Discoid lupus erythematosus in men. Causes and symptoms of chronic discoid lupus

Discoid lupus erythematosus is the most common chronic form of lupus erythematosus, in which skin and mucous membranes are dominant in the picture of the disease. The name "lupus erythematodes" was proposed by P. Kazenav in 1851, believing that the disease is a type of lupus erythematosus. It was first described by P. F. Rayer in 1827.

Synonyms: lupus erythematodes discoides s. chronicus, erythematodes, seborrhea congestiva, erythema atrophicans, etc.

Incidence

According to M. A. Agronik and others, discoid lupus erythematosus accounts for 0.25-1% of all dermatoses. It is more common in countries with a cold, humid climate, mainly in middle-aged people (according to W. Gertler). Women get sick more often than men.

Etiology

The etiology has not been definitively established. A viral origin of the disease is assumed. Electron microscopy reveals tubuloreticular cytoplasmic inclusions in skin lesions.

Pathogenesis

In the pathogenesis of individual cases of the disease, genetic and immune factors are important. In provoking discoid lupus erythematosus and its exacerbations, an important role is played by excessive insolation, medications, and various kinds of injuries (mechanical, thermal, chemical).

pathological anatomy

Discoid lupus erythematosus and its disseminated form is limited to skin changes. With discoid lupus erythematosus, the lesion is localized more often on the face.

Microscopic examination reveals hyperkeratosis, follicular keratosis, vacuolar degeneration of the epidermis, acanthosis. In the dermis, focal lymphoid-macrophage infiltrates with an admixture of neutrophils and plasma cells are visible. The walls of blood vessels are impregnated with plasma proteins. Collagen fibers of the dermis are swollen, picrinophilic, merge into fibrinoid masses. In the area of ​​infiltrates, elastic and collagen fibers are destroyed. During treatment, scarring occurs with atrophy and depigmentation of the skin.

The disseminated cutaneous form of lupus erythematosus is characterized by multiple rashes throughout the body, in which microscopic changes resemble those in discoid lupus erythematosus, but are less pronounced, exudative reactions predominate over proliferative ones, and cellular infiltration is less significant. In the end, there are no scars and areas of skin atrophy.

Clinical manifestations

Discoid lupus erythematosus begins with the appearance of one or two pink, slightly edematous spots, which gradually increase in size, infiltrate, and are covered in the central zone with dense whitish scales. Scraping of the foci causes pain (Besnier-Meshchersky's symptom), since on the underside of the scale there is a horny spine (a symptom of a lady's heel), with which it is strengthened in the expanded mouth of the hair follicle. In the future, cicatricial atrophy develops in the central part of the focus.

In a long-term focus, three zones are clearly distinguished:

  1. central - atrophic,
  2. further - hyperkeratotic,
  3. bordering it - erythematous.

Telangiectasias are often present within the erythematous zone. Along the periphery of the focus, brown hyperpigmentation can be expressed to varying degrees.

Erythema, hyperkeratosis and skin atrophy- cardinal symptoms of lupus erythematosus. Infiltration, telangiectasia, and pigmentation are common but not mandatory.

The most characteristic localization of discoid lupus erythematosus is the areas of the skin that are subject to insolation: the face, mainly its middle part - the nose, cheeks, zygomatic, anterior areas. As well as for systemic lupus erythematosus, the so-called "butterfly" is very characteristic - the lesion on the back of the nose and cheeks. According to I. I. Lelis, who observed the patients, the primary foci of lupus erythematosus were located:

  • on the nose - in 48%,
  • on the cheeks - in 33%,
  • on the auricles or adjacent skin - in 22.5%,
  • on the forehead - in 16.5%,
  • on the scalp - in 10%,
  • on the red border of the lips, usually the lower one, in 12.5%,
  • on the oral mucosa - in 7%.

The defeat of the mucous membrane of the eyelids LN Mashkilleyson observed in 3.4% of patients. More rare are known, including isolated localizations - on the chest, back, shoulders, etc. Lesions of the mucous membrane of the genitals, bladder, cornea, and nail lesions are described.

Along with the typical discoid lupus erythematosus, there are its varieties:

  • hyperkeratotic lupus erythematosus, in which hyperkeratosis is pronounced;
  • papillomatous discoid lupus erythematosus - increased growth of the papillae of the dermis, leading to the formation of a villous surface of the foci;
  • warty lupus erythematosus - papillomatosis is accompanied by severe keratinization;
  • pigmentary lupus erythematosus - excessive deposition of pigment that stains the lesions in a dark brown color;
  • seborrheic lupus erythematosus - hair follicles are greatly expanded and filled with fatty, loose scales;
  • tumor-like lupus erythematosus - bluish-red, strongly elevated foci with edematous, clearly defined edges, mild hyperkeratosis and atrophy.

Rare varieties are:

  • telangiectatic discoid lupus erythematosus with multiple telangiectasias,
  • hemorrhagic discoid lupus erythematosus with hemorrhages in the foci, mutilating.

