discoid lupus erythematosus (redirected from Lupus erythematosus, discoid)

Discoid Lupus Erythematosus 

Definition

Discoid lupus erythematosus (DLE) is a disease in which coin-shaped (discoid) red bumps appear on the skin.

Description

The disease called discoid lupus erythematosus only affects the skin, although similar discoid skin lesions can occur in the serious disease called systemic lupus erythematosus (SLE). Only about 10% of all patients with DLE will go on to develop the multiorgan disease SLE.

The tendency to develop DLE seems to run in families. Although men or women of any age can develop DLE, it occurs in women three times more frequently than in men. The typical DLE patient is a woman in her 30s.

Causes and symptoms

The cause of DLE is unknown. It is thought that DLE (like SLE) may be an autoimmune disorder. Autoimmune disorders are those that occur when cells of the immune system are misdirected against the body. Normally, immune cells work to recognize and help destroy foreign invaders like bacteria, viruses, and fungi. In autoimmune disorders, these cells mistakenly recognize various tissues of the body as foreign invaders, and attack and destroy these tissues. In SLE, the misdirected immune cells are antibodies. In DLE, the damaging cells are believed to be a type of white blood cell called a T lymphocyte. The injury to the skin results in inflammation and the characteristic discoid lesions.

In DLE, the characteristic skin lesion is circular and raised. The reddish rash is about 5-10 mm in diameter, with the center often somewhat scaly and lighter in color than the darker outer ring. The surface of these lesions is sometimes described as "warty." There is rarely any itching or pain associated with discoid lesions. They tend to appear on the face, ears, neck, scalp, chest, back, and arms. As DLE lesions heal, they leave thickened, scarred areas of skin. When the scalp is severely affected, there may be associated hair loss (alopecia).

People with DLE tend to be quite sensitive to the sun. They are more likely to get a sunburn, and the sun is likely to worsen their discoid lesions.

Diagnosis

Diagnosis of DLE usually requires a skin biopsy. A small sample of a discoid lesion is removed, specially prepared, and examined under a microscope. Usually, the lesion has certain microscopic characteristics that allow it to be identified as a DLE lesion. Blood tests will not reveal the type of antibodies present in SLE, and physical examination usually does not reveal anything other than the skin lesions. If antibodies exist in the blood, or if other symptoms or physical signs are found, it is possible that the discoid lesions are a sign of SLE rather than DLE.

Treatment

Treatment of DLE primarily involves the use of a variety of skin creams. Sunscreens are used for protection. Steroid creams can be applied to decrease inflammation. Occasionally, small amounts of a steroid preparation will be injected with a needle into a specific lesion. Because of their long list of side effects, steroid preparations taken by mouth are avoided. Sometimes, short-term treatment with oral steroids will be used for particularly severe DLE outbreaks. Medications used to treat the infectious disease malaria are often used to treat DLE.

Key terms

Antibody — Specialized cells of the immune system that can recognize organisms invading the body (like bacteria, viruses, and fungi). The antibodies are then able to start a complex chain of events designed to kill these foreign invaders.

Autoimmune disorder — A disorder in which the body's antibodies mistake the body's own tissues for foreign invaders. The immune system then attacks and causes damage to these tissues.

Immune system — The system of specialized organs, lymph nodes, and blood cells throughout the body that work together to defend the body against foreign invaders (bacteria, viruses, fungi, etc.).

Alternative treatment

Alternative treatments for DLE include eating a healthy diet, low in red meat and dairy products and high in fish containing omega-3 fatty acids. These types of fish include mackerel, sardines, and salmon. Following a healthy diet is thought to decrease inflammation. Dietary supplements believed to be helpful include vitamins B, C, E, and selenium. Vitamin A is also recommended to improve DLE lesions. Constitutional homeopathic treatment can help heal DLE as well as help prevent it developing into SLE.

Prognosis

For the most part, the prognosis for people with DLE is excellent. While the lesions may be cosmetically unsightly, they are not life threatening and usually do not cause a patient to change his or her lifestyle. Only about 10% of patients with DLE will go on to develop SLE.

Prevention

DLE cannot be prevented. Recommendations to prevent flares of DLE in patients with the disease include avoiding exposure to sun and consistently using sunscreen.

Resources

Organizations

The American College of Rheumatology. 1800 Century Place, Suite 250, Atlanta, GA 30345. (404) 633-3777. http://www.rheumatology.org.

Lupus Foundation of America. 1300 Piccard Dr., Suite 200, Rockville, MD 20850. (800) 558-0121. http://www.lupus.org.

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lupus /lu·pus/ (loo´pus) any of a group of skin diseases in which the lesions are characteristically eroded.

