Discoid lupus erythematosus (DLE) or chronic lupus erythematosus is an inflammatory skin condition that typically affects the scalp, face, ears, and lips. DLE is a type of the autoimmune condition known as lupus erythematosus or Lupus. DLE is on one end of the spectrum of Lupus in which only the skin is involved, compared to systemic lupus erythematosus which has more internal involvement.
DLE affects men and women with of all ages and backgrounds. DLE typically appears as a red scaly bump that turns into a thick or thin, scaly, itchy, plaque that is pink with a hyperpigmented (darkened color) rim and prominent plugged follicles. Hairs are usually broken off or completely missing in the affected area. Over time, the plaque can become atrophied and scar.
Diagnosis is based on a skin biopsy and exam. Blood tests are not important in the diagnosis for DLE; however, annual blood tests are necessary to screen patients with DLE who have an increased risk to develop the systemic form of lupus erythematosus which can affect organs.
Treatment includes oral antimalarial medications and topical steroid creams. In severe cases, immune-suppressing medications are needed. Lifestyle is important to reduce the frequency of flares. Strict sun protection (umbrellas, hats, shade, sunglasses, sunscreen) is necessary as Lupus is very sensitive to the sun and can flare from minutes to weeks after intense sun exposure. I also advise patients to stop smoking because cigarettes have been linked to harder to manage Lupus and frequent flares of Lupus.
Early intervention is vital. With time, inflammation leads to scarring which can destroy follicles and lead to permanent hair loss. There is no cure for Lupus or DLE but with the proper treatment regimen and above lifestyle changes, the condition can be well managed without symptoms.