A special form of chronic lupus erythematosus is centrifugal erythema(erythema centrifugum Biett). It is 5.2-11% in relation to all forms of lupus erythematosus, characterized by clearly demarcated foci of erythema on the face, less often in other areas of the skin. They may have telangiectasia, slight swelling. There is no hyperkeratosis. Atrophy is absent or weakly expressed. Centrifugal erythema quickly succumbs to treatment, but recurs easily. Some authors consider it, along with disseminated lupus erythematosus, to forms intermediate between discoid and systemic.

In the foci of discoid lupus erythematosus on the oral mucosa, dark red erythema, telangiectasias, stripe-like, rough reticulate areas of epithelium opacification, erosion, and superficial ulcerations are observed. On the red border of the lips, lupus erythematosus has the appearance of irregularly oval ribbon-like foci of erythema and hyperkeratosis, sometimes with cracks and erosions. Foci of discoid lupus erythematosus are often solitary, less often multiple. Without treatment, they exist for years, as a rule, do not cause discomfort. Erosive and ulcerative rashes in the mouth cause pain. They are especially persistent in smokers.

Disseminated discoid lupus erythematosus characterized by scattered erythematous-edematous, papular elements or discoid-type foci. Preferential localization: face, open part of the chest and back, feet, hands, skin over the elbow and knee joints.

The general condition of patients with discoid and disseminated lupus erythematosus, as a rule, does not noticeably suffer. However, clinical examination in 20-50% of patients reveals:

  • arthralgia,
  • functional disorders of the internal organs (heart, stomach, kidneys),
  • disorders of the nervous system,
  • accelerated ESR,
  • leukopenia,
  • hypochromic anemia,
  • changes in the composition of immunoglobulins,
  • antinuclear antibodies,
  • immune complexes in the zone of the dermo-epidermal junction, etc.

Profound lupus erythematosus(L. e. profundus Kaposi-Irgang) is characterized by the simultaneous presence of typical skin lesions characteristic of discoid lupus erythematosus, and nodes in the subcutaneous tissue, the skin over which is mostly unchanged. A number of authors, such as L. M. Pautrier, consider this form as a combination of deep Darier-Roussy sarcoids and discoid lupus erythematosus.

Possible Complications

Occasionally, skin cancer develops in the foci of discoid lupus erythematosus, mainly in the foci on the red border of the lower lip, very rarely - sarcoma, erysipelas.

A severe complication, more often observed in disseminated discoid lupus erythematosus, is its transition to systemic lupus erythematosus under the influence of adverse factors.

Diagnostics

Diagnosis in typical cases of discoid lupus erythematosus is established without difficulty.

Differential Diagnosis

Discoid lupus erythematosus lesions may resemble:

  • seborrheic eczema,
  • rosacea,
  • psoriasis
  • eosinophilic granuloma of the face,
  • tuberculosis lupus.

Clear boundaries of foci, horny plugs in dilated hair funnels, tight-fitting scales, a positive symptom of Besnier-Meshchersky, the development of atrophy indicate the presence of lupus erythematosus.

The foci of seborrheic eczema do not have such sharp boundaries, their surface is covered with loose greasy scales, they respond well to anti-seborrheic therapy. Psoriatic lesions are usually numerous, covered with easily scraped silvery scales. Both, in contrast to lupus erythematosus, usually decrease under the influence of sunlight.

With rosacea, there is diffuse erythema, telangiectasias are pronounced, nodules and pustules often appear.

Eosinophilic granuloma of the face is characterized by particular resistance to therapeutic interventions. Its foci are often solitary, of a uniform brown-red color, without hyperkeratosis, with single telangiectasias.

Tuberculous lupus usually begins in childhood, it is characterized by the presence of lupomas with their characteristic apple jelly and probe phenomena. In cases of erythematous tuberculous lupus erythematosus of Leloir, the clinical diagnosis is extremely difficult, histological examination is necessary.

Discoid lupus erythematosus should also be differentiated from Essner-Kanoff lymphocytic infiltration, the manifestations of which are less resistant, tend to resolve in the center, lack desquamation, hyperkeratosis, and atrophy.

Lupus erythematosus on the scalp is differentiated from pseudopelade. The latter is characterized by the absence of inflammation, horny spines, finger-like arrangement, and more superficial atrophy.

Discoid lupus erythematosus on the mucous membrane of the mouth should be distinguished from lichen planus, the rashes of which have a more delicate pattern, are not accompanied by atrophy.

Treatment

Patients with discoid lupus erythematosus, including limited forms, should be examined to exclude systemic damage to internal organs and the nervous system, as well as to identify concomitant diseases.

The leading role in the treatment of discoid and disseminated lupus erythematosus belongs to aminoquinoline drugs, such as chloroquine, delagil, rezoquine, plaquenil, etc. They are prescribed continuously or in cycles, usually 0.25 g 2 times, plaquenil - 0.2 g 3 times a day after meal. The duration of cycles (5-10 days) and the intervals between them (2-5 days) depends on the tolerability of the treatment. Repeated courses of treatment are recommended, especially in the spring. Adding small doses of corticosteroids to chloroquine (2-3 tablets of prednisolone per day) improves treatment outcomes and tolerability. This technique is recommended for particularly persistent lupus erythematosus, extensive skin lesions.

