Makindo Medical Notes

Classical findings include indurated plaques, scarring alopecia, and follicular hyperkeratosis. These changes may leave permanent disfigurement if untreated.

📖 About

• Prevalence: 20–40 per 100,000 people.
• Chronic form of cutaneous lupus erythematosus (CLE), distinct from systemic lupus but may overlap.

🧬 Aetiology

• Autoimmune disease with dysregulated immune response.
• Females affected 5× more often than males 👩.
• More common and severe in individuals with darker skin tones.
• Smoking 🚬 worsens severity and reduces treatment response.

⚡ Causes & Precipitants

• Genetic predisposition (familial autoimmune tendency).
• Ultraviolet light ☀️ exposure (delayed trigger, often weeks before flare).
• Smoking and hormonal factors.

🩺 Clinical Features

• Discrete, erythematous plaques with adherent scales.
• Scale extends into dilated hair follicles → follicular plugging.
• Common sites: face, scalp, pinnae, behind ears, and neck.
• Lesions may also appear in sun-protected sites.
• Peripheral indurated erythema with central atrophic scarring is characteristic.
• Chronic scalp lesions → scarring alopecia.

🔍 Investigations

• Bloods: FBC, U&E, LFT, CRP.
• Autoantibodies:
  • ANA (low titre, often negative).
  • Extractable nuclear antibodies (ENA) positive in ~50%.
  • Anti-annexin 1 antibodies (possible marker for DLE).
• Skin biopsy: shows interface dermatitis, peri-adnexal inflammation, follicular plugging, atrophy & scarring.
• Lupus band test (direct immunofluorescence) often positive.

🛡️ Prevention

• Strict sun protection all year round:
  • Clothing, hats, sunglasses, thick SPF 50+ sunscreen.
  • Glass windows may need UV-blocking films.
• Vitamin D supplementation if sun avoidance is strict.
• Smoking cessation 🚭 strongly advised.

💊 Topical Management

• Potent topical corticosteroids for several weeks (potency tailored to site).
• Intralesional corticosteroids for hypertrophic plaques.
• Calcineurin inhibitors (e.g. tacrolimus ointment) as steroid-sparing alternatives.
• Cosmetic camouflage to improve appearance.

💊 Systemic Management

• Antimalarials (Hydroxychloroquine ± chloroquine) – response in ~80% cases (less effective in smokers).
• Systemic corticosteroids (prednisone/prednisolone) for severe flares.
• Other systemic agents: methotrexate, mycophenolate, azathioprine, retinoids (isotretinoin/acitretin), dapsone.
• Choice depends on severity, comorbidity, and organ involvement.

📚 References

• DermNet NZ – Discoid Lupus Erythematosus
• Oxford Handbook of Dermatology & Rheumatology.
• British Association of Dermatologists Guidelines.