Discoid lupus erythematosus or DLE is the most common type of cutaneoeus lupus. Approximately 10% of people with discoid lupus later develop systemic lupus but it begins as a condition which solely effects the skin and hair. It gets it name from the shape of the lesions which occur on the skin.
Discoid lupus is the most common type of chronic cutaneous lupus. It is classified as an autoimmune skin condition and it fits on the larger spectrum of lupus erythematosus illnesses. It is typified by red, inflamed patches on the skin which mainly form on the scalp, cheeks and ears. Hair loss can happen if the lesions occur on the scalp too. In some instances, the lesions develop into severe scarring and they may differentiate in color or permanently change the color of the skin. There are different kinds of discoid lupus which may develop at different times of life. Patients with discoid lupus may follow a range of different treatment options, including well-known home remedies and medications. Patients usually follow a self-care and self-help program too, to help keep symptoms at bay.
Signs and Symptoms of Discoid Lupus
Discoid lupus erythematosus features coin-shaped lesions on the skin. They first appear as red or purple-red disc shaped lesions on the skin. They can be firm and hard or raised above the regular skin level. The purple-red color then usually begins to pick up white patches in the next stage of development. Finally, the lesions can develop extensive scarring and can lead to pigment change too. The tops of the lesions may crust over, with dried fluid solidifying on top of the lesions. People with darker skin tones may experience more prominent lesions due to the pigmentation being more obvious. The center of the lesions often lose pigment more quickly while the edges can become much darker. People with lighter skin may see the lesions turn grayish in color. In more rare cases the lesions can appear brighter, red in color, and they appear a little like hives.
Location of DSE Lesions
The skin lesions which form on patients with discoid lupus are most often in areas most exposed to the sun. Typically, they form in areas localized from the neck upwards. Commonly they appear on the scalp, the bridge of the nope, in the ears, upper checks and on the lower lip. Patients also report lesions commonly in the mouth, including on the palate, in the nose, vulva and eye. This is because these areas are particularly mucosal. Lesions can occur on other parts of the body, but this is rare. They mat appear on the head and back of the neck and the trunk and arms.
Characteristics of Different DSE Lesions
Discoid lupus lesions can occur in any of the locations mentioned above but when the appear in certain areas they may have special characteristics such as:
- Scalp Lesions: discoid lupus on the scalp has the typical appearance the lesions are known for. The red disc shapes may be flat or raised. Next, patients may begin to lose their hair and extensive scarring develops. Lesions may lose skin pigment and become noticeable on the scalp and they can appear like sunken areas or indentations in the scalp.
- Lip Lesions: discoid lesion on the lip can be particularly irritating and uncomfortable. It can be itchy and tender to touch. Lip lesions usually appear gray or red in color and the top layer of the skin is thickened.
Patients with discoid lupus erythematosus often experience swelling and redness around the eyes too and darker skinned patients may experience the most severe scarring as their skin color changes.
What Causes Discoid Lupus?
Doctors do not have the evidence or research to give a full answer as to the cause of discoid lupus erythematosus. Systemic lupus also has no known cause at present which can make it difficult to find the right treatments for. Discoid lupus can be made much worse by exposure to ultraviolet light. Exposure to UV light can alter the DNA in the skin and make it more prone to allergic reactions and sensitivities. The disease can also be exacerbated by stress.
Is Discoid Lupus Hereditary?
The evidence about genetic links for people with discoid lupus is not extensive. However, some families may carry genes which increase the chance of developing the condition. There is yet to be much research or knowledge into how affected genes impact or influence the disease. More contributory factors include things such as environmental influence.
Classification and Types of Discoid Lupus
Discoid lupus does come in different types and some patients do not experience it for their whole lives. What’s more,
the most common classifications are:
- Localized discoid lupus: where the lumps all occur in a similar location of the body
- Generalized discoid lupus: where the lumps occur in many areas across the body
Below is a closer look at these types of the condition in turn and also a further look at childhood discoid lupus:
Localized Discoid Lupus
Localized discoid lupus only ever appears above the neck.