Discoid lupus erythematosus (DLE) is an unpleasant and incomprehensible disease in origin, one of the subtypes of lupus that affects the skin, but does not affect the internal organs, compared to the more severe form - SLE (systemic lupus erythematosus).

Both men and women of any age get sick with it, however, the female part of the population is more susceptible to the occurrence of this disease, especially in the young period - 15–40 years. Men get sick 10 times less often. The chronic discoid form can turn into a systemic form if the correct diagnosis is not immediately made and treatment is not started. Often, timely therapy can defeat this disease, healing occurs in 40% of patients, and in 1.5-2% of patients it turns into SLE, but, despite a favorable prognosis, you need to be constantly monitored in a medical institution and periodically attend clinical examinations.

The photo shows an example of skin lesions in this disease.

This is a rare immune disease of a chronic form and unknown nature, which has not been fully studied by official medicine. When the immune system fails, the body begins to take its cells for foreign ones, destroying them. The disease is not contagious and is not transmitted from sick to healthy.

It manifests itself in the form of red spots, one or more, on the skin of the face, limbs, neck and upper body. Red spots appear in the form of discs, which gradually increase in size and become covered with scales. They can merge with each other, forming one large disgusting plaque, which begins to itch and itch terribly. Rarely, the oral mucosa is affected.

If treatment does not occur, then ugly scars appear on the surface of the plaques, and the skin itself becomes covered with a dry crust, and eventually dies off completely.

DKV is divided into three types:

  • atrophic;
  • erytomatous;
  • hyperkeratotic-infiltrative.

In recent years, the disease has become much less common than before.

Symptoms of the disease

Depending on the intensity of the disease, the symptoms may manifest themselves in different ways. The main ones are:

  • the appearance of pink-red spots of different sizes, covered with scales. If it is torn off, then pain occurs, and a crust appears in place, similar to the surface of a lemon;
  • the occurrence of atrophy of the skin (thinning) with pronounced scars;
  • accumulation of fluid in the lesions;
  • thickening of the stratum corneum of the epidermis;
  • itching and burning;
  • in 15% of the incidence the oral cavity is exposed - ulcers appear on the mucosa;
  • sometimes there is hair loss, joint pain.

There may also be areas with pronounced pigmentation. Spider veins may appear on the spots. Rashes have different sizes, ranging from 3 mm. They can be either single or multiple. Lesions occur most often on the face (cheeks, nose, scalp and neck). Less often, in severe form, spots appear on the arms, back, abdomen, shoulders, eyes.

Discoid lupus erythematosus (DLE) is a form (stage) of systemic lupus erythematosus (SLE) that affects connective tissue and blood vessels. The disease develops against the background of increased sensitivity to light and is manifested mainly by skin reactions. Under the influence of provoking factors, discoid lupus erythematosus (erythematosis) can turn into SLE.

DKV is diagnosed in an average of one person in a hundred thousand, and predominantly young people aged 18 to 45 get sick. Women are more susceptible to this pathology than men: there are 10-11 women per sick man.

This gender difference is associated with the characteristics of the female hormonal system, in particular, with a high content of the hormone estrogen in the blood. It has been reliably established that androgens (male sex hormones) perform a protective function and prevent the development of lupus erythematosus.

The reasons

Discoid lupus erythematosus is an autoimmune pathology: due to a malfunction of T- and B-lymphocytes, a lot of antibodies are formed that mistakenly attack the body's own cells. The result of their uncontrolled and excessive production is the appearance of specific complexes that spread throughout the body.

One of the main factors contributing to the occurrence of DKV, scientists consider a genetic predisposition, since the disease often occurs in close relatives.

Currently, the exact cause of lupus has not been established, and research on this issue is ongoing. The most promising theories about the viral and streptococcal origin of the disease have not been confirmed, although cytopathogenic viruses and streptococci were found in the blood of many patients.

There is no doubt that discoid lupus erythematosus is an infectious-allergic disease of an autoimmune nature, despite the lack of accurate data on the mechanism of its origin and development. In the blood tests of the sick, there are a lot of gamma globulins, and in the bone marrow - pathologically altered cells. Most patients have endocrine and metabolic disorders.

Very often, the trigger that disrupts the functioning of the immune system is ultraviolet radiation or local exposure to low temperatures and frostbite of the skin.

Risk factors also include the following:

  • frequent traumatization of the skin;
  • chronic infections;
  • allergic reactions;
  • treatment with drugs that cause photosensitivity (sensitivity to light). These can be sulfonamides, antipsychotics, tetracycline, fluoroquinolones, or the antibiotic Griseofulvin;
  • professional activities associated with a long stay on the street. When working in the field or at a construction site, a person receives a significant dose of radiation, especially in the summer;
  • Scandinavian (Celtic) skin type, the owners of which are most sensitive to the action of ultraviolet and other visible radiation.

The discoid type of lupus differs from the systemic type in that pathological reactions occur only on the skin. However, the basis of the pathology is autoimmune inflammation. Under the influence of ultraviolet radiation, in combination with other provoking factors, the molecular structure of DNA changes in skin cells. As a result, the activity of proteins that contribute to the destruction of cells increases.

Working in the field under the scorching sun can cause a malfunction of the immune system and the development of autoimmune inflammation.

