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Discoid Lupus Erythematosus

Author: Devika Sunil 

Chief Editor: Dr Daniel Keith

Discoid lupus erythematosus (DLE) is a chronic autoimmune condition and a form of cutaneous lupus that primarily affects the skin, particularly in areas exposed to sunlight. Sun exposure can sometimes trigger the development of characteristic lesions. While DLE can occur in individuals of all ages and genders, it is commonly seen in women between the ages of 20 and 50. 

Macroscopic Appearance

Localised DLE typically occurs above the neck, making it the most frequent form of DLE. 

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Generalised DLE is when lesion occur above and below the neck. This occurs when the lesions described below, feature on the anterior chest, back of hands and even on lower limbs. 

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  • Lesion Characteristics: The condition usually presents as dry, red patches that can develop into red, scaly plaques. These plaques may appear on the nose, face, cheeks, earlobes, conchal bowl (the deep part of the outer ear), and sometimes the oral mucosa. The plaques often have a discoid (round) shape. 

  • Late-Stage Effects: The lesions may lead to atrophic scarring and skin discolouration in the later stages. If the scalp is affected, DLE can result in scarring alopecia (pseudopelade) and permanent hair loss as the diseases progresses to the chronic stage and active inflammation is replaced by permanent damage to the hair follicles. This is a feature of ‘Burnt- out’ DLE on the scalp. 

  • Skin of Colour: DLE-related discoloration can present as either hypopigmentation (lightening) or hyperpigmentation (darkening) in those with skin of colour. 

 

Below, are two macroscopic examples of red, scaly DLE plaques presenting on the face.

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A macroscopic image showing alopecia as a result of DLE affecting the scalp.

A macroscopic image demonstrating a patch of hypopigmented DLE under the right nostril of a patient with type 6 skin.

Dermoscopic Appearance

The Dermoscopic features of discoid lupus erythematosus can vary depending on the stage of disease progression.

 

In the early stages, the following features could be present:

  • Follicular plugging

  • Perifollicular whitish halos

  • Follicular red dots

  • White scales

 

In the later stages, the following features could be present:

  • Telangiectatic vessels

  • Structureless whitish areas

  • Pigmentation

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A dermoscopic image depicting white hyperkeratosis/scaling (yellow stars), follicular red dots and perifolicular white halo structures (areas enclosed within purple rings).

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An unannotated version of the same image (to the left) for comparison.

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Unannotated version of the same image for comparison.

Image depicting examples of follicular plugging (green arrows) and white hyperkeratosis/scaling (yellow stars).

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Unannotated version of the same image for comparison.

A further example showing ref follicular dots and whitish perifollicular halos (purple ring), follicular plugging (green arrows) and white hypopigmentation (yellow stars).

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Zoomed in version of the same image for comparison.

A zoomed in image showing follicular dots and perifollicular white halos.

Zoomed in image of a follicular red dot surrounded by a white perifollicular halo.

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Scalp DLE

Dermoscopic features when the scalp is involved include:

  • Follicular plugging

  • Thick branching vessels

  • Skin discolouration

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Image of active scalp DLE depicting follicular plugging (black arrows) and red follicular dots surrounded by white halos (area enclosed within purple rings).

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A further example of active scalp DLE, demonstrating folliciular plugging (black arrows), red dots and perifollicular halos (blue arrow).

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Image depicting burnt out DLE (pseudopelade) on the scalp - scarring alopecia. Scarred areas with loss of hair follicles and structureless pale areas indicated by the yellow stars. Tufting of hair follicles where more than one hair shaft grows from the same follicle indicated by the green arrows.

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