Lupus is usually only skin deep
When we think of lupus erythematosus we normally think of systemic disease (SLE). More prevalent though is cutaneous lupus erythematosus (CLE) which specifically involves the skin. We’ve focused on the most common chronic form of CLE called discoid lupus erythematosus (DLE) which affected the singer Seal.
DLE is more common than its systemic cousin, and usually more straightforward to diagnose. Dr Rod O’Keefe, Dermatologist in private practice, Dermatopathologist at Melbourne Skin Pathology, and Director of Pathology at Skin and Cancer Foundation Inc., said DLE usually presents with characteristic clinical signs.
“Early lesions are red scaly patches or plaques in the head and neck region, typically involving ears, cheeks and nose as well as the scalp. More established lesions show plugs of keratin within hair follicles and scarring with loss of pigment and atrophy (skin thinning). There may be increased pigment at the edges of the lesions, and scalp lesions may lead to permanent hair loss due to scarring.”
Dr O’Keefe said the diagnosis may be confirmed on skin biopsy with the key histologic feature being an interface (lichenoid) dermatitis.”
“If a person has only DLE then the risk of developing SLE is between five and 10 per cent. In some studies the risk is put as high as 25 per cent, but I believe it is closer to five per cent in adults with a higher risk in the rarer childhood cases. Those patients who have more disseminated skin disease with lesions on the trunk and limbs seem to be at greater risk of progression to SLE.”
Dr O’Keefe said cigarette smoking has been associated with DLE. Sun exposure may also be a predisposing factor in some people, along with a genetic predisposition to the disease. Although DLE is a chronic condition persisting for years, he said DLE can sometimes ‘burn itself out’ and the disease may eventually become inactive. Early diagnosis and treatment is important in preventing progression to disfiguring scarring and pigmentary change and permanent hair loss.
A few more DLE facts
- It is more common than SLE.
- It is 5 times more common in females than males.
- It can affect anyone at any age although onset is usually between 20 and 40 years of age.
- It is more common and a more severe disease in people who smoke.
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This article appeared in the October 2017 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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