Useful Facts On Discoid Lupus Erythematosus (DLE)

Lupus is a chronic, autoimmune disease which causes inflammation of various parts of the body, especially the skin, joints, blood and kidneys. The body's immune system normally makes proteins called antibodies to protect the body against viruses, bacteria and other foreign materials. These foreign materials are called antigens. In an autoimmune disorder such as lupus, the immune system loses its ability to tell the difference between foreign substances (antigens) and its own cells and tissues. The immune system then makes antibodies directed against "self." These antibodies, called "auto-antibodies," react with the "self" antigens to form immune complexes. The immune complexes build up in the tissue and can cause inflammation, injury to tissues, and pain.

Lupus affects women eight to ten times more frequently than men and often first appears in women of childbearing years (ages 18 to 45). Women of color (African-American, Native American, Asian and Hispanic) are affected more often than Caucasian women.

Discoid lupus erythematosus (DLE) is characterized by a skin rash only. It occurs in about 20% of patients with systemic lupus erythematosus. The lesions are patchy, crusty, sharply defined skin plaques that may scar. These lesions are usually seen on the face or other sun-exposed areas. DLE may cause patchy, bald areas on the scalp and hypopigmentation or hyperpigmentation in older lesions. Biopsy of a lesion will usually confirm the diagnosis. Topical and intralesional corticosteroids are usually effective for localized lesions; antimalarial drugs may be needed for more generalized lesions. DLE only rarely progresses to systemic lupus erythematosus.

In approximately 10 percent of the people with lupus, discoid lupus can evolve into the systemic form of the disease, which can affect almost any organ or system of the body. This cannot be predicted or prevented. Treatment of discoid lupus will not prevent its progression to the systemic form. Individuals who progress to the systemic form probably had systemic lupus at the outset, with the discoid rash as their main symptom. After a few weeks or months, atrophy, pigmentary changes, and telangiectasia (dilated capillaries) are visible. The patches sometimes spread to the scalp and cause hair loss. Sunlight makes the condition worse, so in some patients it virtually disappears during the winter months. Nearly all patients with DLE remain in good health apart from the skin disorder.

The cause(s) of lupus is unknown, but environmental and genetic factors are involved. While scientists believe there is a genetic predisposition to the disease, it is known that environmental factors also play a critical role in triggering lupus. Some of the environmental factors that may trigger the disease are infections, antibiotics (especially those in the sulfa and penicillin groups), ultraviolet light, extreme stress, and certain drugs.

Fever, weight loss and fatigue may be among the first signs of the illness. A skin rash may develop on the face, neck or arms, especially after exposure to the sun. This rash may involve the nose and cheeks and appear as a butterfly-shaped rash.

Ulcers, usually painless, can occur in the mouth or nose. Painful swelling of the joints and prolonged stiffness in the morning can occur. Inflammation of the surface of some organs (serositis) such as the heart and lungs can cause painful breathing or shortness of breath.

The kidneys can be affected without producing symptoms, although swelling (edema) of the legs can occur. Lupus affecting the kidneys may cause protein and blood in the urine and high blood pressure.

Patients with DLE should wear hats and sunscreen to protect their skin. Also, corticosteroid skin creams may be helpful, but should be used only under medical supervision. Ultimately, some of the lesions heal on their own.

In severe cases, hydroxychloroquine (a drug used to treat malaria) may be beneficial. But, because this drug rarely has an effect on the eyes, it should be used with great caution.

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