The autoimmune disease lupus erythematosus (LE) occurs when your body’s immune system attacks its own tissues and organs. Inflammation caused by LE can affect many different body systems which include your joints, skin, kidneys, blood cells, brain, heart and lungs. LE is believed to be in the same category as diseases such as scleroderma, rheumatoid arthritis and polymyositis.
There are four types of LE – systemic lupus, cutaneous lupus, drug-induced lupus and neonatal lupus. Of these, systemic is the most common type, followed by cutaneous lupus. While systemic lupus can hurt any body system, including your skin (most often with a facial rash) and your internal organs, cutaneous lupus only affects the skin.
Although cutaneous lupus can cause many types of rashes and sores, the most notable is a raised, red and scaly rash that appears on the skin in the form of discs or circles. This types of LE is called discoid lupus.
WHAT IS DISCOID LUPUS?
Discoid lupus (discoid lupus erythematosus) is a chronic autoimmune disease that produces coin-shaped lesions on the skin. It causes a severe rash that tends to get worse when exposed to sunlight. The rash appears most often on the scalp, neck, hands and feet, but it can show up anywhere on the body. Severe cases of discoid lupus can lead to permanent scars, hyper- or hypopigmentation (darker or lighter patches on the skin) and hair loss.
WHAT ARE THE SYMPTOMS OF DISCOID LUPUS?
Discoid lupus starts as a red (erythema) papule, typically on the head, neck or other sun-exposed area. The lesions or sores develop in a centrifugal fashion as inflamed patches with scaly or crusty appearances. The non-itchy rash can range from a mild pink patch to skin that looks inflamed and raw. It can show up anywhere on your body, including the neck, hands, soles of your feet, the area opposite your elbows and even inside your ears. In rare cases, the disease can also affect the eyelids. If the lesions occur in hairy areas such as a man’s beard or on the scalp, permanent scarring and hair loss may occur.
In the localized variety of discoid lupus, the lesions are confined to the head and neck area. The generalized variety of the condition will cause issues both above and below the neck. People who suffer from generalized discoid lupus have significantly greater chances of their disease progressing to systemic lupus. Around 10% of discoid lupus patients will develop, or may already have, systemic lupus and, therefore, will have internal organ complications.
The symptoms of discoid lupus include:
- Disc-shaped lesions
- Thick scales on the skin and scalp
- Skin peeling
- Skin blistering
- Thinning of the skin
- Hyperpigmentation or hypopigmentation (which may become permanent)
- Hair loss (which may become permanent)
- Brittle or bent fingernails
- Ulcers inside the mouth
- Permanent scarring
Symptoms of discoid lupus tend to flare up and then may go into remission at any time.
WHAT CAUSES DISCOID LUPUS?
The exact cause of discoid lupus is unknown. What is known is that, as an autoimmune disease, it causes your body’s immune system to incorrectly attack normal skin. It is a genetic condition, meaning that it runs in families. Environmental factors may also play a role, with sunlight, skin trauma and cigarette smoking acting as major contributors to lesion break-outs. Sex hormones may also play a role. Worsening of the disease may occur during pregnancy, menstrual or pre-menstrual periods and with the intake of oral contraceptives. Also, drugs such as procainamide, hydralazine, isoniazide, diphenylhydantoin, methyldopa, penicillamine, guanides and lithium may cause an outbreak of discoid lupus.
WHO GETS DISCOID LUPUS?
As it is a genetic condition, you may be more prone to getting the disease if one or more of your family members is afflicted by discoid lupus. Anyone, however, can develop discoid lupus, although it is rare in children. Females tend to have the condition more then males, outnumbering them 3 to 1. It can occur at most ages, but women between the ages of 20 and 40 seem to be at a higher risk of developing discoid lupus.
HOW IS DISCOID LUPUS DIAGNOSED?
If you or a doctor suspects discoid lupus, a skin biopsy needs to be performed to confirm the diagnosis. This is because there are other conditions that can look like discoid lupus. If the skin biopsy confirms discoid lupus, then further blood tests may be ordered. This will help rule out whether systemic lupus is also involved. Starting treatment right away can help prevent permanent scarring.
HOW IS DISCOID LUPUS TREATED?
There is no permanent cure for discoid lupus. Treatment should aim at preventing new sores, limiting scarring and making the skin look healthier. Because discoid lupus is a scarring autoimmune disease that can plague you for a prolonged period, the psychological impact has to be considered, and the correct treatment – that also may be prolonged – has to be used. Early effective treatment can lead to complete clearing of skin lesions. However, if you fail to treat discoid lupus it can leave you with depressed scars, hair loss and skin pigment changes.
