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Discoid Lupus Erythematosus: A Profile: Original Article
Discoid Lupus Erythematosus: A Profile: Original Article
ABSTRACT
Objective: To determine the demographic data, clinical pattern and therapeutic outcome in patients with discoid lupus
erythematosus (DLE).
Study Design: Case series.
Place and Duration of Study: The Department of Dermatology, Liaquat University of Medical and Health Sciences,
Jamshoro, from January 2004 to December 2008.
Methodology: Patients of either gender aged above 18 years diagnosed with DLE were enrolled for the study. Those with
evidence of systemic lupus erythematosus were excluded. Apart from the onset, duration, symptoms, lesions location,
size and dimensions were noted. Biopsy was taken when the diagnosis was in doubt. Apart from routine investigations
serum anti-nuclear factor was determined in every patient. The data were analyzed using SPSS software version 11.0 for
frequencies and percentages.
Results: There were 110 patients (38 males and 72 females), with ages between 18 and 62 years. Family history was
positive in 3 patients. The plaque form was the most common clinical type seen in 68 (61.8%) patients, followed by tumid
(n=20, 18.2%), panniculitis (n=10, 9.1%) and ulcerative (n=8,7.3%) types. Face was the most common site affected (n=60,
54.5%). Antinuclear antibody was present in 19 (17.3%) patients. Fatigue and joint pains were the commonest symptoms
(n=52, 47%). Pigmentation and scarring were the usual outcome.
Conclusion: DLE is a chronic disease with multiple presentations, which usually ends with pigmentation and scarring.
Key words:
Discoid lupus erythematosus. Systemic lupus erythematosus. Autoimmune disease. Antinuclear antigens. Clinical pattern.
INTRODUCTION
Discoid lupus erythematosus (DLE) is an autoimmune
disease characterized by well-defined inflammatory,
scaly plaques on skin.1 The lesions most frequently
involve sun-exposed areas like face, neck, ears and
upper trunk.2 The disease may occur at any age; with
higher incidence between 20 to 40 years of age.3 DLE
is essentially a cutaneous disease with negligible
propensity for systemic organ involvement. The most
common clinical presentation is an erythematosus,
centrally atrophic plaque with surface telangiectasia and
pigmented borders.4 Its less frequent presentations
include tumid, warty, chillblain, telangiectatic rosaceous,
ulcerative, linear, bullous and acneiform.5-7 The lesions
are localized to head and neck in majority of cases.
Generalized involvement have been reported in 50% of
cases.8
In a hospital-based data from England, there were
0.003% of out-patient consultations for DLE during
2002-2003.9 Its prevalence in Pakistan is unknown.
1
METHODOLOGY
This observational study was conducted at the
Department of Dermatology, Liaquat University of
Medical and Health Sciences, Jamshoro, over a period
of 5 years from January 2004 to December 2008.
All patients aged above 18 years, of either gender,
clinically diagnosed as cases of DLE, were enrolled for
study. An informed consent was sought from them after
due explanation of the purpose and procedure. The
study was approved by local ethical committee. Nonwilling patients and those with systemic manifestations
suggestive of systemic lupus erythematosus or any
chronic systemic disease were excluded from study.
History included; bio-data of patients (name, age,
gender, address and occupation), symptoms, duration,
Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (6): 361-364
361
Doulat Rai Bajaj, Bikha Ram Devrajani and Bhajan Lal Matlani
RESULTS
Of the 110 patients seen, 72 (65.5%) were females and
38 (34.5%) males; with a male to female ratio of 1:1.9.
Figure 1 shows the age and gender distribution of
patients. The mean age at onset was 31.40 9.57 years
ranging from 18 to 61 years. Seventy eight percent of
patients were between 21 to 40 years age, with
maximum number (24, 44%) between 21-30 years.
Twenty seven patients were regular smokers, 22 males
and 05 females were smoking more than 10 cigarettes.
Eighteen patients were rural dwellers.
The demographic data and characteristics of disease
are shown in Table I.
362
Age group
Figure 1: Age and gender distribution of patients.
Female
Total
n= 38 (34.5)
n=72 (65.4)
n= 110 (%)
Rural
12
62
76 (69)
Urban
24
10
34 (31)
46 (41.8)
Inhabitance
Education
Non-educated
40
School
18
30
48 (43.6)
College
10
02
12 (10.9)
00
04 (3.6)
None
06
40
46 (41.8)
Labourer
10
24
34 (30.9)
Farmer
12
08
20 (18.2)
Small business
06
00
06 (5.5)
Official
04
00
04 (3.6)
University
Occupation
Type of Lesion
Plaque
24
44
68 (61.8)
Tumid
14
20 (18.2)
10 (9.1)
Panniculitis
Ulcerative
8 (7.3)
Rosaceous
4 (3.6)
Face
22
38
60 (54.5)
Scalp
10
16
26 (23.6)
Neck
10 (9.1)
Upper chest
8 (7.3)
6 (5.5)
34
56
90 (81.8)
16
20 (18.2)
04
15
19 (17.3)
Site of Lesion
Extent
Localized
Generalized
Antinuclear Antibodies (ANA)
n=number (%).
Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (6): 361-364
DISCUSSION
Discoid lupus erythematosus is essentially a cutaneous
disease with different genetic and phenotypic characteristics from systemic lupus erythematosus (SLE).
Discoid lesions have been documented as a feature of
SLE in many studies conducted at home. There has
been no attempt to describe DLE as a separate disease
entity in our population. Keeping this in mind we sought
to explore the clinical and demographic features of DLE.
The female preponderance seen in this study is
consistent with other studies.10 But it contrasts with the
study by Ng et al. in which the males outnumbered
females.2 However, the number of male and female
patients were equal at the 6th decade in this study. This
feature also correlates with other studies.11 Hormonal
factors such as estrogen are considered additional risk
factors in females.12 The mean age of presentation of
31.40 9.57 years in the patients of this study
coinciding with the age range given in another study, but
it is slightly younger than that (34.115.1 years) reported
by Tebbe and Ng et al.12,13
Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (6): 361-364
363
Doulat Rai Bajaj, Bikha Ram Devrajani and Bhajan Lal Matlani
4.
5.
364
9.
8.
13. Ng PP, Tan SH, Koh ET, Tan T. Epidemiology of cutaneous lupus
erythematosus in a tertiary referral centre in Singapore. Australas
J Dermatol 2000; 41:229-33.
REFERENCES
3.
7.
11. Lin JH, Dutz JP, Sontheimer RD, Werth VP. Pathophysiology of
cutaneous lupus erythematosus. Clin Rev Allergy Immunol 2007;
33:85-106.
CONCLUSION
2.
Dekle CL, Mannes KD, Davis LS, Sangueza OP. Lupus tumidus.
J Am Acad Dermatol 1999; 41:250-3.
1.
6.
Journal of the College of Physicians and Surgeons Pakistan 2010, Vol. 20 (6): 361-364