Name
LUPUS ERYTHEMATOSUS, DISCOID
DESCRIPTION
DETAIL
CAUSES Unknown -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Actinic keratoses β’ Polymorphous light eruption β’ Drug eruptions β’ Sarcoid β’ Cutaneous leishmaniasis β’ Lupus vulgaris β’ Seborrheic dermatitis β’ Lichen planus β’ Plaque psoriasis β’ Rosacea β’ Pemphigus erythematosus β’ Tinea faciei β’ Jessner-Kanof disease β’ Granuloma facialeLABORATORY β’ Localized DLE: positive ANA in low titer (30%) β’ Generalized DLE, may find, increased sedimentation rate, positive ANA (60-80%), positive SS-A (80%), positive SS-B (40%) autoantibodies, positive dsDNA (< 5%), leukopenia, hematuria and albuminuria if concomitant SLE SPECIAL TESTS Immunofluorescent staining of skin biopsies (lupus band test) DIAGNOSTIC PROCEDURES Skin biopsy
TYPENOTES
GENERAL MEASURES Avoid sun exposure, avoid excessive heat, cold, or trauma PATIENT EDUCATION β’ Teach patients proper use of sunscreens and other measures to prevent sun exposure (e.g., wide-brimmed hats, long sleeves, etc.) β’ Advise patient about symptoms of systemic lupus erythematosus (SLE) for which they should watch DRUG(S) OF CHOICE . Localized DLE: . Low to medium potency topical corticosteroid (eg, triamcinolone 0.1% bid) to all active lesions . If no response in 2-3 weeks, move to higher potency topical corticosteroid applied tid (eg, betamethasone) with or without occlusion . Intralesional corticosteroid (eg, triamcinolone 2.5-5 mg/mL for the face or 5-10 mg/mL elsewhere) for resistant lesions. Use 0.5 mL per 1 cm plaque. . Generalized DLE: . Hydroxychloroquine 6.5 mg/kg per day. If no response after 3 months, switch to chloroquine 250 mg qd. . Short-term (1-2 weeks) of topical corticosteroids is helpful at the same time antimalarials are being started ALTERNATIVE DRUGS . Localized DLE: Intralesional triamcinolone 2.5 mg/cc injected at monthly intervals. Prednisone 15 mg bid, then tapered after response. . Generalized DLE: Quinacrine 100 mg qd, dapsone 100 mg qd, azathioprine 100 mg qd. Systemic retinoid (eg, etretinate 1 mg/kg); thalidomide is also effective. . Dapsone is useful in patients who also have vasculitis. It is the treatment of choice for patients with bullous LE. PATIENT MONITORING β’ Recheck patients once or twice per month β’ Ophthalmology followup at 6 month intervals if patient on antimalarial β’ If lesions subside, reduce dosage of antimalarials over 2-3 months, then discontinue PREVENTION/AVOIDANCE Avoid sun exposure or excessive heat, cold, or skin trauma POSSIBLE COMPLICATIONS Hypertrophic scarring, hypopigmentation (especially in blacks) EXPECTED COURSE/PROGNOSIS β’ 40% remit completely; 1-5% may develop systemic lupus (these patients usually have generalized DLE) β’ Not life-threatening unless it turns into systemic type
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
ANTI-NUCLEAR ANTIBODY TEST, URINE ROUTINE, COMPLETE BLOOD COUNT, ANTI-SINGLE STRANDED DNA ANTIBODY, BIOPSY