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A

[Abscess]
[Acne Conglobata]
[Acne Fulminans]
[Acne Neonatorum]
[Acne Rosacea]
[Acne, steroid]
[Acne Vulgaris]
[Actinic Keratosis]
[Actinic Prurigo]
[Actinic Purpura]
[Adenoma Sebaceum]
[Addison's Disease]
[Alopecia, androgenic]
[Alopecia Areata]
[Alopecia, stress-induced]
[Aphthous Stomatitis]
[Artecoll]
[ArteFill]
[Athlete's Foot]

B

[Basal Cell Carcinoma]
[Behcet's Disease]
[Birt-Hogg-Dubé Syndrome]
[Botox]
[Bowel-Associated Dermatosis Arthritis Syndrome]
[Bowen's Disease]
[Bullous Pemphigoid]

C

[Calcium Hydroxylapatite]
[Candidiasis, cutaneous]
[Candidiasis, oral]
[Carcinoid Syndrome]
[Cellulitis]
[Chicken Pox]
[Cicatricial Pemphigoid]
[Collagen, bovine]
[Colloid Millium]
[
Corn]
[Cryotherapy]
[
Cutis Rhomboidalis Nuchae]
[Cymetra]
[Cyst]

D

[Dermal Fillers]
[Dermalogen]
[Dermatitis]
[Dermatitis, atopic]
[Dermatitis, contact]
[Dermatitis, nonspecific]
[Dermatitis, seborrheic]
[Dermatitis, stasis]
[Dermatitis Herpetiformis]
[Dermatofibroma]
[Dermatofibrosarcome Protuberans]
[Discoid Lupus Erythematosus]
[Disseminated Intravascular Coagulation]
[Drug Eruptions (Rash)]

E

[Eczema]
[Epidermal Inclusion Cyst]
[Ehler's-Danlos Syndrome]
[Epidermolysis Bullosa]
[Erythema Migrans]
[Erythema Multiforme]
[Erythema Nodosum]
[Erythroplasia of Queyrat]
[Exanthem, viral]

F

[Fascian]
[Favre-Racouchot Syndrome]
[Freckle]
[Folliculitis]
[Fungal Culture]
[Fungal Infections]
[Furuncle]

G

[Gestational Pemphigoid]
[Glomus Tumor]
[Granuloma Faciale]
[Granuloma Inguinale]

H

[Hair Loss]
[Hand, Foot, and Mouth Disease]
[Hemangioma]
[Herpangina]
[Herpes Simplex Virus]
[Herpes Zoster]
[Hives]
[Hidradenitis Suppurativa]
[Human Herpes Virus 8 (HHV-8)]
[Hyaluronic Acid]
[Hylaform]
[Hyperhidrosis]
[Hyperpigmentation]
[Hypopigmentation, postinflammatory]

I

[Impetigo]
[Impetigo, bullous]
[Incontinentia Pigmenti]
[Infantile Acropustulosis]
[Insect bite or sting]
[Intense Pulse Light]

J

[Juvéderm]

K

[Kaposi's Sarcoma]
[Keloid]
[Keratoacanthoma]
[Keratosis Pilaris]

L

[Laser]
[Laser, CO2]
[Laser, diode]
[Laser, Er:YAG, pulsed]
[Laser, excimer]
[Laser, Nd:YAG, pulsed]
[Laser, Nd:YAG, Q-switched]
[Laser, pulsed dye]
[Laser Hair Removal]
[Lentigo]
[Leukoplakia, oral]
[Lichen Planus]
[Lichen Simplex Chronicus]
[Linear IgA Bullous Disease]
[Lipoma]
[Lupus Erythematosus, discoid]
[Lupus Erythematosus, systemic]

M

[Melanoma]
[Melasma]
[Mesolis]
[Milia]
[Miliaria]
[Moh's Surgery]
[Molluscum Contagiosum]
[Morphea]
[Mucous Membrane Pemphigoid]
[Muir-Torre Syndrome]
[Mycosis Fungoides]
 

 

N

[Neonatal Acne]
[Neonatal Cephalic Pustulosis]
[Neurofibroma]
[Nevus]
[Nevus, dysplastic]
[New-Fill]
[Notalgia Paresthetica]

O

[Ochronosis]
[Onychomycosis]
[Oral Ulcer]

P

[Pachyonychia Congenita]
[Paget's Disease]
[Paronychia]
[Pemphigus Vulgaris]
[Photoaging]
[Photodermatoses]
[Photodynamic Therapy]
[Pityriasis Alba]
[Pityriasis Lichenoides et Varioliformis Acuta (PLEVA)]
[Pityriasis Lichenoides Chronica (PLC)]
[Pityriasis Rosea]
[Poikiloderma of Civatte]
[Polymorphous Light Eruption]
[Porokeratosis]
[Porphyria Cutanea Tarda]
[Postinflammatory Hyperpigementation]
[Postinflammatory Hypopigmentation]
[Psoralen + UVA (PUVA)]
[Psoriasis]
[Purpura]
[Purpura, actinic]
[Purpura, thrombocytopenic]
[PUVA]
[Pyoderma Gangrenosum]

