Discoid Lupus

Overview

What is discoid lupus?

Discoid lupus erythematosus (DLE) is a type of cutaneous lupus erythematosus (CLE). Cutaneous refers to skin. CLE includes types of lupus that affect your skin.

People with discoid lupus get round sores, usually on their face or scalp. Another name for discoid lupus is chronic cutaneous lupus.

What is lupus?

What most people call lupus is systemic lupus erythematosus (SLE). SLE is the most common type of lupus. About 70% of people who have lupus have SLE.

SLE causes widespread inflammation in your body. People with lupus often have:

What are the types of cutaneous lupus erythematosus?

There are three types of CLE. Each type causes a different skin rash:

  • Discoid lupus: Causes circular patches of thick, inflamed skin on your ears, cheeks or nose.
  • Subacute cutaneous lupus: Ring-shaped or scaly rashes appear, usually on your back, chest or neck.
  • Acute cutaneous lupus: Known for a “butterfly rash” that looks like a sunburn across your cheeks and nose.

Can you have more than one kind of lupus?

Some people only have SLE, CLE or another type of lupus. Others have multiple types of lupus.

Most people who have discoid lupus do not have another type of lupus. Only about 5% of people with discoid lupus also develop SLE. About one in four people with SLE develop lesions that look like discoid lesions.

How common is DLE?

About two out of every three people who have systemic lupus also have symptoms of cutaneous lupus. Discoid lupus is the most common type of CLE.

Symptoms and Causes

What causes chronic cutaneous lupus?

Experts don’t know what causes lupus, including discoid lupus. Lupus and other autoimmune diseases tend to run in families.

Who is most likely to have discoid lupus?

You have a higher risk for developing chronic cutaneous lupus if you are:

  • Female.
  • Age 15 to 44, with women in their 30s and 40s most commonly affected.
  • Black (with risk up to four times higher in Black women than in white women), Asian American, Hispanic/Latino or Native American.

What are the symptoms of discoid lupus?

Discoid lupus causes round, coin-shaped lesions (sores). The sores most commonly develop on your scalp and face, but they may show up on other parts of your body.

Discoid lesions typically do not hurt or itch. They may be scaly, thick or red. When the lesions go away, they may leave scars or skin discoloration.

What are the complications of discoid lupus?

If a discoid lupus rash occurs on your scalp, it may cause hair loss. If a scar forms on your scalp, the hair loss may be permanent.

Having a discoid rash that lasts a long time may increase your risk for skin cancer. Discoid sores inside your mouth can increase your risk for a type of skin cancer called squamous cell carcinoma.

Rarely, people may develop chilblain lupus erythematosus. Chilblain lupus causes purple skin patches or lesions that worsen after exposure to cold temperatures. These lesions are often very painful.

Diagnosis and Tests

How is discoid lupus diagnosed?

A dermatologist (skin care doctor) may diagnose discoid lupus. Usually, the dermatologist uses a test called a biopsy.

During a biopsy, your dermatologist takes a small skin sample. The provider sends the skin sample to a laboratory, where specialists examine it under a microscope. Looking at the skin sample under a microscope can tell healthcare providers whether skin sores are due to discoid lupus or another condition.

Management and Treatment

How is discoid lupus treated?

Depending on how severe your symptoms are, your healthcare provider may recommend medications. These medications can reduce discoid lupus symptoms.

Some research suggests that medications are helpful for about 60% of people with cutaneous lupus. Discoid lupus treatment may include:

  • Steroid ointments, such as fluocinolone acetonide (Synalar®) or hydrocortisone butyrate (Locoid®), lower inflammation and decrease swelling.
  • Anti-inflammatory drugs such as dapsone (Aczone®) or low-dose methotrexate (Otrexup™, Rasuvo®) reduce pain and swelling.
  • Antimalarial drugs, such as hydroxychloroquine (Plaquenil®), fight fatigue, reduce rashes and decrease joint pain.
  • Calcineurin inhibitors, such as tacrolimus (Protopic®, Prograf®) or pimecrolimus (Elidel®), decrease inflammation by suppressing your immune system.

How can I prevent discoid lupus symptom flare-ups?

In up to 70% of people who have CLE, their symptoms worsen after exposure to ultraviolet (UV) light. If you have lupus, you need to take extra caution around UV rays.

To prevent discoid lupus symptom flare-ups and protect yourself from light exposure:

  • Apply broad-spectrum sunscreen with at least SPF 30 daily. Reapply sunscreen every four hours.
  • Avoid sunlight when the sun’s rays are strongest, between 10 a.m. and 4 p.m.
  • Limit your time under indoor fluorescent lights.
  • Don’t use tanning beds at all.
  • Wear sun-protective clothing, such as long sleeves and wide-brimmed hats.

Prevention

How can I prevent discoid lupus?

There is no way to prevent lupus. If you have discoid lupus, you can manage symptoms by avoiding sun exposure. To reduce chances of infection and scarring, you should avoid scratching or picking at sores.

Outlook / Prognosis

What is the outlook for people with discoid lupus?

Lupus is a lifelong condition. With treatment, many people with discoid lupus experience symptom relief. Taking precautions around UV rays can keep symptoms from worsening.

Living With

What else should I ask my doctor?

You may also want to ask your healthcare provider:

  • How can I avoid developing discoid rashes?
  • What should I do to treat a discoid rash?
  • What are the warning signs that discoid lupus is not well-controlled?
  • What are the early warning signs of skin cancer?

A note from Cleveland Clinic

Discoid lupus is the most common type of lupus that affects your skin. People with discoid lupus typically develop round skin lesions. These lesions usually are not painful, but they can increase your risk for skin cancer. To prevent discoid lupus lesions, limit your exposure to ultraviolet (UV) light. There is no cure for discoid lupus, but treatment can help you manage symptoms and avoid flare-ups.

Last reviewed by a Cleveland Clinic medical professional on 09/13/2021.

References

  • American Skin Association. Cutaneous Lupus Erythematosus. (https://www.americanskin.org/resource/lupus.php) Accessed 10/1/2021.
  • Arthritis Foundation. Cutaneous Lupus Symptoms and Treatments. (https://www.arthritis.org/diseases/more-about/cutaneous-lupus-symptoms-and-treatments) Accessed 10/1/2021.
  • Centers for Disease Control and Prevention. Lupus symptoms. (https://www.cdc.gov/lupus/basics/symptoms.htm) Accessed 10/1/2021.
  • Chang AY, Werth VP. Treatment of Cutaneous Lupus. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245840/) Curr Rheumatol Rep. 2011 Aug; 13(4): 300-307. Accessed 10/1/2021.
  • Lupus Foundation of America. African Americans and Lupus [PDF]. (https://www.lupus.org/s3fs-public/Doc%20-%20PDF/Ohio/African%20Americans%20and%20Lupus.pdf) Accessed 10/1/2021.
  • Lupus Foundation of America. What is cutaneous lupus? (https://www.lupus.org/resources/cutaneous-lupus) Accessed 10/1/2021.
  • Lupus Foundation of America. What is systemic lupus erythematosus? (https://www.lupus.org/resources/what-is-systemic-lupus-erythematosus-sle) Accessed 10/1/2021.
  • McDaniel B, Sukumaran S, Tanner LS. Discoid Lupus Erythematosus. (https://www.ncbi.nlm.nih.gov/books/NBK493145/) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 10/1/2021.

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