Generalized Discoid Lupus
Patients with generalized discoid lupus may find lesions below the neck. It is also common that people with this condition may find lesions on their chest and arms. Generalized discoid lupus often leads to full hair loss and severe scarring is common on the face and scalp. Patients with this condition often find they have other health concerns such as low white blood cell count.
Childhood Discoid Lupus
Children who develop discoid lupus don’t tend to have abnormal sensitivity to the sun. However, they are much more likely to develop systemic lupus in later life.
Diagnosing Discoid Lupus
Patients presenting with discoid lupus will have a number of tests carry out. The first thing a doctor will need to do is check the patient does not have systemic lupus erythematosus. Doctors will run blood tests to look for anti-nuclear antibodies as well as low white blood cell levels.
To help with diagnosis some doctors will remove a layer of skin from the lesions as they may need to look at the underside of the lesion. Discoid lupus lesions are sometime characterized by langue au chat. This term refers to tiny streaks or spines of keratin which appear a little like tacks in the underside of the lesion.
Diagnosis for discoid lupus is usually confirmed through a biopsy. Once a biopsy is taken the doctor can assess the results and come to a proper diagnosis and begin helping patients find the right treatment for their condition.
Self-Care Tips for Discoid Lupus Patients
Patients diagnosed with discoid lupus can make some lifestyle changes which can help in managing and improving the condition. These include:
If you smoke when you are diagnosed with this condition, it is strongly recommended you stop. Smoking can make this condition much work and can result in poor response to the treatments available.
Appropriate Sun Protection
Increased sun sensitivity is a main symptom of discoid lupus. The following basic sun care tips should be closely followed:
- Wear sunscreen daily: you should opt for sunscreens with an SPF of 30 or more. It should protect against both UVB and UBA rays. Sunscreen should be reapplied every two hours to ensure the highest level of protection.
- Protect your skin with clothing: hats are necessary for protecting the face and neck. Similarly, UV protective sunglasses are recommended. Clothes don’t need to be dark necessarily, but they do need a close-weave or knit to ensure effective sun blocking.
- Vitamin D supplementation: avoiding the sun can result in Vitamin D deficiency. It is important to check with your medical team to see if you should take Vitamin D supplements.
Natural Remedies for Discoid Lupus Erythematosus
Speaking to your doctor about the treatment for your discoid lupus is essential. However, living with a lifelong chronic condition means it is understandable you might want to try different home remedies and natural approaches to managing and treating your condition. Most patients choose to try different natural remedies alongside their regular treatment, and it is always recommended you speak to your doctor before making any drastic changes which could impact on your condition.
Diets rich in particular nutrients are recommended to help combat the irritation that comes with discoid lupus flare-ups including:
- Avocado, nuts and seeds like chia seeds which help to moisturize the skin from the inside out.
- Foods with in omega-3 fatty acids (fish and fish oil) which help to reduce inflammation naturally.
- Cucumber and melon
It is also recommended you avoid foods which can aggravate the condition. There is no exact understanding of what foods may aggravate the condition, but patients commonly find spicy foods or those high in saturated fats can become a problem and cause the condition to flare.
Many studies have found that stress can be linked to discoid lupus flare ups. This means finding ways to relieve and manage stress are key to managing the symptoms of the condition and limiting them from becoming more severe and unmanageable. Stress management is a very personal process and may include anything from your favourite exercise to mindfulness and meditation. Your medical team can help give pointers and guidance for the new and potentially successful ways of relieving and managing stress.
Alternative and Complementary Medicine
There is very little evidence to support the use of alternative and complementary therapies in treating this condition. However, patients may want to explore all avenues, and some do find success or improvement due to particular treatments. What’s more, some therapies such as massage or aromatherapy may help reduce stress which, as already mentioned, can cause flare ups. Some doctors may also suggest mind-body therapies including hypnotherapy and guided imagery therapy, which are also good for relieving the stress.
Some patients opt for herbal medicines to treat their symptoms. Herbs such as ginger and turmeric are known for their anti-inflammatory properties for example. Patients may apply the herbs in tincture form directly to the lesions or they may choose to ingest higher volumes of these well-known anti-inflammatories.
