Discoid Lupus Erythematosus (DLE)

Are you having reddish bumps and scaly patches, especially on your face and neck? Watch out as you could be suffering from Discoid Lupus Erythematosus. Read and know more about the symptoms, causes, diagnosis and treatment of this rare skin condition.

Discoid Lupus Erythematosus Definition

It is a dermatological condition manifested by skin eruptions that may lead to permanent inflammation and scarring of skin. The term “discoid” refers to skin lesions that are flat, circular or disc-shaped. It is a chronic condition that may get further deteriorated on exposure to bright sunlight. Lupus erythematosus is a range of related or similar disorders. Systemic Lupus Erythematosus forms one end of the range that can damage internal organs like skin, joints, kidneys, and brain. Discoid lupus erythematosus, abbreviated as DLE, forms the other end of the range which is confined to the skin and does not lead to any major health issues.

Discoid Lupus Erythematosus Incidence

DLE is a gender-specific disorder and is more common in females. Approximately 10% of all individuals suffering from DLE can develop Systemic Lupus Erythematosus.

Discoid Lupus Erythematosus Types

This particular condition affects only the skin. On the basis of its extent, this disorder is generally classified into two forms:

Localized discoid lupus erythematosus

In this form of DLE, cutaneous lesions appear above the neck. These are especially common on those regions that remain most exposed to sunlight such as scalp, cheeks, nose, ears and lower lips. Some patients may also develop these lesions on unexposed areas of the body, including back and legs.

Generalized discoid lupus erythematosus

It is a widespread form of DLE although generally less common than the localized form. It displays severe symptoms and primarily affects the thorax. In this type, dry rashes appear on the upper back and chest. Upper extremities or upper limbs, other than the head and neck, are equally affected.

Discoid Lupus Erythematosus Symptoms

DLE skin lesions are generally round, slightly elevated and are believed to be asymptomatic. In the initial stage, these lesions appear reddish but gradually change in color. These may occur quite frequently or occasionally. The intensity of the symptoms tends to vary among individuals. Know about some of the other notable signs and symptoms of this disorder.

Scales

Red scaly patches may develop over the lesions and give a crusty appearance. These scales slowly get thickened and undergo change in texture. Light colored scales appear on the center region of the lesions. On the other hand, dark colored scales develop at the peripheral region of the lesions.

Inflammation of the skin

Skin rashes, in the form of circular red patches of about 5-10 mm in diameter, are commonly observed during this condition. These rashes appear scaly and lighter in color in the middle region while the outer region appears darker.

Itching and pain

Itching of skin is not a very common symptom and is generally reported by a smaller section of affected DLE individuals. Sufferers do not generally develop painful lesions.

Atrophy

Permanent scarring and thinning of skin is apparent in patients with DLE. This condition usually takes place during formation of active skin lesions that causes partial or complete loss of the skin.

Pigmentary changes

Hyperpigmentation, or darkening of skin due to excess accumulation of melanin, may occur during this condition. In some cases, there is complete loss of natural skin color which causes Hypopigmentation.

Hair loss

In case of DLE, scalp is the most severely affected region. Scarring of the scalp may involve temporary or permanent hair loss. This particular symptom is not only restricted to the scalp but may also occur in the other hairy regions of the body like chest, armpits and hands.

Photosensitivity

Patients may develop intolerance and acute discomfort when exposed to any form of light including dim light.

Mouth ulcers

Formation of thick scales may spread to the interior region of the mouth, causing open sores or oral ulcers. These open lesions in the mouth can often be painful. These may also multiply if allowed to spread further.

Joint pain and swelling

Affected persons often complain of acute discomfort in the knee and finger joints. This may even lead to extreme swelling.

Discoid Lupus Erythematosus Causes

Actual determinants of this skin disorder have not yet been identified. DLE is considered to be an autoimmune disorder where the body’s own immune system targets the skin, causing acute inflammation and rash.However, some medical experts have a few assumptions regarding the cause of this disorder. These include:

Genetic factors

DLE generally affects genetically predisposed individuals, thus making it seem as if they have inherited this rare disorder from their previous generation.

Hormonal factors

Estrogen plays an essential role in maintaining normal and healthy skin. During hormonal imbalance, estrogen is often produced in excess causing various skin lesions and rashes. Excess intake of antibodies is also suspected to cause this condition.

