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CME

Discoid Lupus Erythematosus

General Information

Description

  • chronic form of lupus erythematosus limited to skin1,2,3
    • purplish scaly papules and plaques - lesions occur on sun-exposed areas and hair-bearing scalp
    • most common clinical subtype of chronic cutaneous lupus erythematosus
    • may result in significant scarring and permanent hair loss
    • may be initial manifestation of systemic lupus erythematosus

Also called

  • discoid lupus

Types

  • cutaneous lupus erythematosus may occur as a skin-limited disease or be associated with systemic lupus erythematosus (SLE)2
  • forms of cutaneous lupus erythematosus include2,4
    • acute cutaneous lupus erythematosus
      • localized - characteristic "butterfly" rash over cheeks and bridge of nose
      • generalized
        • widespread maculopapular rash above and below neck
        • also known as photosensitive lupus dermatitis
    • subacute (subphenotype)
      • symmetric erythematous eruption of nonindurated macules and papules that later develop a fine scale
      • appears most commonly in young and middle-aged women but drug-induced forms occur in either gender and at older ages
    • chronic cutaneous lupus erythematosus (CCLE)
      • discoid lupus - most common clinical subtype of CCLE
      • lupus planus (lupus erythematosus [LE]/lichen planus overlap syndrome)
      • lupus erythematosus panniculitis (LE profundus) - firm depressed nodules in deep dermis and underlying adipose tissues
      • lupus erythematosus tumidus
        • deep erythematous urticarial plaques
        • most photosensitive subtype
      • chilblain lupus erythematosus
        • violet papules and plaques
        • triggered or exacerbated by exposure to cold, damp environment
      • mucosal lupus erythematosus - most commonly in oral mucosa but may affect
        • nasal membrane
        • conjunctiva
        • genital mucosa
  • classic discoid LE1,2,3
    • indurated purplish macules or papules most commonly on
      • scalp
      • face
      • ears (especially conchal bowls)
      • anterior neck
      • extensor arms
    • may be localized or generalized
      • localized form occurs above neck, more common than generalized form
      • generalized form occurs above and below neck, usually involves extensor forearms and hands
  • variants include2,3
    • palmoplantar discoid LE - painful, erosive
    • follicular discoid LE - characterized by follicular papules about 1 cm in size, commonly in elbow region
    • hypertrophic (verrucous) discoid LE
      • hyperkeratotic lesions clinically resemble keratoacanthoma or hypertrophic lichen planus
      • lesions commonly on
        • face
        • extensor surface of arms
        • palms and soles
        • upper back
      • dermal elastin fibers seen on histologic analysis, sometimes with transepidermal elimination
    • LE hypertrophicus et profundus is a rare variant - thick violet-red facial lesion with rolled edges and significant central atrophy

References

General references used

  1. Panjwani S. Early diagnosis and treatment of discoid lupus erythematosus. J Am Board Fam Med. 2009 Mar-Apr;22(2):206-13full-text
  2. Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment. Am J Clin Dermatol. 2009;10(6):365-81
  3. Rothfield N, Sontheimer RD, Bernstein M. Lupus erythematosus: systemic and cutaneous manifestations. Clin Dermatol. 2006 Sep-Oct;24(5):348-62
  4. Grönhagen CM, Nyberg F. Cutaneous lupus erythematosus: An update. Indian Dermatol Online J. 2014 Jan;5(1):7-13full-text

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  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T506599, Discoid Lupus Erythematosus; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T506599. Registration and login required.

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