Discoid Lupus Erythematosus or Discoid Rash is a chronic condition of the skin associated with scarring and inflammation of the skin producing photosensitive dermatosis. Discoid rash appears due to the lupus disease. Lupus is an autoimmune disease affecting the body’s immune system in which the body’s resistance against foreign invaders such as bacteria and viruses are weakened. The weakened immune system is unable to fight the foreign bodies resulting to the inflammation of the tissues and organs. The difference between Discoid Lupus Erythematosus (DLE) and Systemic Lupus Erythematosus (SLE) is that in DLE, the skin is primarily affected and it is less serious compared to SLE. SLE is a systemic disease that affects the different parts of the body including the internal organs with the severity ranging from mild to life threatening.
When the discoid lupus rash develops on hairy areas such as the scalp, there can be permanent hair loss and scarring on the said region. There is also risk for a patient with discoid rash to contract diseases of the internal organs making the person sick. Women aged between 20 and 40 years old are affected twice as often as men.
Causes of Discoid Lupus Rash
Discoid rash is basically a symptom of the discoid lupus. However, the exact cause of discoid rash is unknown, but it is believed to happen to those who are genetically predisposed. The mechanism involving the genetic factor, though, is not yet fully understood.
Subsets of Discoid Rash
- Localized Discoid Rash– Only the head and neck are involved.
- Widespread Discoid Rash– Other parts of the body are also affected regardless whether the head and neck are involved or not. This type requires more treatment and is more likely to become systemic lupus erythematosus (SLE).
Signs and Symptoms of Discoid Rash
Discoid lupus rashes generally appear on the scalp, face, neck and chest areas. They grow as small, red, inflamed patches with scaling and have a brittle appearance. They are painless but are slightly itchy. The discoid rashes are round or oval in shape. Often, mouth sores and white rashes on the tongue are caused by the discoid lupus too. The rashes may recur or continue for years, and when they disappear, they often leave scars.
The person affected by discoid rash may have reticulate telangiectasis or discolored spots on the skin on the legs, Raynaud’s phenomenon or decreased blood flow to the extremities, sensitivity to sunlight, and joint pains.
Diagnosis of Discoid Rash
The diagnosis of discoid rash is not easy since its symptom is only rashes and rashes are associated with a wide variety of diseases. Thus, the determination is made based on not only the clinical features presented but on laboratory examinations as well. However, even blood tests are not enough to confirm the diagnosis, so a biopsy is the only means to determine the presence of discoid rashes due to the lupus disease.
Prognosis of Discoid Rash
The outlook is good for mild cases of Discoid Rash because of the new treatment methods available nowadays. Patients with mild cases of Discoid Rash can expect to have long lives as the new rate of survival is ten years longer for about 80 percent of the cases. However, severe cases of Discoid Rash have steady life expectancy rate since the new treatments that have been developed are applicable only to the mild cases.
A pregnant woman affected with Discoid lupus rash can still expect a normal and full term pregnancy and a healthy baby despite the disease. Intensive monitoring of the mother and the baby should be done after the delivery to ensure there is no heart or lung malfunction.
Management of Discoid Rash
- Protection against the sun – Use sunscreen with SPF 30 or more on the exposed skin. Consult the dermatologist regarding the type of sunscreen that suits your skin best. It is advisable to stay under the shade between 10 am and 2 pm to avoid the heat of the sun. It is also wise to use a hat, cover up, long sleeves, long pants, shoes or any accessory that can protect the skin against the sunrays.
- Avoid smoking – Smoking can induce the discoid rashes to come out.
- Topical steroid – It is applied on the affected areas of the skin to slow the progression of the discoid rashes and improve the condition. It should be applied to the affected areas once or twice daily for as long the dermatologist had instructed.
- Corticosteroid injection – This is injected onto the rashes. Injections are typically more effective than the ointment form of steroids and so are used for severe cases of discoid rash.
- Use of calcineurin inhibitors, pimecrolimus cream or tacrolimus ointment
- Antimalarial medications – These medications, such as Plaquenil, have anti-inflammatory properties that can help improve the condition of the patient with discoid rash. Frequent blood and eye examinations are necessary when taking these medications.
The patient with discoid lupus rash cannot be cured but the condition can be managed. It pays to consult the physician for proper management of the disease to avoid complications.
Discoid Lupus Pictures