Discoid lupus erythematosus (DLE) is a chronic autoimmune skin condition. This form of lupus primarily affects the skin, distinguishing it from systemic lupus erythematosus (SLE), which can impact internal organs.
What is Discoid Lupus of the Eyelids?
When DLE affects the eyelids, it presents as well-defined, red, scaly, disk-shaped patches or plaques. These lesions can lead to scarring, thinning of the skin (atrophy), and changes in skin color, including lighter (hypopigmentation) or darker (hyperpigmentation) areas.
Visible small blood vessels (telangiectasias) may also appear on the affected eyelid skin. Patients might experience eyelash loss (madarosis). The lesions can sometimes cause discomfort, manifesting as itching or pain. While DLE primarily involves the skin, a small percentage of individuals (5-10%) may eventually develop systemic lupus erythematosus, which affects various organ systems.
Identifying Discoid Lupus of the Eyelids
Diagnosing discoid lupus on the eyelids begins with a clinical examination by a dermatologist or ophthalmologist. The appearance of the lesions, medical history, and reported symptoms guide the initial assessment. Since eyelid DLE can resemble other conditions like chronic blepharitis or eczema, a definitive diagnosis requires further investigation.
A skin biopsy involves removing a small tissue sample for microscopic examination. Pathologists look for specific features such as hyperkeratosis (thickening of the outer skin layer), follicular plugging (keratin plugs within hair follicles), vacuolar degeneration of basal cells, and lymphocytic infiltrates around blood vessels and skin appendages. Direct immunofluorescence (DIF) testing detects abnormal protein deposits, such as immunoglobulin G (IgG) or immunoglobulin M (IgM), at the dermoepidermal junction.
Treatment and Management
Treatment for discoid lupus of the eyelids aims to control inflammation, prevent scarring, and improve the appearance of the affected skin. Topical corticosteroids are a first-line therapy, applied directly to lesions to reduce inflammation. However, due to the delicate nature of eyelid skin, long-term or potent use can lead to side effects such as skin thinning.
Topical calcineurin inhibitors, such as tacrolimus ointment or pimecrolimus cream, are alternatives for sensitive areas like the eyelids, as they do not cause skin thinning. These medications reduce the immune response in the skin. For stubborn or localized lesions, intralesional corticosteroid injections can be administered directly into the lesion.
When topical treatments are insufficient or DLE is more widespread, systemic medications may be considered. Antimalarial drugs, particularly hydroxychloroquine, are prescribed to manage DLE. In cases that do not respond, other immunosuppressants like methotrexate, mycophenolate mofetil, or thalidomide might be used.
Living with Eyelid Discoid Lupus
Living with discoid lupus on the eyelids requires consistent self-care and medical follow-up. Sun protection is important as ultraviolet (UV) light can trigger or worsen DLE lesions. Individuals should apply broad-spectrum sunscreen with an SPF of 30 or higher, specifically formulated for the eye area. Wearing wide-brimmed hats and sunglasses helps shield the delicate eyelid skin from sun exposure.
Despite treatment, DLE can lead to permanent scarring and pigment changes, which may have cosmetic implications. Regular follow-up appointments with a dermatologist or ophthalmologist are important to monitor the condition’s progression, adjust treatment plans as needed, and address any complications. Addressing the psychological impact of visible scarring and chronic disease with appropriate support is also beneficial.