Fresh Discoid Lupus Erythematosus Lesions

Proven Lupus Treatment By Dr Gary Levin

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Before central atrophy develops, fresh lesions present as homogenous scaly erythemas. As such, they may resemble a wide spectrum of unrelated disorders.

Actinic keratoses (Fig. 11.1A), as individual lesions, may mimic DLE, especially if flat and inflamed; as a distinguishing mark, they are rougher than DLE lesions and hyperkeratotic rather than scaly (keratotic masses do not detach). At the clinical overview, however, actinic keratoses differ from DLE lesions by their usually smaller size, greater number, and more regular distribution owing to their tendency to concentrate at the sites of the highest cumulative UV damage (forehead, nose, bald head, etc). In addition, patients with actinic keratoses are usually much older than those with DLE (25-45 years), and their facial skin shows signs of chronic actinic damage.

Bowen's disease (Fig. 11.1B) is most often a solitary lesion that maybe located anywhere on the body, including light-exposed areas. It may look similar to a DLE lesion;

it is less inflamed, however, and its surface is velvety and occasionally hyperkeratotic. There is no scaling.

In psoriasis vulgaris, again, individual psoriatic plaques may be similar to DLE, especially fresh lesions and those of the photosensitive type. Psoriatic plaques are round and well demarcated; their scales, however, are large, silvery, and easily detachable. They do not lead to hair loss or epidermal atrophy. At the clinical overview, psoriasis differs from DLE by its exanthematic distribution and its totally different predilection sites. Also, psoriatic plaques of the face are rare. As antimalarials can aggravate psoriasis, psoriasis should be ruled out before treatment of DLE is started.

Again, individual patches of seborrheic dermatitis may resemble fresh DLE lesion because they are well-demarcated, scaly erythemas most often on the face. They differ, however, by their color (light yellow-red) and the type of scaling (small, branny, easily detachable, greasy). At the clinical overview, seborrheic dermatitis is strikingly symmetrical (lesions on and bordering the eyebrows, glabella, nasolabial folds, and V-shaped areas of the chest and the back). Also, it is usually accompanied by seborrheic dermatitis of the scalp. History usually reveals that the condition is chronic, with exacerbations in winter and improvement in the warm season. Importantly, sun exposure can aggravate seborrheic dermatitis, as is also the case in DLE.

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