Discoid lupus erythematosus

Lupus erythematosus (lupus erythematodes) is a complex and serious disease, although it is not very common: approximately up to 1% of all dermatological pathologies. Usually, several types of this disease are distinguished: discoid, disseminated and systemic lupus erythematosus with damage to various organs and systems. In this article, we will talk about the most common type of the disease - discoid lupus erythematosus.

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Causes of Discoid Lupus Erythematosus

The causes of discoid lupus erythematosus have long been a subject of debate among scientists around the world. There are many assumptions about the origin of this disease, and, unfortunately, these are only theories that do not yet have 100% confirmation. In the last century, a hypothesis about the viral etiology of the disease was considered. Yes, cytopathogenic viruses were indeed detected, but they were not specific to this disease.

The streptococcal theory of disease development has caused much discussion: patients with lupus erythematosus often had a large number of streptococci in the affected areas and blood tests. In addition, in many cases, suppression of streptococcal flora led to an improvement in the condition of patients. But, at the same time as these data, in some cases streptococci were not detected in patients, which forced scientists to look for more and more new explanations for the appearance of lupus erythematosus.

Discoid lupus erythematosus is currently recognized as an infectious-allergic autoimmune disease, although the full pathogenesis of the disease has not yet been fully elucidated. A large number of gamma globulins are determined in the blood of patients with discoid lupus erythematosus, and bone marrow tests can detect specific pathological cells. There is suppression of the functions of the adrenal cortex, disorders in the functioning of the reproductive and endocrine systems, and an imbalance in metabolic processes.

It is assumed that a violation of porphyrin metabolism plays an important role in the pathogenesis of the disease.

Although the exact cause of discoid lupus erythematosus has not yet been determined, factors that contribute to the development of the disease and its exacerbation are known:

• skin trauma;
• exposure to ultraviolet radiation;
• taking certain medications;
• infectious diseases;
• exposure of the skin to low temperatures;
• acroasphyxia, Raynaud's disease.

The development of the disease is especially often associated with exposure to solar or artificial ultraviolet radiation, as well as excessive cooling of the skin or frostbite. In such cases, the pathology occurs on damaged areas of the skin.

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Symptoms of Discoid Lupus Erythematosus

Symptoms of discoid lupus erythematosus begin with the appearance (usually in the facial area) of red-pink edematous spots, which over time become dense, with numerous small scales fixed at the base of the hair follicles. When such a scale is removed, tiny spikes can be seen on its adjacent surface - these are keratinized plugs that have come out of the mouths of the hair follicles.

Attempts to remove the scales cause pain in the patient. After removing the scales, the affected area becomes similar to the surface of a lemon peel.

Over time, the affected area expands, and new areas may appear. Infiltration, redness, and keratinization of the skin may develop along the edges of the affected area. In the central part of the affected area, a focus of atrophy is formed: the skin becomes noticeably thinner and is easy to gather into folds. Atrophic changes develop especially rapidly in areas with hair.

Based on the above, the following main symptoms of discoid lupus erythematosus can be identified:

• erythema (redness of the skin);
• infiltration (accumulation of various fluids, elements and substances in tissues, swelling);
• hyperkeratosis (thickening of the stratum corneum of the epidermis);
• atrophy (involution, decrease in volume and thinning of tissue).

In addition to the listed symptoms, the appearance of spider veins (telangiectasia) and areas of increased pigmentation may also be observed.

Symptoms may vary in severity depending on the type and duration of the disease.

The size of the lesions may vary - from 5 mm and more. They may be located either singly or multiple. The most typical location of the spots is in the area of the nose and cheeks, in the form of a "butterfly". They may also appear in the area of hair growth on the head, on the chest, less often - on the auricles and mucous membrane. With extensive spread of the process, the abdominal area, shoulder girdle, back and even fingers may be affected. Rarely, the eyes are affected, which may manifest as blepharitis, conjunctivitis, keratitis.

Discoid lupus erythematosus in men

It is generally accepted that discoid lupus erythematosus occurs more often in women than in men. Indeed, there are only 3 male patients out of 200 cases of the disease. Moreover, these statistics are supplemented by the fact that blondes are affected by the disease more often than brunettes.

The disease is most common in countries with high humidity and a cool maritime climate. In the tropics, despite the constant abundance of sunlight, discoid lupus erythematosus occurs less frequently. Most likely, this is associated with the darker skin of local residents.

Why can women get lupus more often than men? Experts explain this only by the fact that women's skin is more delicate and soft, and women's hormonal processes in the body are much more active. This also explains why women often get sick during pregnancy and soon after childbirth.

According to statistics, discoid lupus erythematosus most often affects women of mature age – from 20 to 40 years old. Men, children and the elderly account for only up to 3% of cases of the disease.

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Diagnosis of discoid lupus erythematosus

As a rule, discoid lupus erythematosus is diagnosed without any problems or difficulties. The principles of discoid lupus erythematosus diagnostics are based, first of all, on the characteristic clinical picture of the disease. This is largely due to the fact that with skin lesions, laboratory tests often do not reveal any changes in the indicators.

Histological and other diagnostic methods are often used only to distinguish discoid lupus erythematosus from other similar pathologies: psoriasis, eczema, lymphoplasia, pseudopelade, sarcoidosis, favus, etc.

