What is chronic discoid lupus erythematosus?
Chronic discoid lupus erythematosus (CDLE) is a fairly rare skin condition that begins with a special inflammatory reaction of the skin. The lesions are seen mainly on the face, and to a lesser extent on the chest and back, especially on sun-exposed skin. It is very probably an autoimmune condition — the body’s immune cells recognise part of the skin cells as “foreign” and attack them.
CDLE patches present as slightly itchy, red, slightly thickened patches on the cheeks, nose or forehead, and less often the neck, décolleté, backs of the hands, lips and eyelids, with a sharp border from the normal skin. The patches often scale and can disappear on their own, leaving a scar. When they occur on the scalp or beard area, the hair follicles also scar, so hair growth (permanently) disappears. About 10% of patients have Raynaud’s phenomenon (an abnormal reduction of blood flow to the fingers and toes after cold exposure), though most people with Raynaud’s do not have CDLE.
Who can get it?
CDLE can arise at any age but is seen mainly in adults between 20 and 45. Women have a 2 times greater chance than men. It is in principle not hereditary. CDLE in children is rare (about 3% of new cases are children under 15).
Which factors worsen CDLE?
Sunlight can worsen CDLE — striking, because most skin inflammations improve in the sun, but CDLE is a clear exception, and most people report worsening in summer. Cold can also worsen the complaints, in about 20% of patients.
CDLE, SCLE and SLE
Besides the chronic discoid form, there is also systemic lupus erythematosus (SLE), in which the autoimmune reaction can also arise in other organs such as the kidneys. Only a small proportion of CDLE patients eventually develop SLE, but the dermatologist will regularly (usually once a year) examine your blood and urine to rule it out. Between CDLE and SLE in the lupus spectrum lies subacute cutaneous lupus erythematosus (SCLE), which leaves no scars and often shows ring-shaped patches.
Treatment of CDLE
What you can do yourself: protect the skin against sunlight (a good sunblock applied several times a day in summer is very important) and against cold.
What the dermatologist can prescribe: Corticosteroid ointment — in most cases CDLE can be well controlled with corticosteroid creams, which must be fairly strong (class 3 or 4), applied daily or on an alternating schedule. Intralesional corticosteroids — for thick patches, the hormones can be injected into the patches (usually every few months) instead of applied. Antimalarials — if corticosteroids work insufficiently, an antimalarial (chloroquine or hydroxychloroquine) can be given; how these work in CDLE is not known, but results are often good, and regular laboratory monitoring is required (CDLE has nothing to do with malaria). Prednisone — for very severe CDLE or acute flares, oral steroids can suppress the inflammation, only under close supervision.
When to see a doctor
See a doctor for persistent, sharply bordered, scaly red patches on sun-exposed skin (especially the face), which can scar and need treatment, and so that a systemic form (SLE) can be checked for.