Discoid lupus

Skin and scalp changes

DLE often affects the face, ears or scalp, although patches can occur elsewhere. They may be scaly, thickened or scarred. Redness can be less obvious on brown or black skin, where patches may look darker. Areas may become lighter or darker after inflammation.

Treatment can help control active disease, but cannot reliably reverse established scars. Colour changes may remain after inflammation has settled; ask your team how to tell the difference.

Is discoid lupus the same as systemic lupus?

No. Discoid lupus is a type of cutaneous (skin) lupus. Systemic lupus erythematosus (SLE) can affect several parts of the body.

Many people with DLE do not develop systemic lupus. It can occur alongside SLE, and some people develop systemic disease later. Your clinician will consider your symptoms and test results rather than assuming that skin changes mean internal organs are affected.

Tell your team about new symptoms beyond the skin, such as ongoing joint pain, mouth ulcers or unusual fatigue. Explore lupus symptoms.

Getting a diagnosis

See your GP about a persistent or changing rash. They may refer you to a dermatologist, a doctor specialising in skin conditions.

The specialist may recommend a skin biopsy, usually using local anaesthetic, and blood tests. These help distinguish skin lupus from other conditions and look for signs of disease elsewhere.

Bring a list of your medicines and, if useful, photographs showing how your skin has changed. Note when patches appeared and how they affect you. Read about lupus diagnosis.

Treatment and follow-up

Your plan depends on the areas affected, how active the inflammation is, and your other health needs. Treatment may include:

• Medicines applied to the skin. Prescription steroid creams or ointments can reduce inflammation. Ask exactly where, how much and how long to use them, particularly on the face. Do not use a stronger treatment or extend a course yourself.
• Tablets such as hydroxychloroquine. These may be used for lupus skin problems. They take time to work and need monitoring. Ask which checks you need, including eye screening where appropriate.
• Other specialist treatments. If the first treatment is not controlling the problem, ask your team to review the plan rather than stopping or changing medicines yourself.

Keep follow-up appointments and report side effects. If you are planning a pregnancy or become pregnant, contact your prescriber for a medicine review.

Read our lupus treatment guide.

Sun protection and daily care

Ultraviolet (UV) light can trigger or worsen skin lupus. Make protection part of your routine, not just something you do on holiday.

• Use SPF 50 or higher sunscreen with strong UVA protection, such as a 4- or 5-star UVA rating.
• Apply enough to exposed skin, including ears and scalp where hair is thin. Reapply regularly according to the instructions, including after swimming, sweating or towel drying.
• Use shade, a wide-brimmed hat and covering clothing. Sunscreen is not complete protection.
• Avoid sunbeds. Ask your clinician for advice tailored to your light sensitivity.

If you smoke, ask your GP or pharmacist for support to stop: smoking can worsen lupus. Discuss any concerns about vitamin D with your team rather than increasing sun exposure.

When to get medical help

These examples are not a complete list of urgent symptoms. Follow your team’s specific advice. The Hibbs Lupus Trust cannot assess symptoms or provide emergency care.