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  • Up to 60% of patients with discoid lupus erythematosus develop lesions on the scalp.

  • DLE causes scaly plaques and scarring alopecia on the scalp. Other typical areas of involvement are the face and ears.

  • Approximately 17% of patients may develop systemic involvement.

  • Diagnosis is based on history, clinical examination, trichoscopy, blood investigations, pathology, and direct immunofluorescence.

  • Treatment mainly includes topical or intralesional steroids and oral antimalarials. Other systemic immunosuppressants can also be used.


  • Scarring, scaling, and hyperpigmentation are classical signs of DLE in light phototypes. Loss of pigment is typically seen in dark phototypes.

  • Trichoscopic findings that support diagnosis include follicular keratotic plugs, follicular red dots, and tortuous irregular vessels. Loss of the honeycomb pattern, absence of pinpoint white dots and blue-grey dots with a speckled distribution are diagnostic for DLE in a pigmented scalp.

  • Trichoscopy-guided biopsy from an area with the above features will aid in the diagnosis.

  • Direct immunofluorescence from lesional skin is positive in 90% of cases. Do not exclude DLE if negative.


  • Response to treatment can take up to several months.

  • If identified in the early stage, hair regrowth can occur, so early diagnosis and treatment are important.

  • At each follow-up, ask the patient for any symptoms that could reflect systemic disease.

  • Perform routine blood tests for excluding systemic involvement (full blood count, urinalysis, and renal function blood tests). Antibody tests are needed only if there are changes in symptoms.

  • Always consider the risk of squamous cell carcinoma arising on the areas of scarring.


  • Patients should be educated on avoiding sun exposure, using sunscreens of SPF 30 or higher against both UVA and UVB, and reapply sunscreen every 2 hours or straight after swimming. Recommend hats with sun protection (CoolibarR).

  • Cessation of smoking (active and passive) should be recommended in all patients as can influence the disease severity and efficacy of antimalarial treatment.

  • Remember that strict avoidance of sun exposure can lead to vitamin D deficiency, so patients should be checked and given supplements if required.

  • Patients should make their clinician aware of any changes in their symptoms, so potential systemic disease will be diagnosed early.


Discoid lupus erythematosus (DLE) is a chronic form of cutaneous lupus, which can cause scarring. It represents the only form or chronic cutaneous lupus erythematosus causing cicatricial alopecia.1


DLE is responsible for 50%–85% of cases of cutaneous lupus erythematosus and occurs two to three times more frequently in women than in men. DLE has also been reported to have a higher incidence in African Americans. Although it may occur at any age, it is more common in the age group 20 to 40 years. Scalp involvement is observed in up to 60% of DLE cases, and one-third of these patients develop ...

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