Discoid Lupus Erythematosus: A Mucocutaneous Autoimmune Condition Explained

Discoid Lupus Erythematosus: A Mucocutaneous Autoimmune Condition Explained

Question. Write notes on discoid lupus erythematosus.

Answer. Discoid lupus erythematosus remains confined to the mucosa and skin.

Etiology

• Genetic susceptibility
• Autoimmune: The Patient develops antibodies to their cells.
• Endocrine: Commacon in pregnant ladies.\

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Clinical Features

• It is seen during the 3rd and 4th decades of life.
• Female predilection is present with a ratio of 5:1.
• Lesion appears as a circumscribed, slightly elevated white patch surrounded by an erythematous halo.
• Skin lesions are slightly elevated. They are purple or red macules and are covered by gray or yellow scales.
• As the removal of scale is done, it results in carpet track extension.
  There is a presence of butterfly-shaped distribution over the malar region at the bridge of the nose.

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Oral Manifestations

• The tongue, buccal mucosa, and vermilion border of the lip are the most commonly involved oral sites.
• The patient complains of burning and tenderness in the involved area.
• Lesion begin as erythematous area with induration and white spots. At times pain is felt in ulcerated area with crusting and bleeding. Scale formation is absent.
• Fine white striae are seen radiating from the margins.
• Lips show an erythematous area, which is surrounded by a keratotic border.

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Histopathology

• It is characterized by hyperkeratosis with keratotic plugging.
• There is presence of atrophy of the rete pegs.
• Presence of liquefaction, degeneration of the basal layer of cells.
• Perivascular infiltration of lymphocytes is present, and their collection at around dermal appendages.
• Basophilic degeneration of collagen and elastic fibers is present.
• Hyalinization is also seen.
• Edema and fibrinoid change is present beneath the epithelium.

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Treatment

Corticosteroids, along with immunosuppressant drugs, are the choice.