Discoid Lupus Complications
Skin cancer is a serious complication for people with discoid lupus. Skin lesions that have been present for a long time and oral lesions are prone to developing cancer. It’s important to monitor all lesions for any changes and has prompt cancer screenings as necessary.
Discoid lupus can have unusual manifestations. For example, a rare form of skin lupus, called lupus profundus, can be associated with discoid lupus lesions and occurs in one to three percent of people with cutaneous forms of lupus. It can cause severe darkening of skin and loss of fat layers underneath the skin.
Those with discoid lupus may face quite a bit of emotional difficulty about their appearance, particularly since their visible skin is likely to be affected. People may react harshly in public to seeing someone with skin issues and mistakenly think rashes or sores are from a contagious illness. Anyone with discoid lupus may need help accepting their appearance and coping with the way people respond to seeing damaged skin.
Approximately five to ten percent of people with DLE will eventually develop SLE; children and people with more severe DLE are most at risk. As mentioned previously, these diseases may not be completely separate and it’s possible that people may have started out with SLE that had heavy skin involvement.
Diagnosing Discoid Lupus
Discoid lupus is diagnosed by taking a skin biopsy of an affected area and testing for DLE. A skin biopsy exposes reveal skin changes that are typically characteristic of discoid lupus. The biopsy may find inflammation or antibodies (revealed by using immunofluorescent staining tests) in between layers or skin.
Generally, any doctor can diagnose via biopsy but once discoid lupus is found it is best treated by a dermatologist who has experience with skin autoimmune diseases. The results of a skin biopsy can help determine which treatment strategy will be most useful.
Treatment for Discoid Lupus
Treating discoid lupus rapidly is essential in order to prevent damage and scarring. Treatment often takes a twofold approach – there are medications used regularly or during flare-ups and there are also many preventative measures used to avoid flare-ups whenever possible.
Topical steroids are often the first and most regular medical treatment used for discoid lupus. Cortisone is a steroid hormone that can reduce inflammation by suppressing the immune system. Cortisone ointment is applied to affected areas of the skin, but if lesions do not show enough improvement then cortisone can be injected directly into problem areas.
While cortisone is used for a wide variety of health issues, fluocinonide is a topical steroid that is specifically used to treat skin disorders. Fluocinonide relieves skin pain as well as itching and swelling. In severe cases of discoid lupus, people may take oral steroids such as prednisone.
Long-term use of steroids can result in unwanted and deleterious side effects, including osteoporosis, high blood pressure, and cataracts – just to name a few. Steroids can also increase sun sensitivity, which is likely already a substantial issue for most people with discoid lupus. For these reasons, people may seek non-steroidal treatment options when possible; alternative options range from calcineurin inhibitors, hydroxychloroquine (Plaquenil), or even acne medication.
Calcineurin inhibitors can specifically suppress immune system attacks on skin. This is because they block calcineurin, a chemical in the skin that activates inflammation. There are two topical calcineurin inhibitors available: tacrolimus and pimecrolimus.
Hydroxychloroquine is an oral medication that is frequently used in SLE but is not usually used in DLE until skin lesions worsen and other medications have not able to keep them under control. It is an anti-malarial medication that is able to tamper down the immune system response.
Other Treatment Options
Less commonly, medications for acne (such as Accutane) or psoriasis (Soriatane) have been used to treat discoid lupus. Soriatane, while shown to be as effective as hydroxychloroquine, typically has more adverse side effects – including more skin issues.
Dermatologic cosmetic surgery can be utilized as a reparative treatment for those with significant scarring of the skin and/or pigment changes. This is a somewhat controversial option among medical professionals as cosmetic treatments are sometimes contraindicated for discoid lupus scars. It’s most often used for those in remission when skin damage is not actively occurring.
Laser resurfacing and collagen fillers are the common types of cosmetic surgery used for discoid lupus-related skin problems. Stimulatory fillers can activate collagen production for people who have lost facial volume. Some people, particularly those with extreme scars, have experienced significant quality of life improvements and self-esteem boosts after cosmetic treatments.
Next page: Tips for preventing flare-ups, and lifestyle tips for living with discoid lupus.