Classical findings include indurated plaques, scarring alopecia, and follicular hyperkeratosis. These changes may leave permanent disfigurement if untreated.

📖 About

Prevalence: 20–40 per 100,000 people.
Chronic form of cutaneous lupus erythematosus (CLE), distinct from systemic lupus but may overlap.

🧬 Aetiology

Autoimmune disease with dysregulated immune response.
Females affected 5× more often than males 👩.
More common and severe in individuals with darker skin tones.
Smoking 🚬 worsens severity and reduces treatment response.

⚡ Causes & Precipitants

Genetic predisposition (familial autoimmune tendency).
Ultraviolet light ☀️ exposure (delayed trigger, often weeks before flare).
Smoking and hormonal factors.

🩺 Clinical Features

Discrete, erythematous plaques with adherent scales.
Scale extends into dilated hair follicles → follicular plugging.
Common sites: face, scalp, pinnae, behind ears, and neck.
Lesions may also appear in sun-protected sites.
Peripheral indurated erythema with central atrophic scarring is characteristic.
Chronic scalp lesions → scarring alopecia.

🔍 Investigations

Bloods: FBC, U&E, LFT, CRP.
Autoantibodies:
- ANA (low titre, often negative).
- Extractable nuclear antibodies (ENA) positive in ~50%.
- Anti-annexin 1 antibodies (possible marker for DLE).
Skin biopsy: shows interface dermatitis, peri-adnexal inflammation, follicular plugging, atrophy & scarring.
Lupus band test (direct immunofluorescence) often positive.

🛡️ Prevention

Strict sun protection all year round:
- Clothing, hats, sunglasses, thick SPF 50+ sunscreen.
- Glass windows may need UV-blocking films.
Vitamin D supplementation if sun avoidance is strict.
Smoking cessation 🚭 strongly advised.

💊 Topical Management

Potent topical corticosteroids for several weeks (potency tailored to site).
Intralesional corticosteroids for hypertrophic plaques.
Calcineurin inhibitors (e.g. tacrolimus ointment) as steroid-sparing alternatives.
Cosmetic camouflage to improve appearance.

💊 Systemic Management

Antimalarials (Hydroxychloroquine ± chloroquine) – response in ~80% cases (less effective in smokers).
Systemic corticosteroids (prednisone/prednisolone) for severe flares.
Other systemic agents: methotrexate, mycophenolate, azathioprine, retinoids (isotretinoin/acitretin), dapsone.
Choice depends on severity, comorbidity, and organ involvement.

📚 References

DermNet NZ – Discoid Lupus Erythematosus
Oxford Handbook of Dermatology & Rheumatology.
British Association of Dermatologists Guidelines.

🧾 Clinical Case – Discoid Lupus Erythematosus (DLE)

A 36-year-old woman presents with well-defined, erythematous, scaly plaques on her cheeks and nose, worsening with sun exposure. Over time, the lesions develop central atrophy, hypopigmentation, and scarring alopeciaDLE, a chronic cutaneous form of lupus. She was managed with sun protection, potent topical steroids, hydroxychloroquine, and regular skin monitoring.

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Discoid lupus erythematosus (DLE)