What Is Discoid Lupus?
Discoid lupus is a type of lupus that affects the skin. It’s the most common form of cutaneous lupus and tends to cause skin sores, lesions, and rashes above the neckline. Many lesions are discoid, which means shaped like a coin or disc.
As a chronic autoimmune condition, discoid lupus primarily causes inflammation of the skin. Different types of inflammatory skin issues can occur particularly if the skin has been exposed to the sun. Treatment is focused on preventing new lesions, treating them quickly, and limiting scarring.
There are three different types of discoid lupus, including localized, generalized, and childhood. With the most common form, localized discoid lupus, skin lesions cluster above the neck. Generalized discoid lupus is more spread out and may affect areas below the neck.
Childhood discoid lupus is similar to the adult version, but it does have a higher chance of progressing to systemic lupus. Although discoid lupus erythematosus (DLE) is typically considered to be a separate condition from systemic lupus erythematosus (SLE), which can affect the entire body, it has been suggested that they may represent a spectrum of lupus instead of being unconnected.
What Causes Discoid Lupus?
Discoid lupus occurs when the immune system begins to attack normal skin as if there were something wrong, such as a virus. Of course, this attack is a mistake – it occurs in the absence of something that would warrant it. As with most autoimmune diseases, the reason why discoid lupus initiates an immune attack has yet to be determined.
As with SLE, the underlying cause of DLE is unknown but may be triggered by exposure to sunlight. Additionally, the illness could be initiated by an increase in female sex hormones, a vitamin D deficiency, or environmental factors such as exposure to silica dust.
Women and African Americans are much more likely to develop discoid lupus than men and Caucasians, respectively. The illness does tend to run in families, suggesting a genetic component, and can be exacerbated by stressors such as infection, exhaustion, or trauma.
What Are the Symptoms of Discoid Lupus?
There is a wide range of symptoms that can occur with discoid lupus and they are all focused on the skin. These symptoms may include:
- Round lesions.
- Red patches.
- Thick scales.
- Crusty skin.
- Light or dark skin pigmentation.
- A pink, red, or purple rash.
- Raw patches.
- Peeling or blistering skin.
- Itchy skin.
- Thickening or thinning of the skin.
These symptoms can occur virtually anywhere on the body, including the ear canal and pelvic area, but some common locations are:
- Bridge of the nose.
- Above lips and ears.
- Soles of feet.
Other symptoms are brittle fingernails and oral lesions such as mouth ulcers and white spots. Hair loss, which can occur with significant damage, is less of a symptom and more of a result of lesions and scars that can cause hair to fall our or prevent hair from regrowing in patches.
Next page: Complications of discoid lupus, how is it diagnosed, and treatment options.
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.
Prevention Discoid Lupus Flare-Up Strategies
Preventing discoid lupus activity and flare-ups can be a very effective treatment strategy. Prevention is easier than treating the disease once a flare has begun. Avoiding sun exposure and limiting stress to the body are both helpful prevention techniques.
How to Reduce Sun Exposure
Staying out of sunlight whenever possible is the best option for those with photosensitivity from discoid lupus. However, it’s not feasible for anyone to completely avoid sunlight. Using protective measures when exposed to sunlight and seeking education about other sources of UV light will help to limit skin issues.
It’s important to use a UVA and UVB blocking sunscreen (Neutrogena with helioplex is often recommended for people with lupus) and to apply sunscreen correctly. Covering up bare skin as much as possible and wearing UV blocking clothing is also recommended. Another useful item in the wardrobe of someone with discoid lupus is a good sun hat with a wide brim.
Some states also allow for extra dark window tints on vehicles for people with photosensitivity, which can be a great tool for any photosensitive person that drives regularly. Other resourceful measures for avoiding sunlight include carrying a large umbrella or seeking shady spots when outdoors. Discoid lupus sufferers can be creative about how they avoid UV rays.
People with discoid lupus should learn about when avoiding sun exposure is most important in their region. Ultraviolet rays can be stronger at certain times of day and during certain seasons. It’s also possible to be exposed to sunlight on cloudy or rainy days, which may surprise some people.
Fluorescent lighting emits UV rays that can be harmful to people with photosensitivity, especially if they are exposed frequently (such as daily exposure in an office setting). Be careful when visiting big box stores that often have uncovered fluorescent lights, as these are more problematic than ones that have a cover.
Stress comes in many different forms. A difficult work situation, emotional trauma, a packed schedule, or a surgery can all cause stress to a body. Cutting down on all types of stress can help to minimize discoid lupus activity.
Smoking is particularly bad for people with discoid lupus due to hydrazine, a chemical in cigarettes that is known to cause lupus flares. Cigarettes and their smoke should be avoided – even in the form of secondhand (or thirdhand) smoke – if at all possible.
Ideally, medical treatments will assist in putting discoid lupus into remission and prevention strategies will help keep it in remission. Each person with discoid lupus needs to develop a unique treatment plan, along with their doctors, that helps them to minimize disease activity and keep their skin healthy.
Living With Discoid Lupus
There are many people throughout the world living with discoid lupus – including the musician, Seal. He developed the disease in his teens and had significant scalp and cheek involvement; his doctors needed to remove muscle tissue from his face during his treatment. Fortunately, his lupus has been in remission for several years.
Seal has communicated throughout several interviews that his discoid lupus scars, which he’s had since his early twenties, initially depressed him. Now, however, he has learned to appreciate them as a unique feature of his face and has expressed that he likes them. The scars on Seal’s face do stand out to his fans and have certainly have been one of the strongest proponents of discoid lupus awareness.
While this condition can be terribly difficult to cope with, there is a good chance that those with it will only have skin involvement – it’s unlikely that they will need to worry about the internal health issues that can occur with SLE. Discoid lupus doesn’t have to severely limit one’s life, either; there are many strategies for living an active life and even traveling with photosensitivity.
Taking advantage of modern medical treatments, prevention strategies, available educational tools, and connecting with others who have the illness will help anyone with discoid lupus live their best life.