There are specific skin signs that occur only in people with LE and those skin lesions that can occur in people with LE, but can also occur in other diseases. There are three broad categories of LE-specific skin lesions: chronic cutaneous LE (CCLE) or diseases limited to the skin, sub acute cutaneous LE (SCLE), and acute cutaneous LE (ACLE). The most common lesion in CCLE is known as discoid Lupus Erythematosus (LE).
LE can be viewed as a spectrum of disease, with DLE on one end, and full-blown systemic lupus erythematosus (SLE) on the other end. Patients with DLE that is localized to the head and/or neck generally will not develop systemic disease, those with SCLE often have associated joint disease, and those with ACLE have active systemic disease. More severe forms involve the kidneys, brain, or other organs, but this is rare.
Discoid lupus (DLE) is the most common form of CCLE. The coin-shaped lesions are mostly present on the scalp and face, but can be seen on other parts of the body. DLE lesions are red, scaly, and thick. With time, there can be scarring and discoloration of skin. When discoid lesions occur on the scalp, permanent hair loss can result. Discoid lesions may also occur with firm lumps in the fatty tissue underlying the skin. This is called “lupus profundus” or “lupus erythematosus panniculitis” (LEP). DLE occasionally occurs in the inside surfaces of the mouth, nose, and eyes and on the hands and feet DLE lesions are usually painless and do not itch. Sun exposure may make lesions in CCLE patients worse. Skin cancer can occasionally develop in long-standing DLE lesions.
Scarring from Discoid Lupus Erythematosus (LE)
There are two clinical forms of SCLE lesions. One type of SCLE looks like psoriasis. The other type has red ring-shaped areas with a slight scale on the edges. Sunlight worsens both forms. The lesions of SCLE are not particularly itchy, and may heal with light or dark marks. Discoid lesions and lesions associated with ACLE can appear in SCLE patients.
Annular lesions of SCLE
The “neonatal LE syndrome” results when infants are born to mothers who have autoantibodies in their blood during pregnancy. Neonatal LE skin lesions usually disappear by six months of age. Congenital heart block can be associated.
There are flattened areas of red skin on the face that look like sunburn. When the cheeks and nose are involved, it is called a “butterfly rash.” Generalized ACLE can be seen on the arms, legs, and body. ACLE lesions are sunlight sensitive (photosensitive) and may discolor the skin, but there is no scarring. ACLE usually occurs in patients with active systemic disease.
Other Skin Lesions In Lupus Erythematosus (LE) (Non-Specific Skin Manifestations)
Vasculitis occurs because of damage to the blood vessels in the skin. This usually occurs in patients with active SLE.
SLE patients who have been severely ill may develop temporary hair loss which is replaced by new hair growth. A severe flare of SLE can result in fragile hair called ‘lupus hair’.
Light Sensitivity (Photosensitivity) is common in all forms of cutaneous Lupus Erythematosus (LE).
Sunscreens and sun protection are extremely important for people with Lupus Erythematosus (LE).
ACLE is treated with systemic drugs such as prednisone, or in combination with other drugs that suppress the immune system. Discoid lesions and SCLE skin lesions can be treated with the application of corticosteroid creams. Individual lesions can be injected with a corticosteroid suspension.
Patients with more widespread Lupus Erythematosus (LE) skin lesions and stubborn lesions are treated with oral antimalarial drugs.
Other oral drugs that are used include retinoids, diaminodiphenylsulfone, gold, thalidomide, clofazimine, or immunosuppressive drugs like methotrexate, azathioprine, myco-phenolate mofetil, or cyclosporine.
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