Useful Facts On Discoid Lupus Erythematosus (DLE)

Useful Facts On Discoid Lupus Erythematosus (DLE)
Lupus is a chronic, autoimmune disease which causes
inflammation of various parts of the body, especially the skin, joints,
blood and kidneys. The body's immune system normally makes proteins
called antibodies to protect the body against viruses, bacteria and
other foreign materials. These foreign materials are called antigens.
In an autoimmune disorder such as lupus, the immune system loses its
ability to tell the difference between foreign substances (antigens)
and its own cells and tissues. The immune system then makes antibodies
directed against "self." These antibodies, called "auto-antibodies,"
react with the "self" antigens to form immune complexes. The immune
complexes build up in the tissue and can cause inflammation, injury to
tissues, and pain.

Lupus affects women eight to ten times more frequently than men and
often first appears in women of childbearing years (ages 18 to 45).
Women of color (African-American, Native American, Asian and Hispanic)
are affected more often than Caucasian women.

Discoid lupus erythematosus (DLE) is characterized by a skin rash
only. It occurs in about 20% of patients with systemic lupus
erythematosus. The lesions are patchy, crusty, sharply defined skin
plaques that may scar. These lesions are usually seen on the face or
other sun-exposed areas. DLE may cause patchy, bald areas on the scalp
and hypopigmentation or hyperpigmentation in older lesions. Biopsy of a
lesion will usually confirm the diagnosis. Topical and intralesional
corticosteroids are usually effective for localized lesions;
antimalarial drugs may be needed for more generalized lesions. DLE only
rarely progresses to systemic lupus erythematosus.

In approximately 10 percent of the people with lupus, discoid lupus
can evolve into the systemic form of the disease, which can affect
almost any organ or system of the body. This cannot be predicted or
prevented. Treatment of discoid lupus will not prevent its progression
to the systemic form. Individuals who progress to the systemic form
probably had systemic lupus at the outset, with the discoid rash as
their main symptom. After a few weeks or months, atrophy, pigmentary
changes, and telangiectasia (dilated capillaries) are visible. The
patches sometimes spread to the scalp and cause hair loss. Sunlight
makes the condition worse, so in some patients it virtually disappears
during the winter months. Nearly all patients with DLE remain in good
health apart from the skin disorder.

The cause(s) of lupus is unknown, but environmental and genetic
factors are involved. While scientists believe there is a genetic
predisposition to the disease, it is known that environmental factors
also play a critical role in triggering lupus. Some of the
environmental factors that may trigger the disease are infections,
antibiotics (especially those in the sulfa and penicillin groups),
ultraviolet light, extreme stress, and certain drugs.

Fever, weight loss and fatigue may be among the first signs of the
illness. A skin rash may develop on the face, neck or arms, especially
after exposure to the sun. This rash may involve the nose and cheeks
and appear as a butterfly-shaped rash.

Ulcers, usually painless, can occur in the mouth or nose. Painful
swelling of the joints and prolonged stiffness in the morning can
occur. Inflammation of the surface of some organs (serositis) such as
the heart and lungs can cause painful breathing or shortness of breath.

The kidneys can be affected without producing symptoms, although
swelling (edema) of the legs can occur. Lupus affecting the kidneys may
cause protein and blood in the urine and high blood pressure.

Patients with DLE should wear hats and sunscreen to protect their
skin. Also, corticosteroid skin creams may be helpful, but should be
used only under medical supervision. Ultimately, some of the lesions
heal on their own.

In severe cases, hydroxychloroquine (a drug used to treat malaria)
may be beneficial. But, because this drug rarely has an effect on the
eyes, it should be used with great caution.