Discoid lupus erythematosus

Red lupus erythematosus (lupus erythematodes) is a complex and serious disease, although it is not so common: about 1% of all dermatological pathologies. Usually, several types of this disease are distinguished: discoid, disseminated and systemic lupus erythematosus with the defeat of various organs and systems. In this article, we'll talk about the most common type of disease - it's discoid lupus erythematosus.

[1], [2], [3]

Causes of discoid lupus erythematosus

The causes of discoid lupus erythematosus have long been controversial scientists around the world. There are many assumptions about the origin of this disease, and, alas, these are only theories that do not yet have 100% confirmation. In the last century, the hypothesis of the viral etiology of the disease was considered. Yes, cytopathogenic viruses did detect, but they were not specific for the disease.

Many discussions led to the streptococcal theory of the disease: in patients with red lupus often found a large number of streptococci in the lesions and blood tests. In addition, in many cases, the oppression of streptococcal flora led to an improvement in the condition of patients. But, concomitantly with these data, in some cases, streptococci were not found in patients, which forced scientists to search for new and new explanations for the appearance of lupus erythematosus.

Discoid lupus erythematosus is now recognized as an infectious allergic autoimmune disease, although the full pathogenesis of the disease has not yet been fully elucidated. In the blood of patients with discoid lupus erythematosus, a large number of gamma globulins are detected, and bone marrow analyzes allow the detection of specific pathological cells. There is an oppression of the functions of the adrenal cortex, a disorder in the sexual and endocrine system, an imbalance of metabolic processes.

It is believed that an important role in the pathogenesis of the disease is the violation of porphyrin metabolism.

Despite the fact that the exact cause of discoid lupus erythematosus has not yet been determined, there are factors that contribute to the development of the disease and its aggravation:

• traumatization of the skin;
• exposure to ultraviolet light;
• taking certain medications;
• infectious diseases;
• exposure to the skin at low temperatures;
• acroasphaly, Raynaud's disease.

Especially often the development of the disease is associated with exposure to sunlight or artificial ultraviolet irradiation, as well as excessive cooling of the skin or frostbite. In such cases, the pathology occurs in the damaged areas of the skin.

[4], [5], [6]

Symptoms of discoid lupus erythematosus

Symptoms of discoid lupus erythematosus begin with the appearance (more often in the face) of red and pink swollen spots, which eventually becomes dense, with numerous small scales fastened at the base of the hair follicles. When removing such a scaly on its adjoining surface, you can see the smallest spines - these are cornified plugs that came out of the mouths of the hair follicles.

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

Over time, the affected area expands, and new areas may arise. At the edges of the affected area, infiltration, redness, and keratinization of the skin can develop. In the central part of the affected area, the focus of atrophy is formed: the skin becomes noticeably thinner, it is easy to gather into folds. Especially rapidly, atrophic changes develop in areas with hair follicles.

Based on the above, we can distinguish the following main symptoms of discoid lupus erythematosus:

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

In addition to these signs, there may also be the appearance of vascular sprouts (telangiectasia) and areas with increased pigmentation.

Symptoms can be expressed unequally, depending on the type and duration of the disease.

The sizes of the centers of a lesion can be different - from 5 mm and more. They can be located either singly or multitudinously. The most typical location of spots - in the region of the nose and cheeks, in the form of a "butterfly". They can also occur 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 zone, shoulder girdle, back and even fingers can be affected. Occasionally, the eyes are affected, which can manifest as blepharitis, conjunctivitis, keratitis.

Discoid lupus erythematosus in men

It is generally believed that discoid lupus erythematosus often occurs in women than in men. Indeed, 200 cases of the disease account for only 3 male patients. And this statistics is complemented by the fact that blondes are affected by the disease more often than brunettes.

The disease is most prevalent in countries with high humidity and sea cool climate. In the tropics, despite the constant abundance of sunlight, discoid lupus erythematosus appears less frequently. Most likely, it is associated with the swarthy skin of local residents.

Why can women get lupus more often than males? Experts explain this only by the fact that women's skin is more refined and tender, in addition, women are much more active hormonal processes in the body. This also explains the fact that very often women become ill during pregnancy and soon after childbirth.

According to statistics, discoid lupus erythematosus often affects women in their sexually mature age - from 20 to 40 years. Men, children and the elderly account for only 3% of cases.

[7], [8], [9], [10], [11], [12], [13]

Diagnosis of discoid lupus erythematosus

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

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

It is easy to distinguish between lupus erythematosus and psoriasis: in case of lupus erythematosus, the main quantity of rashes is concentrated on the face, and with psoriasis, the surface of the face is affected mostly only in children. Scales in psoriasis are removed easily and painlessly, and with lupus they are difficult to separate, and when removed, pain occurs.