Discoid lupus lesions are aggravated by both ultraviolet A and ultraviolet B exposure, so preventive measures need to be taken. These measures include:
- Avoiding sun exposure, especially between 10am and 4pm
- Using plenty of sunscreen
- Wearing sun-protective clothing and wide-brimmed hats
- Limiting the amount of time spent under indoor fluorescent lights
- Avoiding time spent on snow, sand or water where ultraviolet light can be reflected
Discoid Lupus Treatments:
Steroids. Used to help reduce inflammation, prescription-strength ointments or creams can be applied directly to your skin. Your doctor can also administer a steroid injection directly into the affected area, which is usually more effective than ointments or creams. Oral prednisone can be used to reduce lesions by decreasing antibody production and inflammation. Steroids can thin the skin, so you must use them sparingly and under medical supervision.
Non-Steroidal Topical Creams. Non-steroidal topical creams and ointments, such as calcineurin inhibitors like tacrolimus, can also help reduce inflammation.
Anti-Malarial Medications. Anti-malarial medications are another way to reduce inflammation. These oral drugs include hydroxychloroquine, chloroquine, and quinacrine. They tend to have milder side effects than some other drugs.
Immunosuppressive Medications. These may lower production of inflammatory cells.
Immunosuppressive medications are usually used in severe cases or if you’re trying to wean yourself off oral steroids. Some of these drugs are mycophenolate mofetil, azathioprine, and methotrexate.
Other Discoid Lupus Treatments:
Methotrexate. This may help discoid lupus patients who are resistant to conventional treatments. Short-term treatment shouldn’t cause any side effects.
Cyclosporin A. This potent immunosuppressant inhibits lymphocyte activation and proliferation helping to effectively manage discoid lupus.
Tacrolimus. A macrolide derived from the fungus Streptomyces tsukubaensis, this has been used lately to treat inflammatory and autoimmune conditions such as discoid lupus. Used as an ointment, it acts as a local immunosuppressive agent.
Mycophenolate mofetil. This is an immunosuppressive agent that is used to treat various dermatoses that are inflammatory or autoimmune in origin.
Azathioprine. Although it is potentially toxic, it can be used in severe cases of discoid lupus, with particular success with conditions involving the palms of the hands and soles of the feet.
For scarring and pigment changes, treatment options may also include laser technology and plastic surgery. But this can only be determined on a case-by-case basis. If you feel you need these options, your dermatologist or healthcare professional can offer personalized recommendations.
Discoid Lupus Treatment Tips and Guidelines:
- Avoiding the sun can make it hard to get enough vitamin D, so ask your doctor if you should take vitamin D supplements.
- Always use a sunscreen with an SPF of 70 or higher. Reapply every few hours or after getting wet.
- Remember to wear a hat and clothing that protects your skin, even on cloudy days.
- Smoking can aggravate your condition. If you’re having trouble quitting, ask your doctor about smoking cessation programs.
- Certain medications, such as antibiotics and diuretics can make you more sensitive to sunlight. Read medicine labels carefully and ask your doctor or pharmacist if your medication increases sensitivity to sunlight.
- Repeated bouts of discoid lupus can leave you with scars or permanent discoloration. Patches on the scalp can cause your hair to fall out. As your scalp heals, scarring can prevent hair from growing back.
HOW CAN A DERMATOLOGIST HELP WITH DISCOID LUPUS?
Your dermatologist is your best resource and source of support when it comes to discoid lupus. They will be able to help determine whether you have the disease or another skin condition. The skin rash could possibly be another issue such as rosacea or an allergic reaction.
If you do have discoid lupus, your dermatologist can help you with:
- Developing a sun-protection plan that is right for you
- Creating an appropriate treatment plan for your skin
- Recommending skincare products that won’t irritate your skin
- Showing you ways to camouflage your skin with the proper makeup
- Determining whether your discoid lupus affects other parts of your body
- Checking your skin for signs of skin cancer
WHAT IS THE OUTLOOK FOR DISCOID LUPUS?
Discoid lupus is a chronic, scarring and potentially disfiguring disease. It is an important cause of irreversible hair loss and is associated with considerable morbidity. It is extremely important for family physicians to diagnose this relatively uncommon condition early because effective treatment is important to resolve the established lesions and to prevent scarring.
A small percentage of people with discoid lupus will develop systemic lupus at some point. The risk of skin cancer may also be increased if you have long-lasting lesions on your skin or inside your lips or mouth. Discoid lupus is an incurable disease, but it can go into remission.
If you enjoyed reading this article on discoid lupus, you may also like to read Natural Treatments & Home Remedies for Psoriasis.