R

[Radiesse]
[Relapsing Polychondritis]
[Restylane]
[Rhinophyma]
[Rosacea]

S

[SAPHO Syndrome]
[Sarcoidosis]
[Scabies]
[Schamberg's Disease]
[Schnitzler Syndrome]
[Scleroderma]
[Sculptra]
[Sebaceous Hyperplasia]
[Seborrheic Keratosis]
[Shingles]
[Skin Tag]
[Sneddon-Wilkinson Disease]
[Solar Elastosis]
[Squamous Cell Carcinoma]
[Steatocystoma]
[Stevens-Johnson Syndrome]
[Stewart-Treves Syndrome]
[Sweet's Syndrome]
[Syphilis, primary]
[Syphilis, secondary]
[Systemic Lupus Erythematosus (SLE)]

T

[Thrush]
[Tinea]
[Tinea Capitis]
[Tinea Corporis]
[Tinea Cruris]
[Tinea Faciale]
[Tinea Imbricata]
[Tinea Manuum]
[Tinea Pedis]
[Tinea Unguium]
[Tinea Versicolor]
[Thermage]
[Toxic Erythema]
[Trichotillomania]
[Tuberous Sclerosis]

U

[Ulcer, oral]
[Ulcer, skin]
[Urticaria]

V

[Varicella]
[Vasculitis]
[Viral Exanthem]
[Vitiligo]

W

[Wart]
[Wiskott-Aldrich Syndrome]

X

[Xanthoma]

Z

[Zyderm I]
[Zyderm II]
[Zyplast]
 


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Discoid Lupus Erythematosus

 

What is discoid lupus erythematosus (DLE)?

Discoid lupus erythematosus is a skin rash that can occur in lupus; it may be limited to the skin or be a sign of systemic lupus erythematosus (SLE). It consists of reddish purple discoid plaques with white scale. The scale can sometimes be removed in one piece, and the underside may exhibit "carpet tacks", small spikes that indicate where the scale plugged a hair follicle. Lesions may worsen after exposure to sunlight. As lesions mature they appear as depressed atrophic plaques, often with central hypopigmentation and a hyperpigmented rim.  The rash is usually asymptomatic, but may be slightly pruritic.  Mucosal erosions may also occur.

What is the association between hair loss and discoid lupus erythematosus?

Oval patches of scarring alopecia (hair loss) sometimes occur with DLE. The center of the lesion is typically white and atrophic, while the rim is erythematous. As is the case for skin lesions of discoid lupus erythematosus, keratin-plugged follicles are present.  Telangiectasias may be found as well.

With what can discoid lupus erythematosus be confused?

DLE is most often confused with psoriasis. Also in the differential is lichen planus. The focal scarring alopecia of discoid lupus erythematosus has a relatively narrow differntial diagnosis, including tinea capitis and lichen planus.

How is discoid lupus erythematosus diagnosed?

Diagnosis requires a skin biopsy. The lupus band test is positive (i.e. direct immunofluorescence), with immunoglobulins deposited at the dermal-epidermal junction in involved skin.

A complete history should be taken to elicit symptoms of systemic lupus erythematosus, such as photosensitivity, hair loss, oral ulceration, Raynaud's phenomenon, and arthritis.  Laboratory evaluation for SLE should be performed, including anti-nuclear antibody (ANA) and confirmatory anti-DNA antibody tests, complete blood count, and urinalysis.

See: Pathology: Discoid Lupus Erythematosus

 

How is discoid lupus erythematosus treated?

The lesions usually respond to topical or intralesional steroids. Sun protection with broad spectrum sunscreens and sun avoidance is important. Resistant or extensive lesions require systemic therapy, which may include the antimalarial drugs chloroquine and hydroxychloroquine. Alternatives are retinoids, dapsone, and gold compounds. In the case of hair loss, early treatment is directed at preventing eradication of the follicle and irreversible allopecia.

What is the prognosis for discoid lupus erythematosus?

DLE is a chronic but usually manageable disease, with new lesions appearing as others resolve.  Remission occurs in up to 50% of patients. Scarring, postinflammatory hypo- and hyper-pigmentation, and scarring alopecia can occur, which can be permanent. The risk of developing SLE is 5-10% in patients that lack other symptoms of SLE at the time of presentation.

 


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Date created 04/14/2007

Last updated 01/03/2009

 

Copyright Michael Ehrenreich, MD

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