With seborrheic eczema, there is almost always an itching of affected areas. In this case, the scales are fatty and do not contain characteristic "thorns".

In difficult cases, when there are doubts when making a diagnosis, the following studies can be prescribed:

• microscopic examination of hair and scales to detect a possible causative agent of the disease;
• histological examination of tissues - a microscopic analysis of a piece of skin or other tissue that gives 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 method of diagnosis).

All the proposed methods are more than sufficient to establish the correct diagnosis.

[14], [15], [16], [17]

Treatment of discoid lupus erythematosus

Treatment of discoid lupus erythematosus in many respects depends on the clinical form and provoking factors of the disease development.

Begin treatment with the elimination of foci of chronic infection in the body, the normalization of endocrine disorders. Eliminate other irritating and provoking factors, such as direct sunlight, radiation therapy, cold, drafts, external skin damage.

With discoid lupus erythematosus antimalarial drugs are most effective. Use Hingamin (possible use of Delagil, Chloroquine, Rezokhin) orally 250 mg twice daily after meals for 10 days. Further, the frequency of administration is reduced to once a day (10 days) and after up to 2 times a week. You can connect Plakvenil 200 mg to 4 times a day. These drugs are effective, but have a number of undesirable side effects. Therefore, during the treatment it is necessary to periodically carry out a blood and urine test, to observe the status of the fundus and the functionality of the liver.

Positive results were noted in the appointment of Presocil (from one to three tablets three times a day) or Sentona. With early diagnosis of the disease, the effect can be obtained by taking Aminoquinol 0.05-0.15 g three times a day, with courses of 7 days at intervals of 5 days.

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

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

The effectiveness of therapy can be supported using nicotinic acid, which protects the body from the negative effects of ultraviolet, removes toxins, stimulates the function of the adrenal cortex, reduces the side effects of antimalarial drugs. Nicotinic acid is prescribed 50 mg twice daily after meals for 1 month, then after 2-3 weeks the course is repeated. It is recommended to carry out from 2 to 5 cycles of therapy. Treatment is complemented by the use of lipotropic drugs (lipid, etc.). It is also possible to inject 1% nicotinic acid 1-5 ml IM.

To support immunity, multivitamin complexes with vitamins A, C, E, group B are prescribed, except for vitamin D², which can aggravate the state of the disease.

When drawing up a treatment regimen for discoid lupus erythematosus, it should be taken into account that sulfonamides (sulfadimethoxin, streptocid, biseptol, etc.) and streptomycin can not be used in the therapy of this disease, since this has an extremely negative effect on the outcome of the disease, up to its degeneration into the systemic form.

Small changes also affect the diet in case of lupus: it is desirable to eat foods that contain nicotinic acid in large quantities. Such products include cod, liver, beans, peas, lentils, buckwheat, oatmeal, porridge and the like.

As a topical treatment you can use ointments with a photoprotective property: Salol, Quinine, 5% Methyluracil, Fenkortozol. A good effect is ointment based on lanolin and zinc paste. The affected area can be treated with Bijohinol. Often, ointments are combined: in the morning, apply photo-protective creams, and at night - ointments with corticosteroids.

Prevention of discoid lupus erythematosus

Specific methods of prevention of this disease is not, because the etiology of the disease is not fully understood.

For the prevention of recurrence of the disease after the transferred discoid lupus erythematosus, preventive courses are periodically practiced (recommended in the spring and summer season):

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

The patient should avoid a prolonged stay in cold and too hot areas, and also in winter in the cold, in the wind, under direct sunlight. If possible, surgical interventions, injuries, vaccinations and vaccines should be avoided. Physical culture classes, walks in the park or in the forest are welcome.

Nutrition of the patient should be complete, with a small amount of salt and sugar, 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 well-chosen scheme of treatment, long-term relief (remission) can prevail. However, in some cases, the transition of the cutaneous form of the disease into a systemic one is probable: it is no secret that systemic lupus erythematosus is already a serious disease with serious complications. Often this transition is preceded by the violation of certain prohibitions: prolonged exposure to the sun, treatment with sulfanilamide medications and streptomycin, hypothermia, etc.

Discoid lupus erythematosus requires regular dispensary control, with the conduct of clinical and laboratory studies for the timely detection of degeneration in the systemic process. It is important to monitor the function and condition of the organs of urination, heart, respiratory system. The efficiency of these organs can largely determine the prognosis of the disease.