Discoid Lupus Erythematosus – Clinical
Discoid lupus erythematosus (DLE) is a form of chronic cutaneous lupus erythematosus characterized by hyperkeratotic inflammatory plaques which eventuate into areas of scarring. Only 5% of DLE patients go on to develop systemic lupus erythematosus (SLE). However, 25% of SLE patients have discoid lesions. DLE lesions occur most commonly on the head and neck. Patients with generalized DLE lesions involving the skin above and below the neck are more likely to develop SLE. Scalp lesions occur in 60% of DLE patients and usually result in scarring alopecia. DLE lesions are red to purple plaques with hyperkeratotic scale.
There are follicular hyperkeratotic plugs causing a carpet tack appearance as they project from the undersurface of the scale when it is removed from advanced lesions. The dyspigmentation of older lesions often presents as central hypopigmentation and peripheral hyperpigmentation. Patients may have scalp lesions only or may have concomitant lesions on the face, neck, and especially the external ears.