Discoid Lupus Erythematosus Classic Appearance

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Discoid LE (DLE) (Kaposi 1872) is the most common variant of CLE. It typically (but not exclusively) evolves at light-exposed skin: face, ears, extensor aspects of the forearms, scalp, trunk, and, more rarely, the oral mucosa. Lesions are single or sparse in most cases; if numerous disseminated lesions are present, they are haphazardly distributed at the predilection sites without striking symmetry. Among multiple lesions, many are found in the butterfly area (see later herein), and some tend to appear in unusual places, for example, the "niches" of the external ear, the eyelids, the lips, or the vestible of the nose; there is a tendency not to transgress natural border lines, for example, the vermilion border of the lip or the areola mammae.

Lesions evolve according to a characteristic time course. Fresh lesions first present as small, round, well-defined, slightly raised erythemas with dull surfaces that soon become rough to the touch and scaly. Scales are adherent and are often attached to the hair follicles ("carpet tack" phenomenon). Follicular orifices are first widened with keratotic plugs and may then disappear completely; there is a gradual loss of hair in the lesions, leading to irreversible scarring alopecia. Lesions spread slowly and regress at the centers, which become smooth and sunken. Intermediate lesions become elevated and indurated at variable degrees and develop atrophy and loss of normal skin texture in their centers. At the periphery, rests of the active lesion remain as ring-like, arcuate, or polycyclic scaly erythemas that continue to spread. Old (burnt-out) lesions may be disfiguring: they are large, with irregular borders, sharply demarcated, depigmented (porcelain white in dark skin), hairless, flat, thin, and with a scarring appearance. Pitted scars and crateriform indentations may occur. In acral location (e. g., nose and ears), there may be a loss of tissue (mutilation).

It is important to note that the lesions differ in their individual ages; fresh lesions will thus be seen alongside intermediate and burnt-out ones. Activity of lesions may spontaneously cease at all stages; fresh lesions may heal with restitutio ad integrum, older ones result in atrophy.

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