Discoid lupus erythematosus

Discoid lupus erythematosus (DLE) is characterized by the development of red, scaling patches or plaques that develop in areas of actinic exposure, and that can heal with central scarring.

Removal of a punctate scale can show a protrusion that fits into a dilated sebaceous apparatus, the "tack" sign.

DLE is a disease separate from systemic lupus erythematosus (SLE), although patients with SLE can have lesions typical of DLE. It has been estimated that fewer that 5% of patients with DLE will eventually manifest SLE.

Some patients with DLE have evidence of a compromised peripheral circulation developing pernio-like lesions on toes, fingers and elsewhere.

Oral lesions can resemble those seen in lichen planus.

Treatment:

• Sun avoidance and sunscreens of the broad spectrum type are essential.
• Topical and traditional corticosteroids can be used in lesions that are limited in size.
• Anti-malarial drugs such as chloroquine and hydroxychloroquine are effective although slow-acting.
• Isotretinoin has been shown to be of benefit in hyperkeratotic DLE
• Dapsone is used for bullous LE
• Pulse dye laser and argon laser may be used in small areas but care must be taken not to Koebnerize and spread the lesions
• Thalidomide has been explored but has variable responses.

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