Discoid lupus erythematosus

Discoid lupus erythematosus

Discoid lupus erythematosus is a benign disorder generally seen in younger females, particularly people with darker skin pigmentation. It very rarely progresses to systemic lupus erythematosus (in less than 5% of cases). Discoid lupus erythematosus is characterised by follicular keratin plugs and is thought to be autoimmune in aetiology.

Features

• erythematous, raised rash, sometimes scaly
  erythematous, raised rash, sometimes scaly
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• may be photosensitive
• more common on face, neck, ears and scalp
• lesions heal with atrophy, scarring (may cause scarring alopecia
  Discoid lupus erythematosus may cause scarring alopecia
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  Importance: 89
  ), and pigmentation
• serology
  • typically has negative or low-titre ANA, and anti-dsDNA / anti-Sm are usually absent
    Young female, scaly facial rash/scarring alopecia with negative serology --> ? discoid lupus erythematosus
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    Importance: 87
  • this helps explain how progression to SLE is uncommon

Management

Discoid lupus erythematous - topical steroids --> oral hydroxychloroquine

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Importance: 85

• topical steroid cream
• oral antimalarials may be used second-line e.g. hydroxychloroquine
• avoid sun exposure and smoking
  • smoking increases disease severity and reduces response to antimalarials

+PassMedicine Notes

Discoid lupus erythematosus is a benign disorder generally seen in younger females, particularly people with darker skin pigmentation. It very rarely progresses to systemic lupus erythematosus (in less than 5% of cases). Discoid lupus erythematosus is characterised by follicular keratin plugs and is thought to be autoimmune in aetiology.

Features

• erythematous, raised rash, sometimes scaly
• may be photosensitive
• more common on face, neck, ears and scalp
• lesions heal with atrophy, scarring (may cause scarring alopecia), and pigmentation
• serology
• typically has negative or low-titre ANA, and anti-dsDNA / anti-Sm are usually absent
• this helps explain how progression to SLE is uncommon

Management

• topical steroid cream
• oral antimalarials may be used second-line e.g. hydroxychloroquine
• avoid sun exposure and smoking
• smoking increases disease severity and reduces response to antimalarials

ddd124.jpg Discoid lupus erythematous affecting the scalp