Medical Treatment for Discoid Lupus Erythematosus
Once you have a diagnosis of discoid lupus, you can seek the right treatment to help ease the symptoms. It is a condition which cannot be cured but there are effective treatments. The effectiveness of each treatment will vary from patient to patient. Some patients will have better responses to some treatments, so it is important to trial different treatment options to find the right mix for your specific symptoms and severity of condition. Below is a closer look at how discoid lupus may be treated. Bear in mind, the sooner you start treatment the sooner you can prevent the chance of permanent scarring.
Steroids are often used to help reduce inflammation in many inflammatory diseases and this includes discoid lupus. Prescription-strength ointments or creams may be prescribed. Alternatively, your doctor may offer you steroid injections which are given in the area affected by the disease. Some doctors will prescribe oral prednisone. This is a steroid treatment that might alleviate lesions by helping to reduce inflammatory cells and antibody production. It is important to remember that steroids can result in the thinning of the skin so they must only be used under medical supervision. They are not recommended over long periods unless your doctor specifically recommends this.
Topical Ointments (Non-Steroidal)
There are a range of non-steroidal topical creams and ointments which can help in the treatment of discoid lupus lesions. Creams such as calcineurin inhibitors for example tacrolimus can be effective in reducing inflammation.
Immunosuppressive medications work by lowering the production of inflammatory cells. They are usually only prescribed in the most severe cases or if there is a need to wean yourself from oral steroids. Immunosuppressants can include medications such as methotrexate, azathioprine and mycophenolate mofetil. It is particularly important to be aware of the side effects of these drugs.
Anti-malarial medications have been found to be effective in reducing inflammation. They are taken as oral medication and include drugs such as chloroquine, quinacrine and hydroxychloroquine. These drugs are popular due to the milder side effects they have when compared to other treatments.
Please remember medications are not a replacement for good protection against the sun as this is the main way of protecting your skin. Proper sun protection is also key in limiting further complications which can occur with the disease.
What are the potential complications of Discoid Lupus Erythematosus?
If you have repeated bouts or flare ups of discoid lupus, then you can very quickly end up with severe scarring. Permanent discoloration is also a possibility. Where hair loss occurs, it can take some time to grow back too. Patches on the scalp are known to cause hair loss but if scarring occurs it can be hard to the hair to grow back at all.
Research has also unfortunately found that the risk of skin cancer can be higher. Long lasting lesions on the skin or inside the lips and mouth is shown to raise the risk of skin cancer so it is particularly important to be sun safe. As mentioned at the beginning of this piece, people with discoid lupus are at higher risk of developing systemic lupus. Systemic lupus can also affect the internal organs.
Prognosis and the Development of Systemic Lupus
The number of people with discoid lupus who develop systemic lupus is around 10%. Systemic lupus is a chronic condition much like DLE and additional symptoms include:
- Joint pain and stiffness
- Fatigue and uncontrollable tiredness that isn’t helped with extensive rest
- Unexpected weight gain
- Swollen glands
- Sensitivity light which results in rashes on uncovered skin
People with discoid lupus should be vigilant about additional symptoms so they can ensure they get the right treatment and are able to manage symptoms well.
Coping with Discoid Lupus
Studies, such as those examined by the Lupus Foundation of America Medical-Scientific Advisory Council unfortunately show that discoid lupus can cause mental health issues. People with the condition have a worse quality of life compared with those with other dermatological conditions, according to these studies. The damage the condition leaves on the skin can make people particularly self-conscious, especially as there is no way of knowing in advance how the condition may fully impact on the skin. Similarly, as the skin lesions commonly appear on the scalp and the face, so they cannot easily be hidden.
Looking after your mental health and wellbeing is absolutely paramount when living with any chronic condition. Discoid lupus can make day to day life difficult, with social confidence and self-esteem particularly affected. The right treatment can make a difference, but it is important to be aware of side effects too, as this can be counterproductive to any improvement in the lesions.
With many national and international charities in the dermatology field, as well as those specifically focused on lupus, patients need never feel alone. Community groups and even online forums can be very helpful in reaching out to others with the same condition and discussing your worries and concerns.