CHRONIC DISCOID LUPUS ERYTHEMATODES

Chronic discoid lupus erythematodes (CDLE) is a chronic scarring skin disease
which occurs on sun-exposed areas. The face is the commonest
site, but scalp, upper trunk and distal extremities may also be affected.
On the face there may be a "butterfly distribution" on the cheeks and
bridge of the nose, the lips may also be affected. The lesions are welldefined
reddish patches with thick or hyperkeratotic scaling and hyper-,
hypo- or depigmentation, they feel rough on palpation. They slowly increase
in size and form atrophic hypopigmented scars. Exposure to sunlight
aggravates the lesions and causes an increase in symptoms, such as itch
and irritation.
Management of chronic discoid lupus erythematodes
- Sunprotection! Wear a sunhat, protective clothing, and stay out of the sun as much
as possible. Use a sunscreen when outdoors (see albinism).
- Topical steroids e.g. betamethasone 0,1% once daily. If this is not effective after
2 months, this treatment should be stopped, as there is already a high risk of
skin atrophy.
- Chloroquine 150 mg/hydroxychloroquine 200 mg once daily for 6-8 weeks. If
improving continue until maximum improvement (i.e. no active lesions, scars will not
disappear), then slowly decrease the dosage (over months). If no improvement
occurs a double or triple dose may be tried for a short time. Do not use antimalarials
for more than 9 months at a time.
- Sometimes dapsone, with or without antimalarials is effective.