Have you ever noticed that some people have red, slightly raised spots on their face, cheeks, or scalp? Sometimes these don't itch or hurt. While many people think of this as a normal skin condition, this can be a condition that requires a little more attention. Today we're talking about a condition called 'Discoid Lupus' that causes these symptoms. Although this is a bit of an unfamiliar name, it's very important to know about it.
Simply put, what is Discoid Lupus?
Discoid Lupus, more precisely known as `Discoid Lupus Erythematosus (DLE),` is a condition that directly affects our skin. It belongs to the `Cutaneous Lupus Erythematosus (CLE)` classification of lupus. The word `Cutaneous' means `related to the skin.` This means that these types of lupus mainly affect our skin.
A person with discoid lupus develops round, red, slightly raised, and thickened lesions on the skin, especially on the face, cheeks, nose, and scalp. These may become crusty over time. This is also called chronic cutaneous lupus. Chronic means long-lasting.
So what is 'Lupus'?
When we talk about 'lupus', we often refer to a disease called `Systemic Lupus Erythematosus (SLE).` This is the most common type of lupus. About 70 out of 100 lupus patients have this condition.
Now, look, while discoid lupus (DLE) mainly affects the skin, the type called SLE affects the entire body. That's what 'systemic' means. It's an autoimmune disease . Simply put, our body's defense system, the immune system, goes haywire and starts attacking our own healthy cells and tissues. This causes inflammation, or inflammation, throughout the body.
A person with SLE may typically experience symptoms like these:
- Fever that comes on for no reason
- Joint pain and swelling
- Constant fatigue
- Chest pain
- The appearance of various spots and blemishes on the skin
- Sensitivity to sunlight (photosensitivity)
The important thing is that not everyone with discoid lupus will develop systemic lupus erythematosus (SLE), which affects the entire body. We'll talk about that a little later.
What are the types of lupus (CLE) that affect the skin?
As we mentioned earlier, discoid lupus is a type of lupus that affects the skin. There are three main types. Each type has a slightly different pattern of skin lesions.
| Type of lupus | The nature of skin spots |
|---|---|
| Discoid Lupus | Round, thick, red, scaly spots, like a coin. Most often appear on the face, ears, and scalp. |
| Subacute Cutaneous Lupus | Ring-shaped or scaly patches. Usually appear on the chest, back, and neck. |
| Acute Cutaneous Lupus | This is where the famous "butterfly rash" occurs. A red, sunburn-like rash appears across the cheeks and nose. |
Can someone develop more than one type of lupus?
Yes, it can happen. Some people only have one type of lupus. That means some people can have only SLE, and others can have only DLE. But sometimes a person can have more than one type of lupus at the same time.
But remember this. Most people with discoid lupus (DLE) do not have systemic lupus erythematosus (SLE), which affects the whole body. About 5% of people with DLE, or about 5 in 100, will later develop SLE. Also, about a quarter (25%) of people with SLE will develop skin lesions similar to those seen in discoid lupus. So there is a link between the two conditions, but not everyone who has one will develop the other.
What causes discoid lupus? Who is most at risk?
In fact, doctors still don't know the exact cause of lupus, including discoid lupus. But it is clear that it is caused by something wrong with our immune system. Also, this disease tends to run in families . This means that if someone in your family has an autoimmune disease like lupus, you may also be at risk.
Let's take a look at who is at higher risk of developing discoid lupus.
| Risk factor | Description |
|---|---|
| Gender | Women are at much higher risk of developing this disease than men. |
| Age | It usually occurs most commonly in people between the ages of 15 and 44. It is especially common among women in their 30s and 40s. |
| Skin color/race | Research has shown that people with darker skin (e.g., those of African or Asian descent) are at higher risk of developing this disease than those with lighter skin . |
What are the symptoms and complications of discoid lupus?
The main symptom is the discoid lesions we talked about earlier.
- Location: Most commonly seen on the scalp and face, but can also occur on other parts of the body, especially areas exposed to the sun.
