What it looks like and where it appears
The lesion begins with a reddish spot, which gradually rises and becomes covered with dense scales. When you try to remove them, you feel pain, and on the lower surface of the scales you can see horny spines - casts of hair follicles. Over time, the center of the plaque becomes thinner, brightens and sinks, the skin there becomes atrophic and hairless, and redness and hyperpigmentation remain along the periphery. Favorite places are the cheeks and bridge of the nose, the ears and external auditory canals, the scalp, and the vermilion border of the lips.
- Well-defined red plaques
- Dense scales with horny spines
- Recessed atrophic center with scar
- Dark rim around the edge of the hearth
- Localization on the face, ears, scalp
- Scarring baldness in patches on the scalp
Causes and provoking factors
It is based on an autoimmune reaction: under the influence of ultraviolet light, skin cells are damaged and become a target for their own immune cells. That is why exacerbations are clearly associated with exposure to the sun, and they can appear days and even weeks after exposure. Smoking is the second significant factor: it both provokes the disease and significantly reduces the effectiveness of treatment. Hereditary predisposition, skin trauma, cold, and some medications play a role. Young and middle-aged women are more often affected.
- Ultraviolet radiation is the main provocateur
- Smoking worsens response to treatment
- Hereditary predisposition
- Skin injuries and irritation
- Some medications
- Female, young and middle age
Association with systemic lupus erythematosus
In most patients, the disease remains exclusively skin and does not affect internal organs. However, in some people, discoid lesions turn out to be one of the manifestations of systemic lupus erythematosus, which affects the joints, kidneys, blood, lungs and nervous system. The likelihood is higher in case of multiple lesions distributed below the neck, in the presence of general complaints and changes in tests. Therefore, at the first visit, a basic examination is required, and then it is repeated periodically and attention is paid to new symptoms.
- Most often the process is limited to the skin
- The risk is higher with widespread lesions
- Worrying joint pain, fever, weakness
- Changes in blood and urine tests are important
- A basic examination is required when making a diagnosis.
- Periodic monitoring by a rheumatologist
Diagnostics
The support is an examination with an assessment of characteristic plaques and dermatoscopy, in which horny plugs at the mouths of the follicles and a special vascular pattern are visible. The most accurate method is a skin biopsy with histological and, if necessary, immunofluorescence examination. Be sure to prescribe tests to ensure that systemic damage is not missed: a general blood test, a general urinalysis, antinuclear antibodies and other indicators as decided by the doctor. For lesions on the scalp, it is important to assess the condition of the follicles, since follicles that remain viable can still be saved.
- Examination by a dermatologist and dermatoscopy
- Skin biopsy with histology
- Direct immunofluorescence according to indications
- Antinuclear antibodies
- Complete blood count and urinalysis
- Consultation with a rheumatologist if a systemic form is suspected
Treatment and sun protection
The basis for success is strict and constant UV protection: high factor sunscreen every day, including cloudy days, a wide-brimmed hat, long sleeves, avoiding the sun in the middle of the day. The second mandatory step is to quit smoking. Drug treatment begins with external hormonal agents or their administration directly into the lesion; in case of widespread and persistent course, the doctor prescribes antimalarial drugs, which for cutaneous lupus are basic therapy and require periodic examination by an ophthalmologist. Formed scars and areas of baldness cannot be removed with medications, so delay is costly.
- Daily high factor sun protection
- Quitting smoking
- External hormonal and other anti-inflammatory agents
- Introduction of drugs into the lesion
- Antimalarial drugs as prescribed by a doctor
- Regular monitoring by a dermatologist and rheumatologist