B- and T-lymphocytes activate the production of cytokines (molecules that transmit information) and antibodies to elements of cell nuclei - structural parts of chromosomes and nucleic acids. The resulting immune complexes settle on the walls of blood vessels and damage them.

The synthesis of aggressive antibodies in people with a hereditary predisposition can also cause antigens of cytomegalovirus, herpesvirus, DNA-containing parvovirus B19. The molecular structure of all these viruses has a significant similarity with the proteins of cell membranes.

An additional damaging factor is the oxidative degradation of lipids under the action of free radicals. The result of these processes is a large-scale inflammation and death of epidermal cells.

Kinds

The area of ​​the lesion in DKV can be different, therefore, a focal and disseminated, widespread form of the disease is distinguished. Disseminated lupus erythematosus is accompanied by common symptoms: weakness, malaise, fever and joint pain. In addition, with a common form of pathology, there is a high risk of transition to systemic lupus erythematosus.

Disseminated DKV is observed quite rarely, discoid eruptions usually do not tend to grow or infiltrate. Sometimes scales appear on the spots, with mechanical removal of which pain is felt. The number of foci can be different, as well as their localization. Often, erythematous spots are scattered randomly on the face and in the region of the neck and shoulder girdle.

According to the type of DKV lesion, it happens:

  • deep - nodes appear under the skin, which later calcify. Lupus foci are located in the deep layers of the skin, are painless to the touch and can reach 10 cm in diameter. Typical sites of localization are the face, shoulders and hips;
  • papillomatous - warts (papillomas) appear in the area of ​​​​the scalp and on the hands. Pathological foci are covered with horny layers and resemble the symptoms of verrucous lichen planus. This form of lupus is prone to malignancy;
  • dyschromic - plaques are pale in color in the center and darker at the edges;
  • telangiectotic - an extremely rare type, in which the vascular pattern sharply increases;
  • hyperkeratotic (hypertrophic). It resembles papillomatous DKV, but differs in horn-like formations in the form of dense plaques. A typical localization site is the border of the lips; plaques are found somewhat less frequently on the scalp. Despite the absence of subjective sensations, hyperkeratotic lupus is considered a precancerous condition;
  • Biett's centrifugal erythema is a superficial variant in which there is a well-demarcated and slightly edematous erythema of a reddish-pink hue. It is symmetrical and can appear on the cheeks or bridge of the nose.

Symptoms

The first signs of discoid lupus are pink-red, slightly swollen patches, usually on the face. In the future, they are transformed into dense plaques with multiple scales that frame the base of the hair follicles. Attempts to scrape off the scales cause pain, and after removing them, the skin becomes like a lemon peel.

Since the disease proceeds in a chronic form, over time, the number of red spots increases, covering an increasing area of ​​\u200b\u200bthe skin. Along the edges of the plaques, infiltrates, increased pigmentation, and keratinization of the dermis may occur.

In the center of each pathological focus, the skin begins to atrophy and thin. The horny layer of the skin inside the hair follicles, on the contrary, thickens, which leads to their blockage with keratin. The affected skin takes on the appearance of "goosebumps", uneven pigmentation is observed along the edges of the plaques. Often, plugs form in the ducts of the sebaceous glands on the skin near the ear canal, and the top layer of the skin looks like a thimble.


White-skinned people with blond and red hair are much more sensitive to the effects of visible radiation and extreme temperatures.

The defeat of the scalp in almost all cases is accompanied by alopecia - irreversible hair loss, leading to baldness. In addition, scars form in place of the fallen hair.

Sometimes symptoms of discoid lupus erythematosus can be ulcerative lesions of the oral mucosa and deterioration of the nails. The nails turn yellow and become brittle, often deformed. When plaque forms in the mouth, chewing food causes burning and soreness.

In rare cases, DKV affects the organs of vision, leading to inflammation of the cornea, eyelids, or conjunctiva of the eyes. Most often, erythematous spots are located on the face in the form of a butterfly, covering the nose and most of the cheeks.

It should be noted that discoid lupus erythematosus very rarely gives complications. Sometimes secondary grandular cheilitis can develop - a lesion of the salivary glands in the Klein zone, on the border of the red border of the lips. Cheilitis is manifested by increased salivation, peeling and cracking of the skin on the lips. Some patients complain of itchy lips.

The disseminated form of DLE can transform into systemic lupus, which affects the articular structures and vital organs: the heart, kidneys, liver, lungs, and central nervous system. Systemic disease is dangerous because it is difficult to treat and has a poor prognosis. Despite the advances and recent developments in medicine, high disease activity can lead to the death of the patient.

One of the possible consequences of discoid lupus may be the degeneration of pathological erythematous lesions into squamous cell skin cancer. In this case, keratinocytes, which form the basis of the epidermis, form a malignant tumor - squamous cell carcinoma (SCC).

Diagnostics

In the vast majority of cases, the diagnosis of DKV does not present any difficulties. First of all, pathology is differentiated from diseases that have similar manifestations - Besnier-Beck-Schaumann disease, psoriasis, fungal scab, lymphocytoma and alopecia.

