Discoid Lupus: Causes, Symptoms, Treatment, Complications and Prognosis

Discoid lupus is a long term autoimmune skin disease characterized by lesions shaped like a coin, giving the disease its name “discoid.” The rash of discoid lupus can develop anywhere in the body and worsens with sun exposure. The common areas of the rash of discoid lupus are neck, scalp, hands and feet. In acute cases, it can cause hair loss, hyperpigmentation and permanent scarring.

Discoid lupus is different from systemic lupus. The rash of systemic lupus is mild rash and often occurs on the face and can also affect the internal organs.⁽²⁾ Patients suffering from systemic lupus can also develop discoid lesions. Unlike systemic lupus, discoid lupus doesn’t involve the internal organs; however the rash is more severe.

The exact cause behind discoid lupus is not known. This is an autoimmune condition, so the potential cause can be a mix of environmental triggers and genetics.⁽¹⁾

Discoid lupus is rare in children; however anyone can have this disease. Females between the ages of 20 and 40 are at increased risk for discoid lupus. ⁽¹⁾

Some of the contributing factors which worsen this disease are trauma, infection and stress.

The rash on the skin can be a small pink colored patch and can vary in severity where the skin looks raw and red. The rash of discoid lupus can develop anywhere in the body, but more so on the neck, soles, palms, under the elbows and sometimes the ear canal too.

Common Symptoms of Discoid Lupus are:

• Round disc shaped lesion on the skin.
• Peeling of the skin.
• Development of thick scales on the scalp and skin.
• Blistering lesions, more so around the fingertips and elbows.
• There is skin thinning.
• There can also be thickening of the scalp.
• Skin pigmentation which can be dark or light and can become permanent.
• Fingernails which become bent or brittle.
• Hair loss patches that can become permanent.
• Development of ulcers within the lips.
• There can be itching also in some patients.
• Symptoms of discoid lupus flare and can go into remission.
• Discoid lupus generally doesn’t affect the patient’s overall health.

No, discoid lupus does not pass from one person to another.

The diagnosis can be made with physical examination by the doctor. However, a biopsy of the skin is done to confirm the diagnosis. ⁽¹⁾ Immediate treatment upon diagnosis helps in preventing complications such as permanent scarring.

Treatment for discoid lupus consists of:

• Non-steroidal topical ointments and creams can be used to apply on the disc like lesions to decrease the inflammation.
• Steroids are given to alleviate the inflammation where prescription-strength steroid creams or ointments are applied to the lesions of discoid lupus. Alternatively a steroid injection can be in given directly into the lesion. Oral steroids can also be prescribed to lessen the severity of the lesions by cutting down on the production of inflammatory cells and antibodies. Skin thinning is one of the side effect of steroids, hence should be used sparingly and according to doctor’s instructions.
• Anti-Malarial Medications can be prescribed to decrease inflammation.
• Immunosuppressive medications are also prescribed to help reduce inflammation by reducing the production of inflammatory cells and are usually prescribed in acute cases or if the patient is weaning off oral steroids.

• Avoid stepping out in the sun and always use a sunscreen with higher SPF whenever you have to go out.
• Wear protective clothing when outside, such as full sleeves top, trousers and wear a hat.
• The skin becomes more sensitive to sunlight when taking certain medications, such as diuretics or antibiotics. So, always consult or inform your doctor when starting on any new medication.
• Quit smoking as it exacerbates discoid lupus or any other autoimmune disease for that matter.
• For treating any pigment changes and scarring, depending on the severity, the patient can opt for laser or plastic surgery.

Persistent flare ups of discoid lupus results in permanent discoloration or scarring. Lesions on the scalp can cause hair fall and when there is healing of the scalp, the scarring prevents re-growth of hair.

If there are persistent lesions on the skin or within the mouth and lips then it increases the risk of skin cancer.

There is a risk of around five percent of patients suffering from discoid lupus to have systemic lupus in future. ⁽³⁾

Discoid lupus is a chronic disease, which has no cure as of yet; however, it can go into remission. It is important that the patient be in touch with their dermatologist to look for effective treatment for discoid lupus and to decrease the risk of permanent scarring. ⁽³⁾

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