It is easy to distinguish between lupus erythematosus and psoriasis: with lupus lesions, the majority of rashes are concentrated on the face, while with psoriasis, the surface of the face is affected mainly only in children. The scales in psoriasis are removed easily and painlessly, while with lupus they are difficult to separate, and pain occurs when removed.

With seborrheic eczema, itching of the affected areas is almost always present. At the same time, the scales are greasy and do not contain characteristic "spikes".

In complex cases, when there are doubts about the diagnosis, the following studies may be prescribed:

• microscopic examination of hair and scales to detect possible pathogens;
• histological examination of tissues – microscopic analysis of a piece of skin or other tissue, which provides an idea of the external changes in the tissue, its cellular composition and condition;
• immunofluorescence study – based on the interaction of antigens with antibodies (immunological diagnostic method).

All proposed methods are more than sufficient to make a correct diagnosis.

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Treatment of discoid lupus erythematosus

Treatment of discoid lupus erythematosus largely depends on the clinical form and factors that provoke the development of the disease.

Treatment begins with the elimination of foci of chronic infection in the body, normalization of endocrine disorders. Other irritating and provoking factors, such as direct sunlight, radiation therapy, cold, drafts, external skin damage, are eliminated.

In case of discoid lupus erythematosus, antimalarial drugs are the most effective. Use Hingamin (it is possible to use Delagil, Chloroquine, Rezokhin) orally 250 mg twice a day after meals for 10 days. Then the frequency of administration is reduced to once a day (10 days) and then up to 2 times a week. You can connect Plaquenil 200 mg up to 4 times a day. These drugs are effective, but have a number of undesirable side effects. Therefore, during treatment, it is necessary to periodically conduct blood and urine tests, monitor the state of the fundus and liver function.

Positive results have been observed with the use of Presocil (one to three tablets three times a day) or Senton. With early diagnosis of the disease, the effect can be achieved by taking Aminoquinol 0.05-0.15 g three times a day, in 7-day courses with 5-day intervals.

If necessary, antibiotics, mainly penicillin group with a broad spectrum of antibacterial activity, can be prescribed. Tetracycline antibiotics are not used for discoid lupus erythematosus (due to photosensitivity).

If there is a suspicion of the transition of the discoid form of the disease to a systemic form, it is recommended to use individual doses of corticosteroid drugs, possibly with the addition of cytostatics (cyclophosphamide, etc.).

The effectiveness of the therapy can be supported by the use of nicotinic acid, which protects the body from the negative effects of ultraviolet radiation, removes toxins, stimulates the function of the adrenal cortex, and reduces the side effects of antimalarial drugs. Nicotinic acid is prescribed at 50 mg twice a day after meals for 1 month, then after 2-3 weeks the course is repeated. It is recommended to conduct 2 to 5 cycles of therapy. The treatment is supplemented with the use of lipotropic drugs (lipamide, etc.). Injection of 1% nicotinic acid is also possible - 1-5 ml intramuscularly.

To support the immune system, multivitamin complexes with vitamins A, C, E, and group B are prescribed, except for vitamin D², which can worsen the condition during illness.

When drawing up a treatment regimen for discoid lupus erythematosus, it is necessary to take into account that sulfonamides (sulfadimethoxine, streptocide, biseptol, etc.) and streptomycin cannot be used in the treatment of this disease, as this has an extremely negative effect on the outcome of the disease, up to its degeneration into a systemic form.

Minor changes also apply to the diet for lupus: it is advisable to eat foods that contain nicotinic acid in large quantities. Such foods include cod, liver, beans, peas, lentils, buckwheat, oatmeal, barley porridge, etc.

For local treatment, you can use ointments with photoprotective properties: Salol, Quinine, 5% Methyluracil, Fencortosol. Ointments based on lanolin and zinc paste have a good effect. The affected area can be treated with Biyoquinol. Often, ointments are combined: in the morning, photoprotective creams are used, and at night - ointments with corticosteroids.

Prevention of discoid lupus erythematosus

There are no specific methods for preventing this disease, since the etiology of the disease has not been fully studied.

To prevent relapses of the disease after suffering from discoid lupus erythematosus, preventive courses are periodically practiced (recommended in the spring and summer seasons):

• antimalarial drugs (first 1 tablet/day, then 2-3 per week);
• nicotinic acid tablets and injections;
• photoprotective preparations.

The patient should avoid prolonged stays in cold and too hot rooms, as well as in the winter in the cold, in the wind, under direct sunlight. If possible, surgical interventions, injuries, vaccinations and vaccines should be avoided. Physical exercise, walks in the park or forest are encouraged.

The patient's diet should be complete, with a small amount of salt and sugar, and without alcohol.

Prognosis of discoid lupus erythematosus

For the chronic discoid form of the disease, the prognosis for life is favorable in most cases. With a properly selected treatment regimen, long-term relief (remission) may prevail. However, in some cases, the transition of the cutaneous form of the disease to the systemic form is likely: it is no secret that systemic lupus erythematosus is already a serious disease with serious complications. Often, such a transition is preceded by the violation of certain prohibitions: prolonged exposure to the sun, treatment with sulfanilamide drugs and streptomycin, hypothermia, etc.

Discoid lupus erythematosus requires constant dispensary monitoring, with clinical and laboratory studies for timely detection of degeneration into a systemic process. It is important to monitor the function and condition of the urinary organs, heart, and respiratory system. The performance of these organs can largely determine the prognosis of the disease.