Discoid Lupus Erythematosus (DLE) is an autoimmune disorder that affects only the skin. It is more common in women and typically presents with periods of flare-ups and remissions. • Specialized expertise and long-standing scientific training • Comprehensive and effective treatments • Maximum efficacy
Symptoms
DLE primarily affects the face and scalp, with ultraviolet (UV) exposure being the main aggravating factor. The rash usually appears as red, disc-shaped plaques on the cheeks, nose, forehead, and ears. These plaques are elevated, inflamed, and may sometimes itch or swell. The outer edge of the plaques often shows hyperpigmentation, while the center may be hypopigmented. Less commonly, DLE may also affect the oral mucosa, and nodules or hypertrophic lesions may develop. These lesions often leave scars as they heal. The characteristic red plaques of DLE may be covered by scales, and as they heal, they can result in skin depressions and discoloration. Although DLE can affect any part of the body, it typically involves the upper body—especially the face, neck, scalp, and ears. When it affects the scalp, it can potentially lead to hair loss.
Diagnosis
The diagnosis of DLE is confirmed through a skin biopsy, analyzed by a specialized dermatopathologist.
Treatment Approach
The mainstay treatments for DLE include the use of potent topical corticosteroids and antimalarial medications. Topical calcineurin inhibitors such as tacrolimus and pimecrolimus are also frequently used. For hypertrophic lesions, intralesional corticosteroid injections may be required. Retinoids and imiquimod cream have shown beneficial effects in some patients. General preventive measures are equally essential:
Avoid sun exposure between 10:00 a.m. and 4:00 p.m.
Use broad-spectrum sunscreen with SPF 30+ on exposed areas
Wear hats and protective clothing
Avoid tanning beds and solarium use
Medications known to worsen the condition (e.g., procainamide, hydralazine, quinidine) should be avoided. Smoking cessation is crucial, as smoking may exacerbate symptoms and reduce treatment efficacy.
Newer Treatments Belimumab (Benlysta) is a monoclonal antibody that inhibits the BLyS factor, thereby reducing the survival of autoreactive B lymphocytes. It was approved by the European Medicines Agency (EMA) in 2011 as an adjunct to standard immunosuppressive therapy for active systemic lupus erythematosus (SLE), and in 2021 its indication was expanded to include lupus nephritis. In Greece, the drug has been reimbursed by the National Organization for the Provision of Health Services since 2019–2020, under ministerial approval. It is available in both intravenous and subcutaneous formulations and offers a favorable long-term safety and efficacy profile, even in patients with recurrent disease.