You can distinguish lupus from psoriasis by the localization of the rash: with psoriasis, it appears on the face only in children. In addition, psoriatic scales are easily and painlessly scraped off, while in lupus they are difficult to separate and hurt.

Since there is no itching, seborrheic eczema, in which the skin rash is itchy and has oily scales, can be ruled out.

At the initial appointment, the attending physician clarifies who the patient works for, whether he is taking medications that increase light susceptibility, whether he has an allergy or a chronic infectious disease. The presence of close relatives with DLE or SLE will indicate a genetic predisposition.

Laboratory diagnosis includes a complete blood count and rheumatological tests, as well as a skin biopsy. The result of a general blood test shows the development of inflammation, as evidenced by an increase in ESR (erythrocyte sedimentation rate); indicators of leukocytes and platelets are reduced.


With the help of analysis for rheumatic tests, the disease can be detected with an accuracy of up to 90%.

If there is an infection in the body or there are allergic reactions, the level of eosinophils and neutrophils will be elevated.

Caution: With widespread discoid lupus, the test for syphilis may be false positive.

Rheumoprobe tests may detect antinuclear antibodies and antibodies to nucleoproteins. LE cells, which are called lupus, are detected in 5-7% of patients.

Immunofluorescence analysis (lupus strip test) shows the presence of deposits of immunoglobulins and complement, which plays a critical role in maintaining immune regulation. This analysis is done using a fluorescent microscope and is performed on frozen sections of skin biopsies obtained from lesions. However, the lupus strip test is also positive in a number of other pathologies, and therefore is not 100% reliable.

Caution: It is extremely important to differentiate widespread discoid lupus erythematosus from the systemic form of the disease, as the latter requires more aggressive treatment.

Treatment

Treatment of discoid lupus erythematosus is largely determined by its clinical form and causative factors contributing to the progress of the disease. Therapy begins with the elimination of infectious foci and the correction of endocrine disorders. It is very important, if possible, to refuse to take photosensitizing drugs and eliminate existing allergic manifestations.

It is also recommended to avoid direct sunlight on the skin, when going outside, use reflective ointments based on titanium dioxide, mexoril or zinc oxide. Photoprotective qualities are possessed by such means as Methyluracil, Salol, Quinine, Fenkortozol. Bioquinol can be applied to the areas affected by the rash.


When applied topically, methyluracil has an anti-inflammatory and photoprotective effect.

Often, doctors prescribe local combination therapy: photoprotective ointments are used in the morning, and hormonal ointments containing corticosteroids are used in the evening.

The maximum efficiency in DKV is shown by aminocholine antimalarial drugs - Hingamine, Delagil, Chloroquine, Rezochin. These drugs are taken in a course and the dosage is reduced every ten days. During the first ten days they are drunk twice a day, 250 mg each, for the next 10 days - 1 time per day, then every other day.

The ability to suppress an excessive immune response is possessed by Plaquenil, with which doctors often supplement the therapeutic regimen. You can drink it up to 4 times a day. During therapy, it is necessary to remember about the possible development of side effects. In order to make timely adjustments to the treatment, blood and urine samples are regularly taken from the patient. Taking Hydroxychloroquine can adversely affect the condition of the vessels of the eyeball, so patients should be observed by an ophthalmologist.

Very positive results are observed after the use of Presocil, which includes Prednisolone and Aspirin. In the early stages of DKV, a course of Aminoquinol is effective: the drug is taken three times a day at a dosage of 0.05 to 0.15 g. After a week, a 5-day break is taken. The feasibility and duration of further treatment is determined by the doctor.

If antibiotic therapy is necessary, antibiotics are prescribed, mainly of the penicillin series. Tetracycline and its derivatives are not used due to photosensitizing side effects.

In the case of a high probability of discoid lupus becoming systemic, corticosteroids are used, which can be supplemented with cytostatics (Cyclophosphamide, Methotrexate). Means from the group of topical glucocorticosteroids are prescribed depending on the activity of the disease.

If erythematous plaques are present only on the face, mild to moderate drugs such as hydrocortisone or methylprednisolone are used. In the case of the location of pathological foci on the trunk and limbs, Triamcinolone or Betamethasone is prescribed. Clobetasone has the strongest effect, which is used for lesions of the distal extremities - palms and feet.


If standard therapy does not bring results, they resort to drugs with a pronounced immunosuppressive (immune depressant) effect.

For additional protection of the body from ultraviolet radiation and stimulation of the adrenal cortex, Nicotinic acid is prescribed in tablets or injections. Nicotinic acid tablets are taken twice a day, 50 mg each, the course of treatment is a month. After a 2-3-week break, the course is repeated. The maximum effect is achieved after several cycles of therapy: for some patients, it is enough to repeat them twice, while for others, the results are noticeable only after 5 courses of taking the drug.

Caution: Nicotinic acid promotes the elimination of toxins from the body and alleviates the side effects of antimalarial drugs.

To support the normal functioning of the immune system, antioxidant vitamin complexes containing vitamins A, E, C, as well as B-group vitamins are prescribed. When choosing these funds, the negative effect of vitamin D on the course of discoid lupus erythematosus is taken into account, so it should not be part of the drugs used.

