Discoid LE (DLE) lesions also begin as erythematous papules or plaques with scaling but progress to follicular plugging with central atrophy and scarring. Similar to the other cutaneous lesions of SLE, these develop primarily in sun-exposed regions, including the malar area. When present on the scalp, they can result in permanent alopecia. Generalized and localized forms exist, the former being associated more often with systemic symptoms and laboratory abnormalities.
DLE is the most common form of chronic CLE; 15%-30% of patients with SLE have DLE, about 5% as an initial symptom (Cervera et al. 1993). Of patients with localized DLE, 90%-95% express a disease that is limited to the skin. A few patients with DLE may develop other skin lesions, and systemic features like fever are rare, but half of them will exhibit arthritis/arthralgia (Wallace et al. 1992). ANA in low titers is detected in about half of the patients, and other autoantibodies are rarely seen (Bielsa et al. 1991, Wallace et al. 1992). About one third of the patients exhibit some leukope-nia and an elevated erythrocyte sedimentation rate.
Less common clinical forms of DLE are seldom described in larger cohorts. LE profundus may show more frequently systemic signs of lupus than DLE: one third of the patients develop serositis and about one quarter a lupus nephritis. More often, unspecific findings like fatigue and musculoskeletal complaints exist, but overall the disease is milder than SLE (Sontheimer 1999).
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