- Characteristics: These spots are usually not painful, nor do they itch . They are red, slightly raised, and sometimes have a scaly appearance on the surface.
- Later conditions: After these spots heal, they may become scarred and discolored . Sometimes the skin may turn white or brown/black.
Possible complications
- Hair loss: If these spots appear on the scalp, hair in that area can fall out. The worst part is that if a scar forms in that area, hair growth may stop permanently .
- Skin cancer risk: If you have discoid lupus spots for a long time, there is a slightly increased risk of developing skin cancer in those areas. Especially if these spots develop inside the mouth, there may be an increased risk of developing a type of skin cancer called squamous cell carcinoma.
- Chilblain Lupus: This is a very rare condition. In this condition, purple spots or patches appear on the skin when exposed to cold. These can be very painful.
How to diagnose this disease?
If you have these symptoms, the best thing to do is to see a dermatologist . He or she will examine you and run tests to confirm the diagnosis.
This is called a skin biopsy . This involves taking a very small piece of skin from the area where the spot is under anesthesia. It is then sent to a lab and examined under a microscope. By looking at the changes in those cells, we can tell for sure whether it is discoid lupus or another skin disease.
What are the treatments?
Discoid lupus cannot be cured completely. However, treatment can help control symptoms, prevent new flare-ups, and help you live a normal life. Your doctor will prescribe the right treatment for you based on the severity of your symptoms.
Some of the main treatment methods used are listed below.
| Type of treatment | Functionality and examples |
|---|---|
| Steroid Ointments | These are creams that are applied directly to the rash. They reduce inflammation and swelling in the skin. For example: `fluocinolone acetonide`, `hydrocortisone butyrate`. |
| Antimalarial Drugs | These are pills that you take. Don't be surprised, the drugs used for malaria are also very effective for lupus. They help reduce skin spots and reduce fatigue. For example: `hydroxychloroquine (Plaquenil®)`. |
| Immune-controlling drugs (Calcineurin Inhibitors) | These are also types of ointments. They control the activity of the immune system to some extent and reduce inflammation. For example: `tacrolimus`, `pimecrolimus`. |
| Other anti-inflammatory drugs | In cases where the disease is more severe, doctors may also prescribe oral medications such as dapsone and methotrexate. |
Important: Any of these treatments should only be started on medical advice . Do not use medication on your own.
How to prevent flare-ups?
Here's what anyone with discoid lupus needs to know. For about 70% of lupus patients, symptoms worsen when exposed to ultraviolet (UV) light from the sun. This means new spots may appear, existing spots may become red, or enlarge. This is especially important for someone living in a country like ours that has strong sun all year round.
To protect yourself from the sun and prevent the disease from worsening, do the following:
- Apply sunscreen every day before going out in the sun. Choose a broad-spectrum (protects against both UVA and UVB) sunscreen with at least SPF 30 .
- It's a good idea to use sunscreen not only when going out, but also when staying indoors, especially if you're near a window.
- Reapply sunscreen every 4 hours. Reapply before sweating or going into the water.
- Avoid the sun's strongest rays between 10 am and 4 pm as much as possible.
- When going outside, use things like long-sleeved clothes, wide-brimmed hats, and umbrellas .
- Even fluorescent lights indoors can emit some UV rays, so avoid staying under such lights for too long.
- Never use tanning beds .
If you follow these things properly, you will be able to control the symptoms to a great extent.
Take-Home Message
- Discoid lupus is a long-term type of lupus that mainly affects the skin.
- This causes round, red, coin-shaped spots to appear on the face and scalp. These usually don't hurt or itch.
- Although it cannot be completely cured, symptoms can be very well controlled with medical treatment.
- Sun protection is a must! Using sunscreen every day and avoiding harsh sunlight is very important to prevent the disease from worsening.
- If you have spots like this on your skin, definitely see a dermatologist for advice.
- Do not scratch or pick at skin blemishes. This can lead to scarring and infection.
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