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Discoid Lupus



What is Discoid Lupus Erythematosus (DLE)?

DLE is a chronic autoimmune disease that can cause hair loss, changes in coloration of the skin on the scalp and scarring. Affected hair follicles can be destroyed by inflammation leading to bald patches on the scalp with redness, hardness, as well as areas of white or brown pigmentation. Frequently individuals with DLE lesions on the scalp will also have similar changes on the face or ears. Females are most commonly affected, but males can be affected as well.

What is the cause of Discoid Lupus Erythematosus (DLE)?

The cause of DLE is unknown. There can be a familial predisposition to autoimmune diseases.

What are the symptoms and findings?

Bald spots associated with scaly, red patches, tenderness, itching or other types of irritation can occur. Also, the patches of hair loss can have red, white and brown coloration which is referred to as poikiloderma. Another finding can be follicular plugging characterized by enlarged openings filled with dark material at the opening to the follicle.

How is it diagnosed?3

Many individuals first learn that they have DLE after they are examined by a dermatologist and having a skin biopsy performed on an area of hair loss that matches the description above. In addition to a skin biopsy from the scalp, blood tests are usually done to check for any evidence of lupus involving internal body functions.

What tests are needed?

A dermatologist will take a skin biopsy from the scalp.

Blood tests can include anti-nuclear antibodies (ANA) levels, blood counts, chemistry panels, an more to check the kidneys and other internal body systems

What is the expected duration?

Discoid Lupus can go into remission with treatment or come and go for lengthy periods of time, even years.

How can it be prevented?

There can be a genetic tendency to develop lupus so there is no way to prevent DLE, but avoiding sun exposure, cease smoking, getting adequate rest and vitamin D supplements can help control and decrease the spread of DLE.

Treatment

The treatment goal is to get any active DLE lesions to heal and stop new areas of involvement from appearing in order to minimize the risk of permanent scarring and baldness that can occur on the scalp. Topical corticosteroids are the most common medications prescribed for localized areas of activity. If the lesions are sticker are resistant to topical treatment then intralesional steroid injections can be beneficial. When widespread lesions are present on the scalp, an oral antimalarial medication such as Plaquenil (hydroxychloroquine) might be prescribed. Combinations of oral, topical, and intralesional injections are frequently used together to get the scalp to heal as quickly as possible.

When to contact a professional

At the first sign of loss of scalp irritation or bald spots with discoloration it is advisable to make a hair loss appointment right away. If a person has a history of lupus affecting other parts of the body and hair loss develops, the scalp should be examined to check and see if lupus is present.

Prognosis

With early treatment and regular monitoring, DLE lesions can be controlled and damage to the scalp minimized. If caught in time, the areas heal and the hair can grow back in the bald spots. When the hair loss progresses to scarring before any treatment is done, the bald areas can become permanently scarred. The earlier a diagnosis is made and a treatment regimen put in place, the better the outcome can be.

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