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chilblain lupus erythematosus  a form due to cold-induced microvascular injury, aggravated by cold; the lesions initially resemble chilblains but eventually assume the form of discoid lupus erythematosus.

cutaneous lupus erythematosus  one of the two main forms of lupus erythematosus, in which the skin may be either the only or the first organ or system involved. It may be chronic (discoid l. erythematosus), subacute (systemic l. erythematosus), or acute (characterized by an acute, edematous, erythematous eruption).

discoid lupus erythematosus  (DLE) a chronic form of cutaneous lupus erythematosus marked by red macules covered with scanty adherent scales that fall off and leave scars; lesions typically form a butterfly pattern over the bridge of the nose and cheeks, but other areas may be involved.

drug-induced lupus  a syndrome closely resembling systemic lupus erythematosus, precipitated by prolonged use of certain drugs, most commonly hydralazine, isoniazid, various anticonvulsants, and procainamide.

lupus erythemato´sus  (LE) a group of chronic connective tissue diseases manifested in two main types: cutaneous l. erythematosus and systemic l. erythematosus.

lupus erythemato´sus profun´dus  a form of cutaneous lupus erythematosus in which deep brawny indurations or subcutaneous nodules occur under normal or, less often, involved skin; the overlying skin may be erythematous, atrophic, and ulcerated and on healing may leave a depressed scar.

lupus erythemato´sus tu´midus  a variant of discoid or systemic lupus erythematosus in which the lesions are raised reddish purple or brown plaques.

hypertrophic lupus erythematosus  a form of discoid lupus erythematosus characterized by verrucous hyperkeratotic lesions.

lupus hypertro´phicus 

1. a variant of lupus vulgaris in which the lesions consist of a warty vegetative growth, often crusted or slightly exudative, usually occurring on moist areas near body orifices.

2. hypertrophic l. erythematosus.

lupus milia´ris dissemina´tus fa´ciei  a form marked by multiple, discrete, superficial nodules on the face, particularly on the eyelids, upper lip, chin, and nares.

neonatal lupus  a rash resembling discoid lupus erythematosus, sometimes with systemic abnormalities such as heart block or hepatosplenomegaly, in infants of mothers with systemic lupus erythematosus; it is usually benign and self-limited.

lupus per´nio 

1. a cutaneous manifestation of sarcoidosis consisting of violaceous smooth shiny plaques on the ears, forehead, nose, and digits, frequently associated with bone cysts.

2. chilblain l. erythematosus.

systemic lupus erythematosus  (SLE) a chronic generalized connective tissue disorder, ranging from mild to fulminating, marked by skin eruptions, arthralgia, arthritis, leukopenia, anemia, visceral lesions, neurologic manifestations, lymphadenopathy, fever, and other constitutional symptoms. Typically, there are many abnormal immunologic phenomena, including hypergammaglobulinemia and hypocomplementemia, deposition of antigen-antibody complexes, and the presence of antinuclear antibodies and LE cells.

lupus vulga´ris  the most common and severe form of tuberculosis of the skin, most often affecting the face, with formation of red-brown patches of nodules in the dermis that progressively spread peripherally with central atrophy, causing ulceration and scarring and destruction of cartilage in involved sites.

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discoid lupus er·y·the·ma·to·sus (r-thm-tss, -thm-)

n.

Lupus erythematosus in which only cutaneous lesions are present, usually on the face, occurring as atrophic plaques with erythema, hyperkeratosis, follicular plugging, and telangiectasia.

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discoid lupus erythematosus (DLE)

Etymology: Gk, diskos + eidos, form; L, lupus, wolf; Gk, erythema, redness, osis, condition

a chronic, recurrent disease, primarily of the skin, characterized by lesions that are covered with scales and extend into follicles. The lesions are typically distributed on the face but may also be present on other parts of the body. On healing the lesions often leave atrophic, hyperpigmented, or hypopigmented scars. If hairy areas are involved, alopecia may result. The cause of the disease is not established, but there is evidence that it may be an autoimmune disorder, and some cases seem to be induced by certain drugs. It is at least five times more common in women than in men and occurs most frequently in the third and fourth decades of life. Treatment includes use of a sunblock when exposure to sunlight cannot be avoided, application of steroids to the lesions, and use of systemic antimalarial drugs such as hydroxychloroquine; systemic corticosteroid agents may be used in severe cases. See also systemic lupus erythematosus.

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lupus (loo´pus),

n a disease of the skin and mucous membrane.

Lupus.

lupus erythematosus (systemic lupus erythematosus, disseminated lupus erythematosus),

n a chronic inflammatory disease of unknown etiology affecting skin, joints, kidneys, nervous system, serous membranes, and often other organs of the body. The classical facial “butterfly rash” facilitates diagnosis, although the rash need not be present. Other skin areas, particularly those exposed to the sun, may be involved by a scaly lesion that is referred to as
discoid lupus erythematosus.

lupus erythematosus, discoid,

n a form in which only cutaneous lesions are present. These commonly appear on the face as atrophic plaques with erythema, hyperheratosis, follicular plugging, and telangiectasia.

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discoid

1. disk-shaped.

2. a disk-like medicated tablet.

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discoid lupus erythematosus

see lupus erythematosus.

discoid meniscus

an abnormality of the meniscus, usually lateral, in the stifle joint, reported in dogs. Instead of being semilunar in shape it is discoid; the frequency, clinical significance and cause are unclear.