Discoid Lupus

A condition characterized by skin rashes and lesions, often located on the face, ears, and scalp. The lesions are sensitive to the sun and can cause scars, patches of light-colored skin (hypopigmentation), darker skin (hyperpigmentation), and hair loss. Discoid lupus, also known as discoid lupus erythematosus (DLE), is an autoimmune condition, in which the body’s immune system attacks the body’s own tissues. It is distinct from systemic lupus erythematosus (SLE), which is what most people mean when they refer to “lupus.” Unlike SLE, discoid lupus does not cause joint pain or affect internal organs; it affects only the skin. Discoid lupus may occur in people with SLE, although only a small percentage of those with discoid lupus will go on to develop SLE.

Discoid lupus is typically diagnosed after a careful review of symptoms and a biopsy of the affected skin. An antinuclear antibody (ANA) blood test, almost always positive in people with SLE, is positive in only about 20% of people with discoid lupus in the United States. A negative ANA test may therefore help doctors rule out SLE (although a negative test cannot completely rule it out). Another way doctors distinguish discoid lupus from SLE is by the nature of the skin rash. Discoid lupus rashes are generally more severe and usually do not have the distinctive “butterfly” pattern common in SLE.

The main treatments for discoid lupus are topical steroid creams and foams and antimalarial drugs such as hydroxychloroquine (brand name Plaquenil). If these treatments do not control symptoms, doctors may prescribe other topical creams, including as calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel). Doctors may also prescribe disease-modifying drugs, such as azathioprine (Imuran) and methotrexate (Rheumatrex, Trexall). . Oral corticosteroids or corticosteroid injections (given directly into the lesions) may also be helpful. In addition, people with discoid lupus should limit sun exposure, wear protective clothing, and use sunblock. Some people choose to wear wigs and makeup to cover up lesions.

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts.

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