The correct answer is B. She is more likely to develop systemic lupus erythematosus than an adult with these lesions
Correct Answer Explanation
Discoid lupus erythematosus (DLE) presents with plaques characterized by scarring, atrophy, follicular plugging, and scale and photosensitivity. Children presenting with DLE have a higher incident of developing systemic lupus (SLE) than adults. Because of progression from DLE to SLE, children should be screened and followed with antinuclear antibodies and anti- DNA antibodies. Children and adolescents have a higher incidence of renal involvement. Treatment for DLE includes topical steroids, oral steroids, and hydroxychloroquine.
Explanation of Incorrect Answer Choices
Most patients with DLE just have skin involvement (cutaneous lupus). Between 5% and 25% of patients with DLE develop SLE, in which there may be other forms of cutaneous lupus, and other organs may develop the disease. Typically, systemic symptoms are mild in these patients.
DLE may be localized (above the neck in 80%) or generalized (above and below the neck in 20%).
Signs of localiZed DLE include:
- Initial lesions are dry red patches
- These evolve to indurated red or hyperpigmented plaques with adherent scale
- Follicular keratosis, or plugs of keratin within hair follicles, is noted when the surface scale is removed, for example with tape (carpet-tack sign)
- Older lesions are hyperpigmented, especially on the edge of the plaques
- Scarring results in central loss of pigment (white patches) and skin atrophy (tissue loss)
- DLE is typically located on the nose, cheeks, ear lobe and concha
- It may involve lips, oral mucosa, nose or eyelids
- Scalp lesions cause temporary or permanent patches of hair loss
- Hypertrophic (warty) lupus erythematous describes red, very thickened plaques.
Signs of generalized DLE include:
- Plaques on anterior chest, upper back, backs of hands
- Sometimes, plaques on upper and lower limbs
- Can affect palms and soles
- Can affect anogenital mucosa.
- The patient’s main concern is the unsightly appearance of the plaques, but they may also be itchy or sore.
- Chong BF, Song J, Olsen NJ. Determining risk factors for developing systemic lupus erythematosus in patients with discoid lupus erythematosus. Br J Dermatol. 2012 Jan;166(1):29-35. doi: 10.1111/j.1365-2133.2011.10610.x. Epub 2011 Dec 5. Review. PubMed PMID: 21910708.
- Walling HW, Sontheimer RD. Cutaneous lupus erythematosus: issues in diagnosis and treatment. Am J Clin Dermatol. 2009;10(6):365-81. doi: 10.2165/11310780-000000000-00000. Review. PubMed PMID: 19824738.
- Albrecht J, Werth VP. Clinical outcome measures for cutaneous lupus erythematosus. Lupus. 2010 Aug;19(9):1137-43. doi: 10.1177/0961203310370049. Review. PubMed PMID: 20693208; PubMed Central PMCID: PMC3081505.
- Jessop S, Whitelaw DA, Delamere FM. Drugs for discoid lupus erythematosus. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD002954. doi: 10.1002/14651858.CD002954.pub2. Review. PubMed PMID: 19821298.
- Grönhagen CM, Nyberg F. Cutaneous lupus erythematosus: An update. Indian Dermatol Online J. 2014 Jan;5(1):7-13. doi: 10.4103/2229-5178.126020. Review. PubMed PMID: 24616847; PubMed Central PMCID: PMC3937495.
- Okon LG, Werth VP. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol. 2013 Jun;27(3):391-404. doi: 10.1016/j.berh.2013.07.008. Review. PubMed PMID: 24238695; PubMed Central PMCID: PMC3927537.
- Fruchter R, Kurtzman DJB, Patel M, Merola J, Franks AG, Vleugels RA, Femia AN. Characteristics and Alternative Treatment Outcomes of Antimalarial-Refractory Cutaneous Lupus Erythematosus. JAMA Dermatol. Published online June 21, 2017. doi:10.1001/jamadermatol.2017.1160. Journal.