Lupus Erythematosus, Discoid
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- Discoid lupus erythematosus (DLE) is the most common form of cutaneous LE.
- DLE is an inflammatory condition that can lead to permanent scarring, hair loss, and disfigurement.
- DLE is triggered by sun exposure and typically presents as well-demarcated, erythematous, indurated, and scaly plaques.
- DLE types:
- Localized DLE
- Occurs most often on face, neck, and scalp
- Disseminated/generalized DLE
- Occurs on areas of the body below the neck
- Localized DLE
- Synonym(s): chronic cutaneous LE; subacute cutaneous LE; discoid lupus
Neonatal LE is a rare autoimmune disorder (caused by transplacental passage of maternal antibodies) that presents with cutaneous lupus skin lesions and/or other systemic manifestations, including congenital heart block.
- DLE occurs in persons of all ages and ethnicities.
- All forms of cutaneous LE are most common among women of childbearing age.
DLE manifests in up to 25% of patients with systemic lupus erythematosus (SLE) but can occur without systemic involvement:
- Predominant age: 21 to 50 years
- Predominant sex:
- Localized DLE: female > male (3:1)
- Generalized DLE: female > male (9:1)
- Prevalence of cutaneous LE: 73/100,000
- Increased prevalence in women and also in persons of African descent
- Between the ages of 21 and 30 years, prevalence is similar among both sexes.
Etiology and Pathophysiology
- DLE is an autoimmune dysfunction of T cells linked to human leukocyte antigen (HLA) subtypes and environmental triggers.
- Keratinocyte heat shock protein induction after UV light exposure or stress as a target for T-cell–mediated epidermal cytotoxicity
- DLE may occur in genetically predisposed.
- A haplotype of cytotoxic T-lymphocyte–associated protein 4 (CTLA4) showed association with DLE.
- Adult women of childbearing age
- African American
- Avoid exposure to UV-B and UV-A light sources.
- Excessive heat, excessive cold, and trauma to the affected skin may worsen DLE.
- Use appropriate sunscreen, protective clothing (dark colors and closely woven fabrics), and hats.
- Tobacco exposure may decrease antimalarials efficacy.
Commonly Associated Conditions
- Mixed connective tissue disease
- Antiphospholipid syndrome
- Porphyria cutanea tarda (PCT)