surface or have visible, dilated hair follicles on the surface. When discoid lupus is on the lip, it often has a gray or red color with a thickened top layer of skin (known as hyperkeratosis), areas where the top layer has worn away (known as erosion), and a surrounding rim of redness. Patients may state that their lesions are itchy, tender, or asymptomatic. In addition to their skin lesions, they may also have swelling and redness around their eyes, as well as blepharitis.