Coping with Lupus: Discoid lupus (the most common form of skin lupus) accounts for approximately 10 percent of all cases of lupus and occurs in 20 percent of those with systemic lupus. My discoid lupus was most pronounced before I began taking Plaquenil, and after this first baseline drug treatment started, my rashes cleared up on my face, eyelids, hairline, scalp, chest, arms and thighs. Now, occasionally a few discoid rashes between my fingers, on my forehead or cheek, or my hairline.
Forms of cutaneous lupus
The Lupus Foundation of America describes forms of cutaneous lupus in an article on photo-sensitivity and lupus:
1) Acute cutaneous lupus erythematosus (ACLE):
- This is also known as the “butterfly rash” of lupus and occurs over the cheeks and nose.
- It often comes on after sun exposure, and is associated with lupus flares.
- ACLE usually heals within weeks without scarring.
2) Discoid lupus erythematosus (DLE):
- The term “discoid” refers to the disk-shaped lesions of the rash.
- The rash occurs mainly on sun-exposed sites.
- The lesions develop slowly and heal over several months, and may cause scarring.
3) Subacute lupus erythematosus (SCLE):
- SCLE is highly photosensitive.
- It usually shows up as many red, circular shapes on the chest, back and arms.
- It is often a little scaly, resembling psoriasis.
- This form of lupus is particularly associated with antibodies in the blood to the Ro protein (mentioned above).
- SCLE tends to heal over weeks or months and is usually non-scarring.
- It frequently comes back after more sun exposure.
Both SCLE and DLE may occur on their own without the presence of systemic lupus. Although systemic lupus occasionally develops in people who first have DLE or SCLE, it tends to be a milder illness than the usual form of SLE.
Slather on the steroids!
A Lupus Foundation of America research report about a new drug, Efalizumab, in the Treatment of Discoid Lupus Erythematosus discusses the following about discoid lupus.
Discoid lupus is a form of lupus that affects the skin (cutaneous lupus). In most cases the discoid lupus rash appears on the face, neck, or scalp, though it can also show up on other areas of the skin. Severe discoid lupus may result in scarring. The treatments that are used most often for severe discoid lupus are strong immunosuppressants that may have significant side effects, especially when used over long periods of time.
A search on www.webmd.com for drugs used to treat discoid lupus, returned a list that included oral Plaquenil/hydroxychloroquine (brand name/generic,) Thalomid, and Thalidomide, the injectable drugs Kenalog, triamcinolone acetonide and Aristospan Intralesional, and a very long list of 106 different topical steroid medications for application to the lupus discoid skin lesions.
Thalidomide is a drug that has a strong negative stigma about its known relationship to birth defects in the babies of women who used it during pregnancy for their morning sickness. It has been found to be effective in treating some cases of lupus.