It is important to remember that for the treatment of DKV it is unacceptable to use sulfanilamide drugs - Biseptol or Sulfadimetoksin - as they contribute to the progression of the disease and its transition to a systemic process.

Forecast

In the vast majority of patients, discoid lupus erythematosus proceeds favorably. With the correct preparation of the therapeutic regimen and the elimination of provoking factors, a stable and prolonged remission occurs. The main problem is the transition of the discoid form of lupus to SLE or skin cancer, which often ends in death.

During treatment, systematic monitoring of blood counts is necessary in order not to miss a malfunction in the respiratory, cardiovascular and urinary systems. The course and outcome of pathology depends on the normal functioning of vital organs.

Discoid lupus erythematosus (DLE) is a skin disease related to connective tissue diseases. It should not be confused with the system form. In the first case, the lesion is localized, the pathology affects only the skin. In the case of systemic lupus erythematosus (SLE), the disease is diffuse in nature, that is, all organs and systems of the body that have connective tissue are affected. DLE and SLE have the same skin symptoms, and it is important to distinguish between systemic and cutaneous lesions because different specialists treat each other. Discoid lupus is treated by a dermatovenereologist, systemic - by a rheumatologist. It is extremely rare for discoid lupus to transform into systemic lupus, and the reverse transition is impossible.

Reasons for development

The main reason for the development of DKV is hypersensitivity to ultraviolet radiation. Both short-term exposure to the sun and prolonged insolation, for example, after a vacation in southern countries, can provoke a disease. Discoid lupus erythematosus is classified according to only one feature - the number of rashes. Limited form - 1-3 rashes, disseminated - more than 3 foci.

The final theory of the origin of discoid lupus erythematosus has not yet been studied, but a number of basic mechanisms for the development of the disease have long been known:

  • the influence of ultraviolet rays;
  • production of autoantibodies to own cells;
  • local autoimmune reactions;
  • pathology of T-lymphocytes and dendritic cells in the skin.

After exposure to ultraviolet radiation, a chain of biochemical reactions occurs with the participation of certain proteins - p53, TRAIL, Fas. Normally, these proteins regulate programmed cell death (apoptosis), in other words, the natural aging process. With DKV, they are produced in excess, and the processes of apoptosis are disturbed. These disorders in the skin lead to the formation of pathological foci of inflammation on it.

The disease usually manifests itself for the first time at a young age - 20-40 years, women get sick more often, DKV rarely occurs in children. Risk factors for DKV:

  • genetic predisposition; excessive insolation or cooling;
  • the effect of wind on the skin of the face;
  • bright skin;
  • chronic skin diseases;
  • allergic reactions to drugs with skin or systemic manifestations.

Clinical picture of the disease

The main clinical manifestation of the disease is an erythematous rash. It is localized on open areas of the skin. This is due to the ingress of sunlight into these places. The most common localization is the skin of the nose, cheeks, forehead, and auricles. The scalp is also affected by discoid lupus erythematosus, and sometimes such a rash can be the only symptom of the disease. The chest, back, and skin of the hands are rarely involved.

By stages, DKV is classified as follows:

  • erythematous;
  • infiltrative-hyperkeratotic;
  • cicatricial-atrophic.

In the first stage of DKV, sharply defined reddish spots with peeling are observed. Over time, they increase, and in the process of peeling, small grayish scales appear. They sit tightly on the lesion, forming a plaque.

Rice. 1. Discoid lupus erythematosus. On the face, reddish rashes form a kind of "butterfly" symptom.

When the process enters the second stage, the plaques merge, forming large erythematous-infiltrative foci. They are also covered with scales, but there is no intense peeling. If they are removed, then horny spines are found on the reverse side, confirming the second stage of the disease. This symptom is known as "the lady's heel symptom." Removal of scales causes pain to the patient - this is a symptom of Besnier-Meshchersky. If the process affects the skin of the auricles, then Khachaturian's symptom appears - the appearance of sulfur-horn plugs in the auricle, which have an external resemblance to a thimble. When the phenomena of inflammation pass, erythema and infiltration disappear, the process passes into the third stage. Plaques are divided into three zones from the center to the periphery, representing the classic triad of DLE: cicatricial atrophy, follicular hyperkeratosis, erythema.

Rice. 2. Triad of discoid lupus: from the periphery to the center - erythema, follicular hyperkeratosis, cicatricial atrophy

Eruptions on the face are often localized symmetrically. Sometimes a rash appears on the oral mucosa, it is very painful.

If the rash is on the scalp, then in the stage of cicatricial atrophy, foci of alopecia appear on the head. They need to be treated carefully, as over time, squamous cell skin cancer can develop in these foci.

The disseminated form differs from the limited number of foci. In addition, the localization of the rash is more extensive - the extensor surfaces of the forearm and hand may be affected. Accompanying the appearance of foci can be an increase in temperature to subfebrile numbers and pain in the joints.

In addition to the typical form of DKV described above, other rare variants are distinguished. They are characterized by their own characteristics, their treatment is also handled by a dermatologist. Rare forms include the following:

  • centrifugal erythema Bietta;
  • rosacea-like;
  • deep lupus Kaposi-Irgang;
  • papillomatous;
  • hyperkeratotic;
  • tumor;
  • dyschromic;
  • pigmented;
  • telangiectatic.

