What is Cutanous Lupus?
The most prevalent and severe form of cutaneous lupus, which affects primarily the skin, is called chronic cutaneous lupus. It is commonly known as discoid lupus, but has other forms as well (see below). Discoid lupus erythematosus (DLE) occurs in about 20 percent of patients with SLE. The lesions are patchy, crusty, coin-shaped, sharply defined skin plaques that may scar. These lesions are usually seen on the face or other sun-exposed areas. DLE may cause patchy, bald areas on the scalp and hypopigmentation or hyperpigmentation in older lesions. Biopsy of a lesion will usually confirm the diagnosis. Topical and intralesional corticosteroids are often not effective, even for localized lesions. Antimalarial drugs may be needed for some local lesions and for more generalized lesions. DLE progresses to SLE in about 5 percent of cases.
Other forms of chronic cutaneous lupus include:
- Hypertrophic or verrucous DLE is characterized by either thickened lesions (hypertrophic) or wart-like lesions (verrucous).
- Lupus profundus is characterized by firm lumps in the fatty tissue underlying the skin.
- Mucosal DLE is characterized by lesions that occur in the mucus membranes of the mouth and nose.
- Palmar-plantar DLE is characterized by lesions that occur in the hands and feet.
Another form of cutaneous lupus, subacute cutaneous LE is seen in about 10 percent of SLE patients. It produces highly photosensitive papules or cyclic lesions. Skin changes, especially the butterfly rash and the effects of subacute cutaneous LE, can be precipitated by sunlight.
Some patients may develop mouth, vaginal, or nasal ulcers. Hair loss (alopecia) occurs in about one-half of SLE patients. Most hair loss is diffuse, but it may be patchy. It can be scarring or nonscarring. Alopecia may also be caused by corticosteroids, infection, or immunosuppressive drugs.
Skin alterations in the lupus patient, particularly those of DLE, can be disfiguring. As a result, patients may experience fear of rejection by others, negative feelings about their body, and depression. Changes in lifestyle and social involvement may occur.