What is discoid lupus?
Discoid lupus (discoid lupus erythematosus) is a chronic autoimmune disease affecting the skin. It gets its name from the coin-shaped lesions it produces.
This condition causes a severe rash that tends to get worse when exposed to sunlight. The rash can appear anywhere on the body, but you’re likely to see it on the scalp, neck, hands, and feet. Severe cases can lead to permanent scarring, hyperpigmentation, and hair loss.
Discoid lupus should not be confused with systemic lupus. Systemic lupus can also cause a mild rash, usually on the face, but it also affects the internal organs. A person with systemic lupus can also have discoid lesions. Discoid lupus doesn’t affect internal organs, but the rash tends to be much more severe.
What are the symptoms?
Skin rash can range from a mild patch of pink to skin that looks red and raw. This can happen anywhere on your body, particularly the neck, palms, soles, and the area under your elbows. It can even affect the ear canal.
- round lesions
- thick scales on the skin and scalp
- blistering lesions, especially around the elbows and fingertips
- thinning of the skin
- lighter or darker skin pigmentation, which can become permanent
- thickening of the scalp
- patches of hair loss, which can become permanent
- brittle or bent fingernails
- ulcers inside the lips
- permanent scarring
Some people experience itching, though that’s usually not the case. Symptoms can flare up and then go into remission. Discoid lupus doesn’t affect overall health.
What causes it?
The exact cause of discoid lupus isn’t clear. It appears to be an autoimmune disease, involving a combination of genetics and environmental triggers. It does not pass from person to person.
How is it treated?
Your doctor will probably suspect discoid lupus upon clinical examination. But a skin biopsy is usually required for diagnosis. Starting treatment right away can help prevent permanent scarring.
Steroids are used to help reduce inflammation. You can apply prescription-strength ointments or creams right to your skin. Or your doctor can administer a steroid injection directly into the affected area. Oral prednisone can help alleviate lesions by decreasing antibody production and inflammatory cells. Steroids can cause thinning of the skin, so they must be used sparingly and with medical supervision.
Non-steroidal topical creams and ointments, such as calcineurin inhibitors like tacrolimus, can also help reduce inflammation.
Anti-malarial medications are another way to reduce inflammation. These oral drugs include hydroxychloroquine, chloroquine, and quinacrine. They tend to have milder side effects than some other drugs.
Immunosuppressive medications may lower production of inflammatory cells. They’re usually used in severe cases or if you’re trying to wean off oral steroids. Some of these drugs are mycophenolate mofetil, azathioprine, and methotrexate.
Other things you can do:
- Avoid the sun. This can make it hard to get enough vitamin D, so ask your doctor if you should take vitamin D supplements.
- Always use a sunscreen with an SPF of 70 or higher. Reapply every few hours or after getting wet.
- Wear a hat and clothing that protects your skin, even on cloudy days.
- Smoking can aggravate your condition. If you’re having trouble quitting, ask your doctor about smoking cessation programs.
- Certain medications, such as antibiotics and diuretics can make you more sensitive to sunlight. Read medicine labels carefully and ask your doctor or pharmacist if your medication increases sensitivity to sunlight.
- Depending on the condition of your skin, you may be able to wear camouflage makeup. But ask your doctor if that’s advisable and if there are particular ingredients you should avoid.
For scarring and pigment changes, filler, laser technology, and plastic surgery may be options. But this can only be determined on a case-by-case basis. If you’re interested, your dermatologist can offer personalized recommendations.
What are the potential complications?
Repeated bouts of discoid lupus can leave you with scars or permanent discoloration. Patches on the scalp can cause your hair to fall out. As your scalp heals, scarring can prevent hair from growing back.
The risk of skin cancer may be increased if you have long-lasting lesions on your skin or inside your lips and mouth.
About five percent of people with discoid lupus will develop systemic lupus at some point. Systemic lupus can also affect your internal organs.
Who gets discoid lupus?
Factors that may make it worse include stress, infection, and trauma.
Discoid lupus is a chronic, incurable skin condition, but it can go into remission.
Work closely with your dermatologist to find effective treatments to help manage your condition and lessen the chance of permanent scarring.