Diagnostic methods

Laboratory indicators for the diagnosis of DKV do not differ from those characteristic of SLE. These include tests for LE cells, antinuclear antibodies, antibodies to native DNA. The lupus streak test is used to diagnose discoid lupus exclusively. Using this method, the attachment of autoantibodies in the area of ​​the dermis-epidermis junction is detected in immunofluorescence reactions.

A dermatologist, when diagnosing, excludes to some extent similar diseases: SLE, polymorphic photodermatosis, limited psoriasis, rosacea, dermatomyositis, lupus erythematosus, facial eosinophilic granuloma, benign skin lymphocytoma. The main method is histological examination of the biopsy. Signs of DKV include:

  1. 1. Hyperkeratosis at the mouths of hair follicles.
  2. 2. Atrophied germ layer of the epidermis.
  3. 3. Vacuolization of cells of the basal layer.
  4. 4. Edema and infiltration of the dermis.
  5. 5. Destruction of collagen
  6. 6. Thickening of the basement membrane with the deposition of mucin in the dermis.

If a histological conclusion containing these signs comes, then a diagnosis of "discoid lupus erythematosus" is made.

Treatment of the disease

It is impossible to completely recover from discoid lupus erythematosus, since the disease has an autoimmune mechanism. Therefore, therapy has two goals - to slow down the progression of the process and prevent scarring of the skin. Among non-drug methods of treatment, skin protection from ultraviolet radiation is of decisive importance. Clothing should cover exposed areas of the body, it is necessary to use sunscreens and sprays with a high protection index - at least 50.

For the treatment of DKV, two main groups of drugs are used - antimalarial drugs and topical glucocorticosteroids - drugs for topical use in the form of ointments, lotions and creams.

Among antimalarial drugs, hydroxychloroquine is preferred because it is the best tolerated compared to others. However, against its background, some patients may experience retinal pathology - retinopathy, therefore, regular examinations by an ophthalmologist are necessary during treatment. Hydroxychloroquine is prescribed at a dosage of 200 mg twice a day. As soon as a response to therapy is obtained, the dosage is halved, and treatment is continued for another 3 months. The total duration of therapy can reach several years. It should be noted that the drug is recommended by the world society of dermatologists, however, discoid lupus erythematosus is not indicated in the instructions for use.

Topical glucocorticoids of weak and moderate activity are recommended for the treatment of a typical form of DKV with a lesion in the facial area. These are preparations containing fluocinolone acetonide, it must be applied twice a day for at least 3 months. If the rash is localized on the limbs and body, then drugs of average activity are recommended - triamcinolone or betamethasone. The frequency of application and duration of application is prescribed by the doctor according to individual indications. If the lesion affects the scalp, highly active drugs are needed - clobetasol.

Additionally, in the complex therapy of DKV, antioxidant vitamins are used - vitamin E, 50 or 100 mg per day. You can not do without drugs that improve microcirculation - pentoxifylline 200 mg three times a day in courses of 1 month every six months. Treatment of pregnant women is allowed only with topical glucocorticoids in combination with vitamins.

Discoid lupus erythematosus is one of the most commonly diagnosed forms of autoimmune disease.

It can occur in an acute or chronic form, manifested by characteristic changes in the skin and concomitant lesions of the internal organs of a person.

It is the destruction of internal organs and systems that is the most dangerous consequence of discoid lupus, since such destruction is irreversible at the advanced stage of DLE.

An autoimmune disease at the initial stage of development leads to a significant deterioration in the appearance of the skin, reduces their elasticity and ability to resist the external effects of bacteria and viruses.

This picture is a consequence of the inhibition of the adrenal cortex, which cease to function normally. Skin cells melt even in the deep layers of the epidermis: the process is irreversible, so it is important to treat the disease in a timely manner.

Dermatologists note that most often this disease occurs for the following reasons:

  1. Mechanical damage to the skin on the face can provoke the manifestation of the disease. Over time, the skin condition worsens, signs of an atopic process appear, and subsequent atrophy of the upper layer of the epidermis develops.
  2. Frostbite on skin areas, even on a small scale, can lead to DLE. Frostbite zones turn into foci of the inflammatory process, the tissue in them loses its elastic qualities, becomes thinner, dries up and dies.
  3. Infections undermine the protective qualities of the skin, which provoke the development of DLE.
  4. Treatment with a number of medications that provoke changes in connective tissue cells against the background of a drop in human immunity.
  5. The fall in the protective properties of the body as a whole, chronic diseases, stress, prolonged exposure to the scorching sun without adequate protection - all these are provoking factors for the discoid form of lupus.

The following video details the nature, causes and consequences of the disease.

Symptoms of DKV

The first symptom that accompanies discoid lupus erythematosus is a rash on the skin. At first, such symptoms cover the face, and only then they move to other parts of the body.

A small rash on the face takes on a specific butterfly shape located on the bridge of the nose and cheeks. A number of other symptoms may also occur: erythema appears on the skin, hyperkeratosis gradually develops, and atrophy of epidermal cells. Over time, the size of the spots increases significantly due to the merging of small pimples into larger inflamed areas, other signs of DLE appear:

  • intoxication of the body;
  • subfebrile temperature;
  • general weakness, malaise, dizziness, nausea.

