Overview
Discoid lupus erythematosus (DLE) is a chronic skin condition characterized by well-defined, erythematous, scaly plaques that can lead to scarring and potentially progress to systemic lupus erythematosus (SLE) 1.Diagnosis
Clinical Features: Erythematous, raised, indurated papules or plaques, including rare periorbital localization 3.
Recommended Tests: Complete blood count with differential, urinalysis, complement levels (C3, C4), antinuclear antibodies (ANA), erythrocyte sedimentation rate (ESR), hepatic function tests, and renal function/electrolytes 1.
Classification Criteria: Ongoing development of 12 clinical and histopathologic items for formal classification criteria through expert consensus 2.Management
First-Line Treatment: Hydroxychloroquine 1.
Adjunctive Treatments: Topical corticosteroids, antimalarials, and in severe cases, systemic corticosteroids or immunosuppressants (specific dosing not detailed in abstracts) 1.Special Populations
Pediatrics: Consensus on screening labs including CBC, urinalysis, complement levels, ANA, ESR, hepatic function, and renal function/electrolytes; intensified evaluation for SLE if arthritis or nephritis develops 1.
Comorbidities: No specific recommendations provided for comorbidities like psoriasis affecting management 3.Key Recommendations
Perform comprehensive screening labs including CBC, urinalysis, complement levels, ANA, ESR, hepatic function, and renal function/electrolytes in pediatric DLE patients (Evidence: Moderate 1).
Initiate hydroxychloroquine as first-line therapy for DLE (Evidence: Expert opinion 1).
Evaluate for SLE progression with intensified assessment if arthritis or nephritis is present (Evidence: Moderate 1).
Consider the development of formal DLE classification criteria based on expert consensus for improved diagnostic consistency (Evidence: Expert opinion 2).References
1 Arkin LM, Buhr K, Brandling-Bennett H, Chiu Y, Chong B, Curran M et al.. Practice-based differences in paediatric discoid lupus erythematosus. The British journal of dermatology 2019. link
2 Elman SA, Joyce C, Nyberg F, Furukawa F, Goodfield M, Hasegawa M et al.. Development of classification criteria for discoid lupus erythematosus: Results of a Delphi exercise. Journal of the American Academy of Dermatology 2017. link
3 Serarslan G, Atik E, Sarikaya G. Periorbital edema and erythema: an unusual localization of DLE in a patient with psoriasis. The Journal of dermatology 2011. link