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These strange skin changes: Do you know what are the surprising characteristics of the skin lesions of discoid lupus erythematosus?
Discoid lupus erythematosus (DLE) is the most common type of chronic cutaneous lupus. This is an autoimmune skin disease that typically occurs on the spectrum of lupus-like diseases. Patients develop red, painful, inflamed skin lesions that are coin-shaped and have a scaly and crusty appearance, most commonly on the scalp, cheeks, and ears. If the lesions appear on the scalp, they may cause hair loss. These lesions may persist for up to several years if left untreated.
Skin lesions of discoid lupus erythematosus usually appear on sun-exposed areas, especially the skin of the head and upper back.
Characteristics of lesions
Lesion shape
The skin lesions of DLE initially appear as dull or purple-red rounded flat or raised areas. Over time, the lesions will produce more and more white attached scales. Eventually these lesions will cause extensive scarring and skin atrophy, accompanied by pigmentary changes. If the skin is darker, the center of the lesion may lose skin pigment and the surrounding ring may show darker pigment; conversely, in patients with light skin, the lesions may appear gray or have little or no color change.
Lesion location
These skin lesions most often appear on areas exposed to the sun, especially the upper part of the head, including the scalp, nose, upper cheeks, lower lips, and ears. Of note, approximately 24% of patients develop lesions in the mouth (usually the roof of the mouth), nose, eyes, or vagina, which are all mucous membranes.
Specific lesion characteristics
Scalp lesions
When DLE occurs on the scalp, it begins as red, flat or raised skin, followed by hair loss and extensive scarring. These lesions may be depigmented and appear white with surrounding red or non-red areas, giving a sunken appearance.
Lip lesions
When lesions occur on the lips, they usually appear gray or red with a thickened layer of skin on the surface (called hyperkeratosis) and may be accompanied by a surrounding red ring.
Some patients report that their lesions may be itchy, tender, or even completely asymptomatic.
Treatment Plan
Treatment of DLE usually involves a variety of approaches, starting with advising patients to stop smoking and use sunscreen products that target UVA and UVB rays. Additionally, a medical professional may prescribe powerful topical steroids or inject steroids directly into the lesion. If these modalities do not improve the condition, antimalarial drugs such as oral hydroxyclozine or other related drugs may be considered.
Prognosis
Discoid lupus erythematosus is a chronic disease, and it is not uncommon for lesions to persist for years without treatment. About 50% of patients will improve spontaneously over time. If a patient does not have signs of systemic lupus at the time of illness, the likelihood of developing systemic lupus in the future is lower.
Conclusion
As awareness of discoid lupus erythematosus increases, understanding the characteristics and treatments of its skin lesions will have a significant impact on the quality of life of many patients. However, there are still many unsolved mysteries about this disease that deserve further exploration. Have you ever wondered why certain individuals are more susceptible to this disease?