Environmental factors

Prolonged exposure to ultraviolet light and tobacco smoke may induce increased growth of lesions.

Discoid Lupus Erythematosus in Children

DLE is a rare condition in children and is known as Childhood Discoid Lupus Erythematosus. Studies have shown that only 2% of the patients suffering from DLE may develop its symptoms in childhood. Infants may also get affected, with the minimum age being only 1 week. Clinical manifestations are identical to that in adults and may include formation of discoid or flat plaque, atrophy, and scars. Children do not suffer from photosensitive although they may have a higher chance of developing Severe Systemic Lupus Erythematosus. However, DLE in children is not female dominant.

Discoid Lupus Erythematosus in Dogs

Canine Discoid Lupus Erythematosus is a common form of DLE that frequently occurs in dogs. Symptoms are quite similar to that in humans including scaly patches and pigment loss. The surface of the nose may turn gray, along with the formation of skin sores. Lips, ears and genitals may gradually get affected. However, it does not progress to Systemic Lupus Erythematosus and is generally very mild.

Discoid Lupus Erythematosus Diagnosis

Skin experts generally perform a thorough physical examination of the skin as the first stage of diagnosis. This is further followed by few laboratory tests to detect the exact condition of the skin. These include:

Blood test

Individuals suffering from DLE have an elevated level of anti-nuclear antibodies (ANAs) in their bloodstream. These are actually auto antibodies that are produced in higher numbers in the body during autoimmune conditions. Patients may also show low white blood cell (WBC) count and erythrocyte sedimentation rate (ESR).

Urine test

Affected patients may have increased amount of proteins in the urine, owing to inflammation of the skin.

Skin biopsy

In this process, a small section of discoid lesion is removed and examined by using Direct Immunofluorescence Test (DIT) to detect the presence of immunoreactants. In this technique, a single antibody is made to bind to a fluorophore that recognizes the target molecule (immunoreactant) and attaches to it completely. A fluorescence microscope is generally used to detect such molecules. DIT is normally positive in DLE patients. However, biopsy of nascent and older lesions generally gives a negative result.

Discoid Lupus Erythematosus Treatment

Although DLE cannot be completely cured with the help of routine medical treatments, it can always be controlled by alleviating its symptoms. Preliminary measures include exposing oneself less to sunlight and cigarette smoke as well as wearing protective clothing. Sunscreens and protective makeup can also be applied on the face to avoid sunburns when exposed to sun. Medical treatment involves use of:

Steroids

These are normally applied topically or can be injected into the skin lesions. Steroid lotions or foams are generally used for scalp. Weaker steroids are applied on the face. On the other hand, steroids like Triamcinolone acetonide are administered directly into the skin lesions.

Antimalarial drugs

Hydroxychloroquine and Acitretin are often found to be effective in the treatment of DLE. However, occurrence of frequent side effects may restrict the intake of these drugs.

Immunosuppressants

Azathioprine, methotrexate and mycophenolate mofetil are the most commonly used drugs for suppressing the immune system. Production of autoantibodies against the skin can be prevented for a prolonged duration in this way. Topical immunosuppressants like tacrolimus,  pimecrolimus and imiquimod can also be applied directly on the lesions.

Surgery

Skin lesions that are initially burned-out using a small electric current can be surgically removed or excised. However, there is a possibility of reappearance of the skin lesions. In the case of localized DLE, laser therapy is normally preferred for complete elimination of the lesions.

Discoid lupus erythematosus is not a life-threatening condition and does not affect the regular lifestyle of patients in a major way. However, early treatment is highly essential as it might aid in reducing atrophy before DLE evolves into severe Systemic Lupus Erythematosus. Hence, a person detected with any of the DLE symptoms must seek immediate medical care to ensure quicker recovery and more effective management of symptoms.

References:

http://en.wikipedia.org/wiki/Canine_discoid_lupus_erythematosus

http://www.patient.co.uk/doctor/Discoid-Lupus-Erythematosus.htm

http://www.localhealth.com/article/discoid-lupus-erythematosus/treatments

http://en.wikipedia.org/wiki/Discoid_lupus_erythematosus

 

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