In addition to the symptoms described, sometimes patients have spider veins and skin areas with increased pigmentation. Also, redness of the mucous membranes rarely occurs - they water and itch.

Atrophic zones develop faster in those areas of the skin where hair is present. In some patients with DLE, eye lesions occur, accompanied by diseases such as: keratitis, blepharitis, conjunctivitis.

The speed and intensity of the manifestation of symptoms is largely determined by the form of the course of the disease:

  • acute: symptoms appear in 1-2 months;
  • chronic: the manifestation of vivid symptoms can take up to six months.

The diagnosis of the chronic form of lupus can be established using a number of studies:

  • visual examination of the epidermis, mucous membranes of the patient;
  • blood tests: general, biochemical, for antinuclear antibodies;
  • Analysis of urine;
  • neurological examination;
  • electrocardiography;
  • x-ray of the joints, chest;
  • Ultrasound of the abdominal organs.

After confirming the diagnosis of SLE, the attending physician determines the method of treatment, topical medications, etc. Self-treatment of such a complex disease of an autoimmune nature is not only ineffective, but also harmful in most cases.

Diagnosis of the disease: basic approaches

Diagnosing disseminated lupus erythematosus is quite difficult, since the symptoms of this disease are similar to rashes in many other diseases. For example, such a clinical picture is typical for:

  • dermatophytosis of the skin on the face;
  • lichen planus;
  • psoriasis;
  • eczema;
  • atopic dermatitis;
  • neurodermatitis, as well as a number of other skin diseases.

Diagnosis is also difficult because in most cases, specialists do not suspect that the patient has a disease. If such suspicions are present, it is important to prescribe a laboratory blood test for the presence of antibodies to native DNA in it.

If antibodies are detected in the blood, then the diagnosis in favor of DKV is confirmed. Although it happens that this type of lupus is combined with other skin lesions that also require treatment.

Additional laboratory tests will help confirm the diagnosis of discoid lupus erythematosus:

  • histological examination of the epithelium from the affected area;
  • analysis of hair and scales under a microscope will identify the causative agent of the problem;
  • immunofluorescent analysis.

What is the danger of the disease

The danger of chronic lupus is not in the rash itself, which covers the skin of the face and body. The problem is much more complicated, because in the course of the disease, the internal organs of a person are destroyed, their functional ability decreases. Also, with DKV, joints, connective tissue suffer, alopecia manifests itself, but kidney and central nervous system damage is most dangerous.

Autoimmune kidney damage leads to chronic kidney failure, the need for regular hemodialysis, and even kidney transplants.

With damage to the central nervous system, mental disorders occur, often patients suffer from obsessions, carry nonsense. But such changes in the work of the central nervous system are characteristic of the later stages of the disease, if treatment is not started in a timely manner.

How is DKV treated?

Treatment of the discoid form of lupus erythematosus with medications with timely diagnosis of the disease allows for a complete cure. If the disease is detected at later stages of development, the effectiveness of therapy decreases significantly.

The drug method of combating the disease is carried out with the help of such drugs:

  • cytostatics;
  • glucocorticoids;
  • non-steroidal anti-inflammatory drugs.

Other medications are used based on the characteristics of the patient's condition, the presence and degree of damage to internal organs. In any case, treatment should be comprehensive, regular, continuous and aimed at suppressing all manifestations of the pathological process.

Of great importance for the effectiveness of treatment is the selection of dosage and duration of medication. Only a qualified specialist will correctly determine their compatibility and tolerability.

Is it worth using folk methods

Traditional medicine can be an additional help in the treatment of disseminated lupus erythematosus. It helps to maintain immunity, eliminate increased dryness, flabbiness and peeling of the skin.

It is worth using preparations based on honey, other bee products orally or for external application to the skin. This will eliminate the increased dryness of damaged skin areas, accelerate the process of their healing and recovery of the patient as a whole. However, doctors do not recommend drinking infusions and decoctions of herbs, as they can provoke the development of allergic reactions and aggravate the course of the disease.

Important! As an independent treatment, traditional medicine methods are usually not used due to their low efficiency.

Preventive measures and prognosis of DKV

To prevent the manifestation of disseminated lupus will allow the exclusion of the main causes of its development. It is important to provide reliable skin care in adverse weather:

  • moisturizing - protection from ultraviolet radiation in summer days;
  • food - increasing the protective qualities against wind, low temperatures.

Do not use rough scrubs and peelings for people with hypersensitivity of the skin of the face. They can lead to mechanical damage to the epidermis, which increases the risk of developing DLE.

In addition to local prevention, it is important to maintain immunity at a high level, treat inflammatory and infectious lesions in a timely manner, eat a balanced diet, and get more rest.

A photo

The rash with DKV looks like this.

Summing up

Discoid CV is an autoimmune disease whose underlying causes are still controversial in the medical community. The main factors that can provoke the disease are frostbite, burns, mechanical damage to the skin. Careful skin care, maintaining the immune properties of the body at a high level will help reduce the risk of developing DLE.