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Highlights & Basics
- Discoid lupus erythematosus is the most common form of chronic cutaneous lupus erythematosus. Lesions are generally well-demarcated erythematous macules or papules with a scaly surface, which frequently evolve into larger coin-shaped plaques; typically neither pruritic nor painful.
- Age of onset is usually between 20 and 40 years. Lesions are often precipitated or aggravated by ultraviolet light exposure; smoking is also considered a risk factor.
- Over time, lesions slowly expand, producing areas of peripheral inflammation or hyperpigmentation, leaving a central region of scarring with telangiectasia and hypopigmentation. In hair-bearing areas, follicular plugging (scale at hair follicle) is often seen and scarring alopecia may be found.
- Diagnosis is usually made on clinical grounds, but if in doubt is confirmed with a skin biopsy.
- The mainstay of treatment for localized/limited disease is topical corticosteroids. Disseminated disease, or severe or refractory localized/limited disease, is treated with antimalarials, progressing to immunosuppressants if there is no response.
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O'Kane D, McCourt C, Meggitt S, et al; British Association of Dermatologists' Clinical Standards Unit. British Association of Dermatologists guidelines for the management of people with cutaneous lupus erythematosus 2021. Br J Dermatol. 2021 Dec;185(6):1112-23.[Abstract][Full Text]
Lu Q, Long H, Chow S, et al. Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus. J Autoimmun. 2021 Sep;123:102707.[Abstract]
Kuhn A, Aberer E, Bata-Csörgő Z, et al. S2k guideline for treatment of cutaneous lupus erythematosus - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol. 2017 Mar;31(3):389-404.[Abstract][Full Text]
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