The discoid lupus is a skin disorder that is often manifested by ring – shaped lesions on the face, neck, arms and scalp, chronic.
This term is used to differentiate it from systemic lupus erythematosus, which affects not only the skin, but also other organs such as the kidney, heart, etc. However, it must be borne in mind that discoid lupus can also evolve into a generalized form.
Causes of discoid lupus
The cause of lupus is unknown, but various factors are believed to play a role in its presentation. On the one hand, there are predisposing genetic factors and, on the other, environmental factors that can add to them. Among the environmental factors are drugs, ultraviolet light and viruses.
The drugs capable of producing lupus are multiple, but generally the lesions they cause disappear when their administration is abandoned.
Ultraviolet light has been linked to the development of lupus for a number of reasons. This pathology appears more frequently in individuals who work exposed to sunlight and in areas of the skin on which ultraviolet rays affect, such as the malar region. Both sunlight and artificial ultraviolet light can cause the appearance of lesions, with both ultraviolet A and B light being responsible for these.
Viruses have also been linked to the development of lupus, and some authors suggest that they could trigger the disease.
The mechanisms responsible for the lesions are not well defined, although it seems that it is the deposit of antibodies on the skin, or the different organs affected in the case of systemic lupus erythematosus, that cause the disease. Deposition of these antibodies on the basement membrane at the dermoepidermal junction has been demonstrated by antibody-bound fluorescein staining.
Ultraviolet light could act to form photodimers in the cell’s DNA. After DNA repair, these would be expelled outside the cell, where they would bind to the antibodies formed by the white blood cells.
Discoid lupus symptoms
Discoid lupus usually manifests as erythematous plaques, which are red lesions that rise above the skin surface. They are of varied size, with clear limits and three areas can be distinguished: an erythematous area, another keratotic and a third of scar atrophy.
Erythema is the predominant sign and appears on the border or growth zone. The more congestive and red the edges appear, the greater the lupus activity; on the contrary, the more violaceous they appear, the less this activity is.
Keratosis is a lesion in which there is an increase in thickness in the horny layer of the skin and in the case of lupus, the location in the follicular orifices is characteristic, which are dilated. This gives it a dotted appearance and, when detached, the existence of extensions in the form of stalactites is observed on its underside, which are called corneal spikes.
Atrophy is seen as a thinning of the skin that affects the epidermis and dermis, in which the normal skin marks and attachments (hair follicles, sebaceous glands, etc.) disappear. It has variable shape, intensity and coloration.
The typical arrangement of these lesions is concentric, with the erythema located in the peripheral area, the atrophic scar in the central area, and the keratosis between the two. The evolution of the plates is slow, over years, and does not tend to return spontaneously. It does not cause any discomfort, such as pain, itching or stinging.
The most frequent location is on the face, although we can also find it on the hands, scalp, manifesting itself in the form of alopecia and mucous membranes of the lips. Sometimes it appears in a localized way, while others it affects more extensive areas, and can even evolve to SLE (systemic lupus erythematosus), affecting other organs, such as the kidney, pleura, etc.
How is it diagnosed?
The diagnosis is achieved, in most cases, by performing a biopsy. For this study to be effective, it is necessary to biopsy the most appropriate lesion, which must be evolved, since in the first days the changes may be nonspecific; and choose covered areas, since the alteration of the sun can cause alterations.
In the biopsy we will find lesions in the dermis and epidermis. Increased thickness of the horny layer and horny plugs will appear in the epidermis, alternating with atrophic areas. In the dermis, invasion by white blood cells is observed around the blood, lymphatic and adnexal vessels.
Through the study with fluorescein-labeled antibodies, we will verify the existence of antibodies at the dermoepidermal junction.
Discoid lupus treatment
First, it is necessary to establish a series of general measures that help to facilitate the management of the disease. It is important to communicate to the patient the need to follow these measures, as they can help reduce the use of drugs.
Among these measures are: reducing physical or mental stress (which may be enough to trigger or intensify injuries), drugs capable of inducing lupus, and solar radiation avoiding exposure or through the use of sunscreens.
When the number of lesions is limited, intralesional therapy can be applied through the use of corticosteroid injections. The main secondary effects, due to the abuse of these, would be subcutaneous atrophy and hypopigmentation. If the number of lesions is greater, corticosteroids in ointment are used.
If the previous treatments were not effective, oral treatment will be carried out.
The most widely used drugs are antimalarials and within these chloroquine. Its mechanism of action is not known, but its application produces a notable improvement in the lesions. Its main side effect is damage to the retina, so an ophthalmological examination should be performed every six months. other side effects would be the appearance of hematological and intestinal alterations.
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.